- Email: [email protected]
Strictures on the Destruction of the Nerves in the Treatment of Carious Teeth.
636 From the deportment of alcohol towards the acid phosphate of lime, I am led to infer, that a fluid so universally partaken of may be considered as one cause of its presence in an insoluble form in the pilous structure. Experiment indicates, that when alcohol is added to the acid or soluble phosphate of lime, an insoluble phosphate or bone-earth becomes precipitated, owing to the predominating affinity of the spirit for the phosphoric acid. How much soever this point may have been overlooked by writers on the pathology of earthy deposits generally, I shall not allow this opinion to pass, for the future, altogether disregarded ; it deserves, I feel persuaded, a minute Investigation. The formation of the acid phosphate of lime, by the chemical relation of the elements of nutrition, is evidently intended to secure important results to the well-being of the organism. The principal amount of the calcareous matter which enters the system is in a phosphatic form. In the flesh, blood, and other parts of animals, there exists no free alkali. Lime is invariably combined with phosphoric acid; but during the vital process other acids are generated, which possess an equal or a near affinity for this substance, and thus give rise to the liberation of phosphoric acid-i. e., to the formation of a certain amount of the acid-phosphate of lime. If all the insoluble compounds of this-substance which enter the organism could be disposed of in this way, it is evident that its abnormal accumulation or presence in any Structure would be of rare occurrence. The opinion advanced in a former paper relatively to this subject would appear to be greatly strengthened by the data organic chemistry furnishes us; for without doubt it is the abnormal presence of the insoluble phosphate of lime which stands principally associated with this condition of the hair, irrespectively of the numerous causes which may primarily influence its establishment. Reverting to the sources of lime in the system, we find that the ashes of all seeds, and of flesh and blood, contain a certain amount of soluble and insoluble phosphate of lime; whilst the ashes of vegetables contain no free alkali, but only the insoluble phosphate of lime. Now, these vegetable ashes contain a greater amount of lime than what is required for the neutralization of the phosphoric acid present. Hence, on incinerating a plant, together with its seeds, and lixiviating , the presence of the insoluble the ashes, we perceive phosphate of lime, although the lixivium of the ashes of the seeds, when incinerated and lixiviated by themselves, yield a considerable amount of the soluble phosphate of lime. From this it is obvious, that the excess of lime contained in the leaves and straw here enter into combination with the phosphoric acid of the soluble alkaline phosphate, forming an in-
which
only
soluble compound. It is this form of the substance, however induced in the system,-whether by the imbibition of alcoholic drinks, by diet, or by disease, &c.,—that we conceive constitutes the proximate cause of that condition of the hair to which we directed attention. ,Braunston, Northamptonshire, June, 1848.
have
which the pulp is affected, but the subsequent stage—in volving, as it does, the periosteum—is infinitely more perni. cious to the health and well-being of the rest of the mouth. A single quotation from Sir Benjamin Brodie must set this at rest. "The inflammation, on which the toothach depends," says that gentleman, in one of his clinical lectures, terminates, as it always does, in the death of the pulp of the tooth. Then the whole tooth dies, and is now like a portion of dead bone, or any foreign substance, stuck in the jaw." (Medical Gazette, vol. xv. p. 347.) Operations, therefore, for the artificial destruction of the pulp of a carious tooth, have no higher object in view than the hurrying of the disease through its most pain. "
ful stage, in order the sooner to induce the more advanced and far more injurious one. They are, in fact, operations for the more speedy production of stumps; their sole aim is, to remove pain at the expense of a greater evil. As such, it is evident that they have nothing in common with the operations of general surgery, which have for their object ultimate benefit, though purchased by immediate pain; and it is but natural to suppose that they owe their origin to the urgency of the patient rather than the suggestions of science. " When a tooth is so far gone as to be incapable of restoration without destroying the pulp, the sooner it is extracted the better, for the mouth is sure to suffer ultimately in proportion to the number of dead teeth allowed to remain."
