after consultation with and corroboration by other men, the author is quite convinced that focal infection from the mouth and tonsils plays no small part in a certain class of skin diseases. After conscientiously prosecuting this work in quite a number of cases of zoster, and after observing in many cases rapid recovery or improvement after removal of the offending tooth or other foci, Lain is fully convinced that there is a true herpes zoster which has its origin in a specific infection, having a focal point most frequently in pus pockets surrounding or at the apices of one or more teeth.

Although Lain assures the reader that he is conservative and critical in his observations, the brief case histories which accompany this article do not in themselves suffice to prove the contention. They are not even illustrative. If the cases referred to really afford convincing evidence, their histories have been introduced in too abbreviated a form.

Journal of the American Medical Associa
tion, October 20, 1917.]
Alcresta Ipecac. REPORT OF THE COUNCIL ON
PHARMACY AND CHEMISTRY, A. M. A.

This is a brief note contained in the wellknown column "Propaganda for Reform." In 1915 Alcresta ipecac tablets (Eli Lilly & Co.) were admitted to "new and non-official remedies." Since that time advertising claims, less modest than the earlier ones, drew the attention of the Council to this preparation. Among this advertising material were statements to the effect that ipecac alkaloids have a demonstrated usefulness in pyorrhea. "Such an unequivocal statement is unwarranted. In spite of the enthusiastic advocacy, in the past, of ipecac alkaloids as a specific in pyorrhea alveolaris, the preponderance of scientific evidence indicates that ipecac is of questionable value in this condition."

On the basis of this and other extravagant ciaims it will be necessary to omit Aleresta ipecac from "new and non-official remedies."

[Den Norske Tandlaegeforenings Tidende, July 1917.]

St. Apollonia and Her Picture in the Nidaros Breviary. BY JOHN WESSLER. The earliest picture, so far discovered, of St. Apollonia is reproduced as a frontispiece

to Wessler's article. It was discovered by him in London in 1914. This, the oldest known painting of the patron saint of dentistry, is artistically delineated on a sheet of parchment in an old breviary, dating from the end of 1300 A.D. The breviary belonged to a Dominican cloister in Flanders. The picture is framed by the V in Virgo at the beginning of the text, which is in Latin in Gothic script. A translation here follows:

Concerning St. Apollonia, Virgin and Martyr. For us, O Apollonia, pray heartily to the Lord, lest for our sins we be afflicted with sickness in our teeth. Versiculus. Pray for us, blessed Apollonia, that we be made worthy. Let us pray. Oratio. Eternally omnipotent God, for whose honor blessed Apollonia, virgin and martyr, steadfastly suffered the horrible crushing-out of her teeth, grant Thou as we desire, that we may be made happy in commemoration of her, through whose most pious intercession we were freed from toothache and all imminent evils. Through Christ our Lord. Amen.

Another breviary, that of Nidaros, in Norway, printed in 1519, of which three copies are extant, has recently re-awakened interest, in that its title-page which was missing in all three existing copies-has been found in Griefswald, Germany. In Wessler's opinion there is no doubt that also here we have to do with a representation of St. Apollonia, although the picture which comprises the titlepage of the breviary is not accompanied by other evidence than the forceps.

[Lancet, London, October 6, 1917.] A Case of Vincent's Infection Involving Mouth, Eyes, and Penis. By F. B. Bow

MAN.

After a gradual onset of about two weeks' duration, the local lesions and the systemic condition were so bad that the patient had to be admitted to a hospital. There was a severe conjunctivitis, with copious thin discharge and photophobia. The mouth was half open, and the lips covered with angry herpeticlooking ulcers. The gums were reddened, the teeth bathed in pus, pressure on the gums caused severe bleeding. Three days later there was found on the penis a small red ulcer with a membrane over it surrounding the meatus. Smears made from all three areas showed

[Dental Outlook, New York, May 1917.] Clinical Methods of Treating Hypersensitive Dentin. BY HERMANN PRINZ.

A necessary prerequisite to any rational method of treating hypersensitive dentin is a consideration of the factors, structures, or conditions which permit of this hypersensitiveness.

The entire question of a nerve supply to the dentin is still sub judice. Prinz suggests that if there are nerve fibers in the dentin, they are not of a sensory or motor type, but are trophic in function.

