is a non-irritating isotonic wound antiseptic. All of these solutions have sporadically come to prominence in the past. While the laboratory reports, as far as the germicidal power of these solutions is concerned, appear to be highly satisfactory, the results of their practical application are not altogether so. It should be borne in mind that most of these preparations are irritating, and that chlorin solutions are labile compounds. All of these enumerated solutions lose their activity within a week. or two, hence the disappointing results when commercial stock preparations are employed.

To overcome the difficulties encountered in the utilization of the unstable aqueous solutions of chlorin, Dakin devised chloramin-T, and finally dichloramin-T. The latter term is the abbreviated name of toluene-parasulfon-dichloramin. This compound forms a comparatively stable solution with certain chlorinated oils, and readily parts with its chlorin content in the presence of wound secretions.

It is to be regretted that the writers furnish so little information regarding the practical application of this new compound in hospital work. As the book is primarily intended for the use of physicians and surgeons, nothing is said regarding the use of dichloramin-T for the purpose of sterilizing infected rootcanals and other dental purposes. It is here, however, that this new chlorin compound will achieve its greatest triumphs in the practice of dentistry, and the reviewer, from an extended clinical experience with it, predicts for dichloramin-T a most important place in the armamentarium of the dental practitioner.

H. P.

[INTER ALLIED DENTAL CONGRESS.] CONGRÈS DENTAIRE INTERALLIES. Tenu à l'Ecole Dentaire de Paris du 10 au 13 Novembre 1916. Comptes rendus publiés par Georges Villain, Secretaire-général. Tomes I. II.

Paris, 1917.

The subject matter of the reports is almost entirely devoted to the treatment and physiology of fractures of the mandible and the maxilla.

All the authors agree that it is essential to reduce the deformity and insert an appliance as soon after the injury as possible. On account of the injury of the soft tissues the appliances will vary. The second essential point is frequent irrigation of the entire mouth and wound under pressure.

Throughout the entire series of reports one is impressed with the number of appliances used for correcting the secondary contractures and deformities. It is especially noted that the correct primary appliances and treatment will greatly diminish the number of these deformities. There is no one method that is applicable to all cases, but the ingenious methods reported are very admirably described and should be more generally known. While it would seem unnecessary, it is noted in the reports that after bony union has occurred it is not advisable to attempt any method of correction without first dividing the bone.

An interesting point is that practically all the work has been developed upon the fudamental principles laid down by Claude Martin in his work. The cicatricial contracture of soft tissues is shown to be admirably treated by continuous pressure and massage.

These reports are the most complete it has been the reviewer's pleasure to

"Practical Dietetics with Reference to Diet in Health and Disease." By ALIDA FRANCES PATTEE, Graduate of Department of Household Arts, State Normal School, Framingham, Mass. Late Instructor in Dietetics, Bellevue Training-school for Nurses, Bellevue Hospital, New York City; former Instructor at Mount Sinai, Hahnemann, and the Flower Hospital Training-schools for Nurses, New York City; Lakeside, St. Mary's, Trinity, and Wisconsin Training-schools for Nurses, Milwaukee, Wis.; St. Joseph's Hospital, Chicago, Ill.; St. Vincent de Paul Hospital, Brockville, Ont., Canada. Eleventh Edition, revised and enlarged. Price $1.75. Mount Vernon, New York: A. F. Pattee, 1917.

"Dental Electro-Therapeutics." By ERNEST STURRIDGE, L.D.S.Eng., D.D.S., Fellow of the Royal Society of Medicine, Member of the British Dental Association, of the British Society for the Study of Orthodontics, of the American Dental Society of Europe; contributor on Dental Electro-Therapeutics in "The Science and Practice of Dental Surgery," on Ionic Medication in Prinz' "Dental Materia Medica and Therapeutics." Second Edition, thoroughly revised. With 164 engravings. Philadelphia and New York: Lea & Febiger, 1918. Price $2.75.

