Page images
PDF
EPUB

cament or its effect on bacterial growth. An additional danger seems to have arisen by the causing of a more or less serious paralysis. We have just been informed of a case, where emetine was injected into the shoulder with the result of producing a partial paralysis of the arm lasting two days. We have not as yet received the full particulars. The authors have also seen a case of local necrosis of the alveolus from the injection of a few minims of a 1⁄2 of a 1% emetin hydrochlorid solution in the gums around a pyorrhea pocket.

CONCLUSIONS.

Owing to the fact that the evidence is largely circumstantial, which has indicated that endamebae are the chief causative factor in pyorrhea alveolaris, based, in a great part, on the known bad reputation of its cousin's species, the endameba histolytica of amebic dysentery, and since the evidence against this conclusion is in great part incomplete, we strongly urge the withholding of judgment until further researches shall have established sufficient of the following data.

1. The successful production of the lesions of pyorrhea alveolaris by inoculation with endameba, according to Koch's law, namely, (a) an organism, if it causes the disease, must be present in all cases, (b) the organism shall be isolated in pure culture, (c) a pure culture, if inoculated into a susceptible animal, must produce the disease, (d) the chemical products must produce the same alterations.

2. Or, the successful production of the lesions by inoculation with some other organism, or organisms, or by some other means.

3. Or, the demonstration that the endamebae of the mouth are non-pathogenic and are incidental or helpful inhabitants of the oral cavity as scavengers; not only harmless of themselves, but not producing either toxins or harmful enzymes.

4. If the endameba buccalis is the chief causative factor in pyorrhea alveolaris why is the endameba Kartulisi found alone is so many of the typical cases?

5. The establishment of the role of emetine, including a close differentiation between its amebicidal and its bactericidal actions.

6. A determination as to whether the beneficial action of emetine is that of an amboceptor, acting upon the bacteria or protozoa with their protein and toxin contents (the toxiphor group) thru the agency of the complement, and also whether the action of emetine is that of a complement as in the case of lecithin with snake venomen. (22).

7. A determination as to what is involved in so-called bacteremia, which is clinically so common as a result of instrumentation and of certain medications and is this action bacteremic, septicemic or toxemic.

8. The establishment of the precise local tissue changes involved in the development of the lesion of pyorrhea alveolaris and of the successive processes constituting its repair.

9. The establishment of the precise role served by instrumentation in the process of repair of pyorrhetic lesions and the significance in this process of the removal of foreign material, bacterial plaques and degenerating tissue, also of polished surfaces, local stimulation of circulation by frequent massage, etc.

10. The development of a means for the reattachment of vital tissue to dead and denuded cemental surfaces of roots.

11. The establishment of the role of pyorrhea alveolaris pockets as culturing places for pathogenic organisms, as those of the streptococcus-pneumococcus group, which from this lesion as a primary focus, affect other organs and tissues of the body, and the establishment of the symbiotic effects of the organisms on each other.

12. Granting that the endameba is the causative factor of pyorrhea alveolaris and that emetine hydrochlorid is a specific for it, why has no pyorrhea pocket, of the many cases treated by the authors, been more greatly modified in the way of repair than the more or less marked improvement of the following factors: the quantity of pus flowing; the relative quantity of micro-organisms growing in the pockets and the general tonicity of the surrounding connective tissues, with practically no considerable change within several months of the bone lesion itself surrounding the tooth.

13. And chiefly, by the establishment of a mass of circumstantial evidence, bearing on the above and related problems, which shall be so carefully interpreted and tabulated that it will indicate the probable answers to most all of the above questions, before they can be clinically and technically established. This will best be done by as large a number of skilled observers as possible, including those skillfully treating pyorrhea alveolaris, either as a local lesion, as a systemic lesion, or as both; those treating other diseases primarily but also observing, competently, the effects on local mouth lesion and those studying by intensive methods in pathological and bacteriological laboratories, etc., etc., sending reliable statements of their observations and findings to some central committee or organization, such as the Research Commission of the National Dental Association, for classification and publication, a considerable quantity of which has already been received.