However this question may be decided in the future, for the present Prinz advances a simple adequate explanation of the mechanism of hypersensitivity. The basis of this theory is the practical incompressibility of water. The sequence of events as Prinz pictures them is somewhat as follows:

There is a break in the enamel covering. The thereby exposed fibrilla of the dentin absorb water from the saliva and swell; then the slightest pressure upon this swollen dentin will be transmitted through the odontoblastic processes to the bodies of the odontoblasts, and these in turn will compress the nerve plexus underlying and encircling the odontoblasts.

The validity of this explanation is supported by the clinical experience that dehydration will remedy hypersensitiveness. The warm-air blast, alcohol, and acetone will dehydrate dentin, but penetrate so short a distance that frequent repetition is necessary. Sharp instruments used with dexterity conduce to minimize the pressure exerted upon the swollen dentin.

The use of agents which anesthetize the tooth by lowering its temperature is unsatisfactory.

Two classes of drugs may be used to overcome the hypersensitivity-caustics and anesthetics. Among the caustics are mercuric chlorid, silver nitrate, zinc chlorid, sodium

or potassium hydroxid, and phenol. All these agents act only superficially, and their application must be continually repeated. Consequently, except in slight cases of hypersensitivity, they are rather unsatisfactory.

The condition of analgesia induced by a general anesthetic, e.g. nitrous oxid, is not completely satisfactory. So deep an anesthesia that all sensation is inhibited alone meets the requirements of many cases.

Prinz's views upon local anesthesia and the technique of its induction are so well known and so accessible that they need not be given here.

In closing, he emphasizes the danger and needlessness of resorting to copyrighted preparations used for desensitizing purposes. The employment of preparations containing arsenic or formaldehyd is pleasantly satirized.

[Den Norske Tandlaegeforenings Tidende,

June, July, and September 1917.] Aneurysms of the Arteries of the Head and Neck. BY HOLBAEK-HANSSEN.

This article is written in German, and hence is accessible to a much larger circle of readers than if it had been presented in one of the Scandinavian languages.

To follow this work intelligently throughout it will first of all be necessary to be informed of the author's definitions and classification. A pathological condition of the arterial wall is the essential character of an aneurysm. The pathological process must have affected and altered the intima, media, and adventitia-either one of these layers or all together. Five forms are distinguished, viz:

I. Aneurysma verum diffusum-an extensive widening of the arterial wall. According to the form and structure these genuine aneurysms may be subdivided as (a) Aneurysma fusiforme et A. cylindroides; (b) A. cirsoideum.

II. A. verum circumscriptum s. sacciforme. III. A. mixtum. In this form one or two of the arterial walls are expanded after separation of the arterial layers from each other. (a) A. mixtum sacciforme; (b) A. dissecans -here the adventitia in a somewhat marked degree is, after a circumscribed perforation of the inner layers, raised up off of them.

IV. Aneurysma spurium s. traumaticumalso known as an arterial hematoma. The

blood escapes, after a wounding of the arterial wall, into the surrounding connective tissue, and here is collected either as (a) A. spurium traumaticum diffusum, or as (b) A. spurium circumscriptum-here the escaped blood is collected into a sac.

V. A. arterio-venosum.

These are the forms to which the author makes recurrent reference. If an aneurysm be manually and instrumentally accessible it is known as an external aneurysm; if in whole or part manually and instrumentally inaccessible it is called an internal aneurysm. Clinically only the two chief forms, A. verum and A. spurium, are of interest. The latter form in most cases is encountered in the external aneurysms, while the true aneurysms practically are met with in all arteries. Clinically, a pulsating tumor, communicating with an artery and filled with arterial blood, fulfils the general concept of an aneurysm. The false aneurysms are encountered more frequently than the true forms; of the latter the circumscriptum and mixtum predominate. Age, sex, and occupation play a definite rôle in the occurrence of aneurysms. Most of the aneurysms occur between the ages of thirty and forty, and forty and fifty. Their number in males exceeds that in females. However, aneurysms of the arteries of the head and neck, extra- as well as intracranial, occur approximately in both sexes with equal frequency. These lesions are found generally in the working classes, particularly in men with hard and long bodily labor.

Although the genuine extracranial aneurysms play a very small rôle in comparison with that of the intracranial forms, still for the dentist the latter type is relatively of less interest.