"Elementary and Dental Radiography." By HOWARD RILEY RAPER, D.D.S., Professor of Roentgenology, Operative Technic, Materia Medica and Therapeutics at the Indiana Dental College, Indianapolis. Past Dental Surgeon to the Indiana School for Feeble-minded Youth. Member of the American Institute of Dental Teachers, of local, state, and National dental societies, of the First District Dental Society of the State of New York, and the Western Roentgen Ray Society; Associate Fellow A. M. A., Section on Stomatology.

With over 500 illustrations. Second Edition. Adopted as a Textbook by the National Association of Dental Faculties. New York: Consolidated Dental Mfg. Co. London: Claudius Ash, Sons & Co., Ltd. Price $7.00.

"Injuries of the Face and Jaw and Their Repair, and the Treatment of Fractured Jaws." By P. MARTINIER, Professor in the Dental School of Paris, Dentist to the Seine Asylums, Hon. Director Dental School of Paris, and Dr. G. LEMERLE, Professor in the Dental School of Paris, Dentist to the Hospitals. Translated by H. LAWSON WHALE, M.D., F.R.C.S., Captain R.A.M.C., T. (formerly Capt. I.M.S.), the Oral Dep't, No. 83 Gen. Hospital, Br.E.F.; Visiting Surg. to the Throat, Nose, and Ear Dep't, County of London War Hospital, Epsom; Laryngologist to the London Temperance Hospital and Hampstead General Hospital. New York: Wm. Wood & Co., 1917.

"Technique and Scope of Cast Gold and Porcelain Inlays." With a Chapter on Endocrinodontia, or the Ductless Glands-Their Expression in the Human Mouth. By HERMAN E. S. CHAYES, D.D.S., New York City. With 372 illustrations. St. Louis: C. V. Mosby Co., 1918. Price $7.00.

"Gould and Pyle's Pocket Cyclopedia of Medicine and Surgery." Based upon the Second Edition of Gould and Pyle's Cyclopedia of Practical Medicine and Surgery. Second Edition, revised, enlarged, and edited by R. J. E. SCOTT, M.A., B.C.L., M.D., New York, formerly Attending Physician to the Demilt Dispensary and the Bellevue Dispensary; Author of "The State Board Examination Series," Editor of "Witthaus' Essentials of Chemistry and Toxicology" and "Hughes' Practice of Medicine," etc. Philadelphia: P. Blakiston's Son & Co. Price $1.25.

"Health by Instruction." An Effort in Favor of a Biologic Teaching. By LUIS SUBIRANA, Cirujano-Dentista, Professor in the Dental School of Madrid. English Translation by FRANK J. YOUNGER, D.D.S. Madrid: Sociedad de Artes Graficas, Fuencarral, 137. 1918. Price $1.00.

The title of this book does not properly indicate its contents. It is in reality an interesting and valuable expression of the author's views on the subject of education in hygiene.

[British Dental Journal, December 15, 1917.] Some Observations on the Replantation and Transplantation of Teeth, with Special Reference to the Patho-histology of the Tissues of Attachment. By F. C. WILKINSON.

Recent interest in this old procedure has been signalized by the work of Marshall (see DENTAL COSMOS, 1918, p. 169) and Chiavaro (ibid. p. 261). Wilkinson prefaces this study with a concise historical orientation on the matter which is well worth reading by anyone interested. His original investigations on this subject were conducted with the object in view of establishing the method of fixation of replanted teeth to the surrounding tissue, with special reference to the function of the periosteum in these cases, and also to study the process of absorption which takes place. For this purpose monkeys (species not given) were taken as being the highest form of animal easily obtainable. Similar teeth were extracted from each side of the mouth, and after several days' interval were replanted under identical conditions, with the exception that in one side the tooth was completely stripped of its periosteum, and the other was left intact. After these teeth had been in position for about two months that specimen was obtained and the sections made. The technique of the operation is given in detail.