[blocks in formation]

the blood cells will greatly interfere with the observations of the endameba and other organisms. Place a small drop of warm normal salt solution on a warm slide, and without allowing the temperature to change, carefully dissolve the material carried on the instrument or toothpick in the normal salt solution, being careful not to grind up the organisms unduly. We do not advise the use of the so-called hanging drop slides but prefer a plain 3x1 inch slide and a square thin cover slip, 4 inch. Lay the cover slip on the drop of water, after the solid matter has been pushed to one side, leaving mostly stained liquid. After placing the cover slip in position make slight pressure to reduce the layer of fluid to an even strata. Dry off around the cover slip and while keeping the slide warm, quickly heat the end of a piece of sticky wax, such as S. S. White's Orange Sticky Wax, and run a thin layer of the hot wax along each of the four sides of the cover slip. This prevents currents in the fluid from air drafts, also the changes due to surface tension of the fluid, as well as the evaporation, and if the microscope is kept in a warm place the endameba and mouth organisms will usually stay alive for hours, not infrequently for half a day, if the warm stage is used on the microscope, and for an hour or two without the warm stage if the microscope is in a warm place. It is desirable to have the warm stage temperature slightly higher than body heat. By referring to the illustrations of the various forms taken of the endameba previously presented in this article, you will readily recognize these organisms by the fact that they are usually larger than the erythrocytes or the leukocytes and have peculiarly refractile areas or pseudopods resembling segments of disks of paraffine or wax, when in the motile stages and characteristic granular centers in the resting or spore stages. The endameba buccalis is much less motile than the endameba Kartulisi, the former throwing out lobose pseudo

pods in various directions, usually only one being in mo on at a time, while the latter usually extends an armlike pseudopod carrying forward its ectosarc and then proceeding to flow its endosarc with its granular masses and nuclei into this elongated pseudopod, producing a flowing motion within itself, usually in a definite direction, as shown in the illustrations.

For fixing and staining we would recommend the following technic and procedure. The following three methods we have chosen to be best for fixing speci

mens:

1. A solution suggested by Schaudin, (24) which is made by adding 50 C. C. of absolute alcohol and 5 drops of glacial acetic acid to 100 C. C. of saturated bichlorid of mercury. A wet smear is dropt into this solution for ten minutes. Wash for ten minutes in a little alcohol containing a little iodine and then in 70% alcohol for thirty to forty minutes.

2. A method suggested by Dr. Hartzell, which is to drop a wet smear into saturated bichlorid for thirty minutes.

3. Pass an air dried smear thru a flame.

There are also three good methods for staining. In using Heidenhain's Iron Hematoxylin (25) the specimen must be fixed in either of the first two solutions above mentioned. The stain is prepared by dissolving one gram of Hematoxylin crystals in 10 C. C. of hot absolute alcohol and then adding 90 C. C. of water. This solution is allowed to stand in an open, cotton plugged, bottle for four weeks and is then diluted with an equal volume of water before using. The iron solution is made by dissolving 2.5 grams of Ferric Ammonium Sulphate in 100 C. C. of distilled water. The fixt specimen to be stained is first soaked in the iron solution from four to eight hours, then rinsed and immersed in the Hematoxylin from 12 to 24 hours. It is again rinsed and differentiated by immersion

in the iron solution until black clouds cease to be given off. With this method the endosarc is well differentiated, while the ectosarc is recognized by the absence of the stain. Drs. Bass and Johns (20) nave recently suggested a stain for ameba, which can be carried out and examined almost immediately after the specimen is taken, consisting of dipping the specimen in carbofuchsin, which is prepared by dissolving one gram of fuchsin and 10 C. C. or absolute alcohol and then adding 5 grams of carbolic acid crystals. 10 this mixture add 100 C. C. of distilled water. Leave for 24 hours and filter. The carbofuchsin is immediately washed off and the specimen differentiated in a solution of Loeffler's Methylene Blue. To 30 C. C. of alcoholic solution of Methylene Blue add 100 C. C. of one in one thousand of Aqueous solution of Caustic Potash. The specimen is stained in this solution for one-half minute, washed, dried and examined, preferably with a high power. Another method is that of Giemsa. (27) The specimen must be fixt in either bichlorid or Schaudin's solution. It is then stained for one hour in a freshly prepared solution of 10 drops of Giemsa solution and 10 drops of one per cent of Aqueosus solution of sodium carbonate in 100 C. C. of distilled water. The Giemsa solution is staple and can either be bought or prepared in the laboratory. It is prepared by dissolving 3 grams of Azur II Eosin and .8 of a gram of Azur II in 350 C. C. of 60% methol alcohol. To this solution 250 C. C. of glycerine is added and the whole allowed to stand for 24 hours and then filtered.