Microscopically the media is found to have undergone the greatest change in cases of aneurysmal alterations of the vessel wall. The at present dominant view is that a mesarteritis and an endarteritis are the most important factors in the etiology of the true aneurysms. Holbaek-Hanssen mentions syphilis, arterio-sclerosis, and joint rheumatism as among the causes of this inflammatory change in the vessel wall. Apropos of the etiology of the aneurysms of the arteries of the head and neck, it may be said that the anatomical relations and the intra-arterial blood pressure work together with (1) syphilis for the

intracranial forms in general, although here arterio-sclerosis may be a factor; (2) arteriosclerosis for the extracranial forms, particularly for the carotis communis and its branches in the arteries of medium size, e.g carotis interna. The author was unable to find in the literature a case where an aneurysm of the carotis communis was associated with syphilis.

In this connection may also be mentioned (a) aneurysms which are conditioned by mere increase of the intra-arterial blood pressure, the anatomical relations, and the physiological functionings; (b) the embolic-mycotic erosion aneurysms-which are very rare in the region of the head and neck, although the literature records an aneurysm of the internal carotid following a dental abscess.

There are two classes of symptoms from intracranial aneurysms-(1) those which arise from a direct action of the aneurysm on the brain substance, and (2) those which are seen when the several cranial nerves are exposed to the pressure of the aneurysm. Among these symptoms the trigeminal nerve may be affected, with consequent severe pains in the orbit and attacks of facial neuralgia. (Cf. Shannon, 1917: Case of an aneurysm of internal carotid, intracranial portion, and its effect on patient's vision, Arch. of Ophthal mology, New Rochelle, Nov., p. 518.) Facial paralyses have been observed, especially after ruptures of the aneurysm. At times a facial edema rapidly follows the development of an aneurysm of the common carotid.

Obviously the diagnosis of external aneurysms is essentially easier than in the case of the internal forms. An aneurysm at the middle third of the internal carotid, and also one of the external carotid, by displacement of the posterior belly of the digastric may condition a swelling immediately behind the angle of the mandible. A certain sign of aneurysm of the internal carotid is said to be a systolic rustling in the region of the parotid.

Aneurysms of the external maxillary artery are great rarities. On the external arteries of the head and neck aneurysms are often formed; but they naturally are rarities and are in most cases purely traumatic injuries of the vessel walls, with consequent formation of an aneurysm or arterial hematoma. Among the head and neck arteries, which border on the oral and pharyngeal cavities, aneurysmal

formations in the internal maxillary artery have been found. The diagnosis is not easy. Generally these are of traumatic origin.

In respect to extracranial aneurysms the symptomatology is more distinct and capable of differentiation than in intracranial aneurysms. In particular, aneurysms which are in the region of the oral cavity or pharynx are readily confused with tonsillar and retropharyngeal abscesses. In all cases an exact examination and a thorough history of the condition have great influence in securing correct interpretation. When it is desirable to decide whether an aneurysm is localized on the internal or external carotid, the temporal artery on each side is observed. If there be no difference in the rhythm of the pulse it is probable that an aneurysm of the external carotid can be excluded.

Aneurysms which have been conditioned by gunshot wounds are relatively rare on the cervical arteries. When the frequency of the wounds of the head and neck seen in the present war are considered, it must be admitted that the aneurysms in question are relatively rare. In part this is to be explained by the fact that wounds seriously involving these arteries bring death before help can come. In part the elasticity of these arteries and their possibility of being shoved aside by the missile account for the infrequency of traumatic aneurysms. Likewise aneurysms which have been caused by stabbing and cutting instruments are rare, because the wounds leading to the outside from these arteries are so large that there is no opportunity for thrombosis and sac formation. It is also peculiarly noteworthy that aneurysms after wounds to the bones of the head and face

are not often seen. Aneurysms in the head and neck regions are relatively frequently seen after operative procedures. Fischer mentions an aneurysm of the internal maxillary artery which Surrage observed after the extraction of a third molar.

A summary of the purely traumatic extracranial aneurysms found in the literature, including two within the author's own experience, is as follows: Internal carotid, 6; internal maxillary, 4; external maxillarysuperficial temporal, deep temporal, and ascending pharyngeal, each 1.

The author carried on some animal experiments (rabbits) to determine the forms of the

wounds, resulting in aneurysms, which could be inflicted by sharp, cutting objects. In only two instances was he successful in producing aneurysms artificially. These experiments are detailed and their significance discussed.

The treatment of aneurysms is divided into two groups-(1) general, and (2) local. The former method is usually the only one applicable in the case of internal aneurysms. The essential feature of this is to keep the patient in a condition of absolute rest, so as to equalize and minimize cardiac activity. In the case of intracranial aneurysms iodin preparations show a favorable action. When it is known that the lesion is of syphilitic origin many authors recommend iodin, mercury, and salvarsan. Operative interference can also be resorted to, in the form of ligature of the internal carotid.

