tuted a course of lectures delivered to the "Army Dental Reserve Corps," or, strictly speaking, to a section thereof, at the Forsyth Dental Infirmary. The lectures are presumably an exposition of the curriculum of specialized instruction authorized by the Surgeons-general of the Army and the Navy for officers of the Dental Reserve Corps, as printed in the introductory part of the work. One hundred and sixty-four pages, constituting the first five chapters, are devoted to elementary matters which in more detailed and systematic form are embodied in the standard curriculum of dental schools, and with which the members of the Dental Reserve Corps may safely be assumed to be familiar; therefore, why should. they be rehearsed?

The chapter on Maxillary Fractures is open to the same criticism, and further, it is mainly a compilation of methods. and appliances taken from older writers. of standard works on the subject, e.g. Kingsley, Garretson, Heath and Hamilton, and Angle, with a few illustrative cases from the reports of the American Ambulance Hospital in Neuilly by Dr. G. B. Hayes.

inductive reasoning faculty is taxed to a degree in the endeavor to trace out the connection between "Army Dentistry" and the following information with respect to the Care of Horse: "If a horse has been brought up in the army, he has been taught by experience to take care of himself. . . . If a horse is not acting normally, his rider can be sure he needs food or water or some of the other essentials"-in which respect, we may add parenthetically, the horse resembles a flivver, but differs therefrom in the respect that, to quote again, "He must be approached on the right side and never riled."

We cannot conscientiously say that we think this book fills a long-felt want, or at any rate a generally recognized need.

Books Received.

Books received are acknowledged in this column, and such acknowledgment must be regarded as a sufficient return for the courtesy of the sender. Selections will be made for review in the interests of our readers and as space permits.

"Oral Primer." Presented by the Educational Committee of the Genesee County Dental Society, New York.

Oral Hygiene Committee of the Dental Soci"Prophylactic Rhymes." Published by the ety of the State of New York. Copies of this booklet may be procured from Dr. A. W. Smith, 33 Chestnut st., Rochester, N. Y., chairman of the Oral Hygiene Committee.

"A Child's Book of the Teeth." By HARRISON WADER FERGUSON, D.D.S. Illustrated by the Author. Yonkers-on-Hudson, New York: World Book Co., 1918.

A commendable group of primers intended for the instruction of school children in oral hygiene, presenting methods of caring for the teeth in an interesting and attractive manner which should appeal to the little ones.

[Journal of the American Medical Association,

Chicago, May 11, 1918.]

A Surgeon's Impression of Trigeminal Neuralgia, Based on Experiences with 302 Cases. BY CHAS. H. FRAZIER.

True trigeminal neuralgia must not be confused with a peripheral neuritis initiated by some infective focus in tooth or sinus, or with the neuritis of toxic or obscure origin. One occasionally hears or reads of the cure of trigeminal neuralgia by the drainage of a sinus, by an intranasal operation, or by the removal of an infected tooth. Frazier has never seen or operated on a patient in a case of the major type of trigeminal neuralgia in which there was any reason to suspect any one of these lesions as the exciting cause. If this were accepted, it would serve one useful purpose; that is, vain attempts to find peripheral lesions as a cause would be abandoned, and patients would be spared many sinus operations and the extraction of a majority of sound teeth.

The facts presented in this paper are the outcome of an experience with 302 cases of neuralgia of the trigeminal nerve. This includes 39 peripheral operations, 99 alcoholic injections, 130 intracranial operations, and 34 cases that were not treated.

There are no grounds for discussing any method of treatment other than alcoholic injection or the avulsion of the sensory root. The alcoholic injection is of only transitory effect. Properly given, it will arrest pain immediately and absolutely, and for an average period of nine months. It is in no sense of the word a permanent cure. The radical operation assures absolute and permanent relief. As an exception to the generality of these two methods, there are a few cases in which the pain is limited to the distribution of the supra-orbital branch. Alcoholic injection of this branch is not very effective;

peripheral resection may with propriety be employed first.

The untrained physician is no more qualified to employ alcoholic injection than he is to perform the operation. Frazier stresses the fact that with confidence born of experience the injection may be made painless. Great caution must be taken as to the injection of the Gasserian ganglion. The incidence of corneal complications, apart from injuries to the abducens and oculomotor nerves, is not small. The toll is too high, and Frazier makes prohibitive the treatment by injection, except in the few instances in which the operation may be contra-indicated.