For reference books we would recommend the following:

Practical Bacteriology, Microbiol-
ogy and Serum Therapy-A.
Besson. Publishers Longmans,
Green and Co., New York. Trans-
lated by Hutchins
Pathogenic Micro organisms-Mac-
Neal, Publishers P. Blakiston's
Son and Co., Philadelphia, Pa.... 2.25

$11.00

[blocks in formation]

studies, to secure a microscope, which need not be an expensive one, but equipped with a highpower dry objective and each a high and a low power eye piece, and some good reference books, and proceed to make observations and records, both for the great advantage of understanding and interpreting the conditions of their own patients as they present themselves and that they may contribute their collected findings to the sum total of data. It is only by collective and earnest study that the contradictions and evidence previously herein recited can be resolved into simple statements of facts, for truths do not conflict or contradict, tho partial truths and misread conditions do.

BIBLIOGRAPHY.

1. The term endameba is used in preference to ameba, as pointed out by Williams' "Pathogenic Micro-organisms." p. 155. The endameba is parasitic for man and the ameba a free living saprophyte. Endameba is preferred to entameba, as pointed out in a note by Bass & Johns, as suggested by Smith in J. A. M. A., Vol. 64, No. 7, p. 19.

2. Prowazek-reference-Arbeit aus dem kaiserlich Gesundheitz amte. 1904 Vol. XXI, p. 42.

3. Sternberg-reference-Leitschr F. Gegewartige medizin 1862, Nos. 21-24.

4. Grasse-reference-Die protozoi parassiti e specialmente diquelti che sono nell uonro-Gazzetia medica italiana 1879.

5. Gros-reference-Cit leg neveer Lemaire 147. 6. Flexner-reference-Baltimore.

7. Chiavaro-Dental Review-Vol. 28, No. 12, p. 1122.

8. Die Protozoa als Frank Kranklieitserreger Jena 1901, p. 30.

461.

9. See Jordan, "General Bacteriology." p. 10. Barret-Dental Cosmos 54-No. 8, p. 949.

11.

Skilled Bacteriologists Affirmative. See 14. 12. McFarland-Pathogenic Bacteria and Protozoa-p. 372.

13. Amesse J. A. M. A., Vol. 63, No. 21, p. 1811.

14.

15.

Barret-Dental Cosmos 54, No. 8, p. 949.
Bass & Johns-N. O. M. & S. J., Vol. 67-
No. 8, p. 13.

Smith, Middleton & Barrett, J. A. M. A.,
Vol. 63, No. 20, p. 1746.

Johns J. A. M. A., Vol. 64-No. 7, p. 553.
Evans & Middleton-J. A. M. A., Vol. 64,
No. 5, p. 422.

Bass & Johns-N. O. M. & S. J., Vol. 67,
No. 5, p. 456.

Hartzell-This Journal. Howe, D. Cosmos, Vol. 57, No. 3, p. 307, J. A. D. S., Vol. 19, No. 14, p. 584.

[blocks in formation]

The Research Department is now receiving, regularly, tungsten and molybdenum of splendid quality and can furnish, immediately, or on short notice, these materials in almost any quantities for thoro testing and practical uses. Special diamond dies have been constructed for drawing the metal in the larger sizes in splendid quality. Application forms for the materials can be secured from the chairman.

As we are furnishing these materials at cost, we will ask you to kindly include insurance postage and registration or fee, as well as the amount for the metal.

RESEARCH FUND REPORT.

We, herewith, publish in detail the amounts of cash and subscriptions received to date from the various states and their chief cities. This report includes only the cash and pledges that have reached the Chairman by April 15, 1915. Several states have reported more than is shown in these figures but the signed subscriptions, or their equivalent, have not yet been received. In many communities only one payment is due, while in others two and three, which, in a large part, accounts for the difference in the ratio of payments to pledges. Several states are planning to take the work up at their spring and summer meeting.

The total cash and subscriptions to date, April 15, 1915, for which the pledges are in hand, are.......

The total cash received to date..

[blocks in formation]

..$48,692.43

Colorado Springs. Denver

[blocks in formation]

12,312.50

Balance of State.

[blocks in formation]
[blocks in formation]

This money is being used for paying technicians, for laboratory expenses, etc. No money is paid to the various directors of researches. The seemingly imperative research work that we must push next year is so urgent that our budget must, if possible, be double what it is this year. This will be possible if some of the states that have not acted as yet do so promptly. Those who have made subscriptions will see the necessity of making their payments promptly as they come due.

The following is a detailed statement: A financial statement of the Scientific

[blocks in formation]
« PreviousContinue »