The operative or local treatment plays the greater rôle in the case of the aneurysms of the head and neck arteries. The methods here applicable are those of Hueter and Hunter. Hueter's method consists in the ligation of the afferent and efferent arteries as closely as may be to the sac and when possible the total extirpation of the aneurysm. In the case of small aneurysms of the external and internal carotids (the latter very rarely). thyroid, lingual, and any of the superficial arteries whose anatomical relation warrants the employment of this method, Hueter's technique is followed.

For Hunter's method a point on the afferent arterial branch is chosen, and here it is ligated. In the case of the larger cervical arteries, and the extracranial arteries covered by muscles and fat, and in the case of all intracranial arteries, Hunter's operation is that indicated.

So far as the author knows, arterial suture or transplantation has not yet been applied to cervical arteries for eradication of aneu

rysms.

In looking back over this very extensive report on cervical and cephalic aneurysms one must admire the diligence and care with which Holbaek-Hanssen has presented so thoroughly such an unusual topic. Although it has but slight affinities with the exigencies of general dental practice, though relatively and absolutely rare, it becomes of interest at this time, when the frequency of such lesions is increased in the casualties of warfare.

[Journal of the American Medical Association. December 1, 1917.]

Facial Paralysis Following Pasteur Antirabic Treatment. BY ROBERT L. LEVY. There are records of only 150 cases in which paralyses have followed the use of this treatnient, and of these patients but 25 died. Levy reports here a case of facial diplegia with onset 73 days an exceptionally long latent period after the beginning of the prophylactic inoculations. This is an unusual form of "treatment paralysis." The author includes in this article a table and analysis of 10 other cases of facial paralysis, from the literature, following antirabic treatment.

[British Medical Journal, November 17,
1917.1

The Relative Germicidal Efficiency of
Antiseptics of the Chlorin Group and
Acriflavin and Other Dyes. BY H. D.
DAKIN AND E. K. DUNHAM.

"The object of the following paper is to point out certain common errors in the testing of antiseptics of the chlorin group which lead to totally inaccurate inferences as to

their germicidal potency; secondly, to compare the results obtained by methods eliminating these errors with those furnished by other antiseptics; thirdly, to examine the claims for the alleged vastly superior germicidal potency of acriflavin and certain other dyes; and lastly, to indicate how important the matter of the velocity of disinfection is in forming a judgment of the utility of antiseptics in surgical practice, and also the methods suitable for their successful employmient."

After a detailed report of the extensive experiments in vitro, the authors summarize their work as follows: "(a) The rapid and complete disinfection brought about by solutions (one volume) of members of the chlorin group of antiseptics of the strength commonly used in the treatment of wounds, when added to heavily infected blood serum-muscle extract mixture (two volumes); (b) under similar circumstances, solutions of acriflavin, proflavin, brilliant green, and malachite green failed to sterilize in six hours mixtures which the chlorin antiseptics sterilized completely in five minutes or less."

Using Beeswax.-When beeswax is left immersed in water that is too hot, its useful working qualities are impaired. A blanching or whitening of the surface shows that it has been heated to too high a temperature. A rather large volume of water at the right temperature (about 40° to 50° C.) should be employed, and full time allowed for the beeswax to become warmed and softened throughout.-D. M. SHAW, Dental Record.

Dental Neuralgia or Pain Referred to Branches of the Fifth Nerve.-Patients who have only the roots of carious teeth remaining may suffer much from neuralgic headaches, referred to various parts of the head, but often appear to have lost the toothache which they had prior to the crowns of the teeth breaking off. They are then reluctant to believe that the roots left are the cause of the headache, for, as they express it, they

"have no toothache now, only headache." I often tell them that the result of the referred pain is much the same as the confusion which exists in a servant's mind as to which bell has been rung in a house.

It is not infrequent for patients to seek medical advice for what they believe to be inflammation in the ear, while on examination the ear is found to be quite free from trouble, although a posterior molar is badly affected. An opposite case is where patients insist on having a number of sound teeth extracted, while the real trouble is the far more serious condition of disease of the Gasserian ganglion. Occasionally pain, usually caused by a diseased lower molar, is referred to the shoulder or arm, and is then apt to be wrongly diagnosed as neuritis. Reflex paresis or paralysis affecting the arm has occasionally disappeared on extraction of an offending tooth.T. WILSON SMITH, British Dental Journal.