Since 1901, in almost all his cases Frazier has practiced the avulsion of the sensory root as a substitute for gangliectomy. Physiologically sound and technically practical, the avulsion or even the division of the sensory root is in every sense a radical cure. Frazier gives the general principles of the technique, and this part of the article is very well and clearly illustrated.

In considering the results Frazier refers only to the major operation. There can be no doubt as to the permanence of relief if the entire root is sectioned. His first operation was performed in 1901, and when last heard of, fifteen years after the operation, the patient was free from pain. In all his 121 intracranial operations, he has only once been called to operate a second time. In this case the inner portion of the root had escaped section. The motor and sensory sequelæ are of no very great moment, at least when compared with the intense suffering for the relief of which the operation is performed. The only sequel that might be said to be of serious moment is keratitis. If promptly recognized and properly treated the corneal ulcer will heal.

There seems to be an extraordinary misconception on the part of the profession as

to the status of the operation on the ganglion or root. It is usually represented as a sort of kill-or-cure method, as a result of which the patient, if he survives, will be paralyzed on one side of the face, and will lose his eyesight. Because of the frame of mind in which the patient consults the surgeon, the former needs some reassuring. In stating the risks of the operation, Frazier refers only to his own clinic. Since 1901 there have been four deaths in 160 operations. Two of these were due to apoplexy, and all of them were among the subjects of the 121 intracranial operations. In a series of 87 consecutive operations there have been no deaths since 1912.

Over other radical operations, such as the removal of the ganglion, the Abbe operation, or the Hutchinson operation, avulsion of the sensory root has so many advantages that it should be and is recognized as the operation of choice. It is easier of execution than any other; it subjects adjacent structures to no risk, and it is attended with a smaller percentage of corneal complications and with a lower mortality.

[Journal of Medical Research, Boston,
March 1918.]

The Bactericidal Action of Arsenical Com=
pounds on Experimentally Produced
Streptococcic Septicemia. BY CLARENCE
S. ALLISON.

In

It has been known for some time and now is generally appreciated that in those cases of pyorrhea alveolaris or other gingival affections in which spirochetes could be demonstrated the various organic arsenical preparations exert an almost specific action. the British Dental Journal for March 15, 1918, p. 197, is a note to the effect that W. Kolle has identified a particular spirochetal form which he believes plays the principal part in pyorrhea, and records marked improvement sequent to intravenous injection of neosalvarsan.

The present study of Allison is of interest in that it demonstrates that the indubitable clinical improvement following administration of arsenicals is not of necessity solely attributable to their spirocheticidal specificity.

Colebrook and Douglas (Lancet, London, January 22, 1916, pp. 81 and 181) proved

that salvarsan and neosalvarsan are bactericidal for cultures of staphylococci, both in watery solution and in the serum and whole blood of patients who had received therapeutic injections of arsenical compounds. Allison here offers experimental work showing that salvarsan, neosalvarsan, and arsenobenzol have a marked bactericidal action on different strains of streptococci in vitro, and that these arsenicals are of value in the treatment of experimental septicemias due to these organisms.

For this work, there were used fifteen different strains of streptococci, representing both the hemolytic and the viridans groups. It is inferable that none of these strains were isolated from dental lesions. The experimental animals were rabbits.

The results of Allison's study with watery solutions of salvarsan, diarsenol, and arsenobenzol lead to the following conclusions:

(1) They possess a distinct bactericidal power against virulent strains of streptococci in vitro, in dilutions up to 1: 3000, and an inhibiting power over these organisms for at least twenty-four hours in weaker dilutions.

(2) They possess a bactericidal action against streptococci in the blood stream of animals (rabbits). The success of the treatment depends largely upon the virulence of the organisms, and upon reaching them before they become localized in remote parts of the body.

(3) They produced no untoward effects on the animals in which the maximum doses were frequently repeated.

Miller and Chalfant (Journ. A. M. A., June 22, 1918, p. 1975) give a note upon the treatment of puerperal blood-stream infection by means of arsphenamin. In seven of the Women a streptococcus was found in the blood. "With the intravenous injections of arsphenamin we have been able to rid the blood stream of its invading organism in every instance. All varieties of organisms so far encountered seem to be equally influenced. After arsphenamin has been given there is a marked increase in the leucocyte count." These clinical results strikingly confirm Allison's laboratory findings, and suggest that the good clinical results of pyorrhea treatment with arsenicals are possibly attributable not solely to their spirocheticidal properties.