Under low power of the microscope these sections show that absorption of the roots has begun in both cases, but it is notable that the root upon which the periosteum had been left shows more absorption than the root from which it had been stripped. In fact, except for the slightly greater amount of absorption in one case than in the other, it is quite impossible microscopically otherwise to distinguish between the two roots replanted,

the one with the periosteum left intact, and the other from which it has been removed. In the sections it is to be noticed that absorption is not equally distributed over the roots. In places the cementum seems to remain intact, and no evidence of absorption can be found, while in other parts it is proceeding rapidly. Wilkinson suggests that this condition is due to asepsis not being perfectly maintained, a very difficult proposition when operating in the mouth and with bony tissue. The alveolus shows little sign of any absorptive process, but in some places new bone has grown out from the alveolus and fused to the cementum.

In summary: (1) The presence or absence of periodontal ligament upon a replanted tooth has no appreciable effect upon the mode of attachment.

(2) Absorption seems to take place to a greater or less extent in all cases, the immediate cause being large multinucleated cells, osteoclasts.

(3) Three kinds of attachment can be differentiated (a) in certain portions of the root the alveolar bone is found directly united to the root; this osseous union probably occurs in places where the root and alveolar bone came in close apposition; (b) in other places attachment is obtained by ordinary scar tissue (this is the preponderating method of attachment); (c) in a small part attachment may be by long connective tissue fibers markedly simulating the normal periodontal ligament. At such places there is no absorption of the root. The establishing of this effort at a true regeneration is one of the most interesting points of the author's observations. This tissue has nothing to do with retained periodontal ligament on the replanted root. Under ideal conditions, which Wilkinson is unable to define, it might be possible to obtain such a form of attachment

throughout, which presumably would be as permanent as in the normal condition.

In this connection a letter from C. Lotinga in the British Dental Journal for January 15, 1918, p. 52, is of practical interest. A right maxillary second incisor with a history of caries and death of the pulp, root-canal treatment, and subsequent abscess, was extracted. Tissue paper, soaked in phenol, was wrapped around the root, its crown was cut off, and its hypercementosed apex resected. The periodontal ligament was stripped off in toto. A Richmond crown was fitted and a Dale's porcelain inlay was placed in the apex. The thus remodeled tooth was replanted in its socket just six hours after extraction. A splint was kept on for six weeks. The tooth remained perfectly comfortable for sixteen and a half years, when it was fractured by accident. Two-thirds of the root were left in position, from which to date an additional period of three years there has been no trouble.

The Pathological Anatomy of Epulides. BY R. ERAUSQUIN.

The first two papers deal with case histories and surgical intervention. The last paper is a rather pretentious survey of the patho-histology of these growths.

Campbell reports two cases. One was an angeio-fibroma of the gum in a white girl of sixteen years. The family and personal history was negative. About seven years previously there was first noticed a lump, about the size of a pea, on the labial surface of the upper left gum in front of the first molar. It gave no pain, and grew slowly until about one year ago, when it began to increase rapidly and bleed rather freely. The general

health had been good until quite recently, when the patient began to lose flesh and feel ill. On examination was seen the pointed end of a reddish tumor protruding from between the lips and extending distal to the faucial pillars. It is raised above the teeth so that she cannot close her mouth. The teeth are irregular, decayed, broken, and very black. A cherry-red nevus is around the corner of the mouth. The tumor does not involve the cheek, but pushes it outward. The Wassermann was 4 plus. The blood showed 3 million reds, 7000 whites, and hemoglobin below 50 per cent.

Under ether anesthesia, the periphery of the entire mass was well infiltrated with a 0.25 per cent. novocain and 12 per cent. 1: 1000 adrenalin in physiologic salt solution. There was very little hemorrhage. Recovery was complete. Microscopically the deep portion of the growth was fibrous, while its anterior and superficial parts were angeiomatous. There was no indication of malig

nance.

The second case was that of a colored woman, age sixty. The family and personal history was negative. About six years ago a small lump was first noticed on the labial surface of the lower right gum between the second incisor and the canine. There was no pain until about two weeks ago, when the growth began to throb as if it would burst. It was about the size and shape of a whiteoak acorn, firm, and the color of the gum. It had separated the teeth between which it grew, and apparently had a thick pedicle.

Under local anesthesia the adjoining teeth were extracted, and a V-shaped piece of the gum with the tumor was cut away and the margin of the alveolus pinched off to insure complete removal. Microscopically the growth was a pure fibroma.

Campbell's article is illustrated with three portraits, not of special value.

The original part of Reder's paper is a case report. Four illustrative portraits of the "before and after" variety are introduced. The case was that of a woman, age fifty-two. Several teeth in the maxilla were loosened by a hen flying into her face. About one month later, a bad persistent toothache began. A tooth was extracted. There was prompt relief. Two weeks later she noticed a swelling on the upper gum near the right canine.

[Journal of the National Dental Association, March 1918.]

The Relative Efficiency of Medicaments for the Sterilization of Tooth Structures. BY M. M. BROOKS AND W. A. PRICE.

This paper is limited to the sterilization of infected dentin and cementum as involved in root canal infection following the death of the dental pulp. A very interesting historical survey serves to orient the reader in the problem, and furnishes a valuable bibliography.

The authors recognize that the following structures and conditions exist as important factors: (1) The root-canal to which the infection has access, and through which the infection can reach the dentin; (2) the dentin with its tubuli; (3) through the foramen or foramina the infection can reach the cementum, which probably can also be infected from the dentin; (4) the periapical tissues, which constitute not only the pabulum but also a locked area which may contain an infected culture medium, which may reinfect the cementum and dentin and the root-canal contents.

The experiments have been arranged in the following order: (1) A study of the ability of the medicaments to sterilize dentin and cementum under the most ideal conditions, irrespective of compatibility with clinical conditions; (2) the study of the ability of the medicaments to even retain the sterility of a medicated dressing when placed in an infected root-canal without the influence of a periapical infection; (3) the influence of a periapical infection upon these last-named conditions; (4) the ability of medicaments placed within the root-canal to sterilize infected dentin and cementum while these tissues are surrounded by a periapical infection, including a study of the areas of these structures that are most readily sterilized; (5) a study of the time factor, and (6) a study of silver-ammonium-formalin and Dakin solutions.

The results of the first series of experiments show that even under ideal conditions, where the medicament bathes both the inner and the outer surfaces of the infected tooth structure, and even where the mass of the medicament is relatively large and without

compatibility for the surrounding tissues, the dentin and cementum were not disinfected except with a few medicaments, namely, formalin in all strengths (in the protocols this is given in percentages of formaldehyd-40, 30, 20, 10, 5, and 1) and chlorphenol. The great majority of results were negative and in direct contradiction to the general teachings and expectations in current dental practice. It is very difficult to destroy bacteria growing in dentin and cementum.

The conclusions to the second series of experiments are that the most radical disinfectant is dichloramin-T. This medicament in a concentration of 15 per cent. as used in these experiments gave 100 per cent. efficiency in all treatments, but also produced irritation of living tissue. A further observation on the lowest percentage needed for root-canal sterilization and the amount of time for the production of this condition will be continued. This drug may, in dilute solution of 1 per cent. or less, be both safe and efficient, but it is one of the most painful and destructive medicaments tried in practical cases. The members of the profession are warned never to place the 15 per cent. or even 5 per cent. solution of dichloramin-T in eucalyptol, its solvent, in any tooth or on tissues. (However, the newer solvent, chlorcosane, is devoid of this irritative effect.)

The third series of experiments shows that under the conditions specified above, the medicaments used-Buckley's phenol compound, dichloramin-T 15 per cent., formocresol, iodincreasote, iodin U. S. P., formalin U. S. P., phenol U. S. P., and oil of cloves 50 per cent. --are not ideal disinfectants. The interpretation of this experiment is probably that the penetration of the disinfectant is not sufficient to reach the remote and minute recesses of the tubuli. To find some disinfectant or method that will meet this requirement is the subject of the remaining experiments, although these are not yet completed.

The fourth series emphasizes that the efficiency of a medicament to sterilize all tooth structures should be the criterion of a disinfectant.

Experiments upon Howe's silver nitrateammonia-formalin method (see DENTAL COSMOS for September 1917) incline the authors to believe that a perfected technique will produce sterilization of the tooth structures