On the Application
of Transfusion and Galvano-acupuncturation in cases of Asphyxia. By ROBERT BRANDON, Esq., M.R.C.S., &c. Mr. BRANDON remarks,"
The presence of non-arterialized blood in the bloodvessels the cause of thte cessation of the vital functions asphyxia. Warm baths, friction, brandy, artificial respiration, the inhalation of pure oxygen, have been used with various degrees of success to remedy this condition. Sometimes galvanism has been employed, so as to excite muscular contractions; the two poles of a galvanic battery being applied by means of conducting wires, placed on the sides of the body. Occasionally success has crowned these efforts made to restore vitality; but we must not be astonished to find that we fail in the treatment of asphyxia, when we recollect how very indirect are the means used to oxygenize the blood. I conceive that the direct application of arterial blood to the system, in cases of asphyxia,’by transfusion,’ would be a sure means of recalling the play of the vital organs; and that galvanism should be applied, in the first place, over the region of the heart, by means of pins, con. nected with the two poles of the battery, and introduced into the skin. Should this arrangement not succeed, I should not hesitate to introduce the pins into opposite sides of the heart itself, knowing, as I do, that such an operation is neither painful nor dangerous. If you want to make any muscular organ contract, you must apply the power to the organ itself." seems to be in cases of
____
Artificial Palate.-Employment of Gutta Percha and
Analyses OF
COMMUNICATIONS IN MS. RECEIVED FOR PUBLICATION IN THE LANCET. Strictures on the Destruction of the Nerves in the Treatment
of Carious Teeth.
By J. B. MITCHELL, M.D. &c., London. AFTER remarking that, there is no department of practice in which so many pernicious errors are continually permitted togo uncorrected as that of dental surgery," Dr. Mitchell refers to a report of a case published in TuE LANCET of Nov. 24th last, inwhich the writer states-" I then extracted two. superior molars, and cut across and destroyed the nerves of the four "
incisors." ,upper "
I am perfectly aware" (says Dr. Mitchell) " that the latter of these operations is of every-day occurrence among dentists, hut it is, nevertheless, one that cannot, for a moment, be defended on scientific grounds. In the case detailed, the four .upper incisors were doubtless affected with caries. Now the natural progress of dental caries is from decay of the crown to destruction of the pulp, and gradual wasting of the fang; .the latter process being uniformly accompanied with more or less of morbid action in the periosteum of the socket. The most painful of these several stages is, beyond doubt, that in
Caoutchouc. A correspondent says," I have found the substance, gutta percha, suitable for making artificial palates, very easily moulded on a cast of the mouth into the necessary shape, and retaining its firmness and smoothness unimpaired by the temperature to which it is there subjected. Kneaded out into a smooth sheet, about the thickness of a sixpence or a shilling, and pressed into the proper form,-the edges accurately following the sinuosities of the teeth, and a hooked process or two of the same material adjusted in the usual way,-it will be found to answer very well, being smooth, light, and firm. If required, a slight rint of gold, fitted to a. few of the teeth, may be fixed to the edge of the gutta percha. If care be used to mould the material equably and smouthly, it will be more agreeable in the mouth than a metallic body. When the Schneiderian membrane is too tender to permit the use of the sponge and plate,—a period with some patients of long duration,-this simple, cheap, and effective instrument will be found valuable. It may supersede the use of the soft crumb of bread, soaked dossils of soft lint, &c., which are used as temporary expedients to close the orifice in cases where bones are coming or have recently come away. But even when the membrane has become firm, a palate of this material-with or without a piece of prepared caoutchouc adherent to the upper part of the gutta. percha, so as to press into the exact shape of tie orifice, and form a sort of air-tight valve-will be as agree.
which
only
soluble compound. It is this form of the substance, however induced in the system,-whether by the imbibition of alcoholic drinks, by diet, or by disease, &c.,—that we conceive constitutes the proximate cause of that condition of the hair to which we directed attention. ,Braunston, Northamptonshire, June, 1848.
have
which the pulp is affected, but the subsequent stage—in volving, as it does, the periosteum—is infinitely more perni. cious to the health and well-being of the rest of the mouth. A single quotation from Sir Benjamin Brodie must set this at rest. "The inflammation, on which the toothach depends," says that gentleman, in one of his clinical lectures, terminates, as it always does, in the death of the pulp of the tooth. Then the whole tooth dies, and is now like a portion of dead bone, or any foreign substance, stuck in the jaw." (Medical Gazette, vol. xv. p. 347.) Operations, therefore, for the artificial destruction of the pulp of a carious tooth, have no higher object in view than the hurrying of the disease through its most pain. "
ful stage, in order the sooner to induce the more advanced and far more injurious one. They are, in fact, operations for the more speedy production of stumps; their sole aim is, to remove pain at the expense of a greater evil. As such, it is evident that they have nothing in common with the operations of general surgery, which have for their object ultimate benefit, though purchased by immediate pain; and it is but natural to suppose that they owe their origin to the urgency of the patient rather than the suggestions of science. " When a tooth is so far gone as to be incapable of restoration without destroying the pulp, the sooner it is extracted the better, for the mouth is sure to suffer ultimately in proportion to the number of dead teeth allowed to remain."
On the Application
of Transfusion and Galvano-acupuncturation in cases of Asphyxia. By ROBERT BRANDON, Esq., M.R.C.S., &c. Mr. BRANDON remarks,"
The presence of non-arterialized blood in the bloodvessels the cause of thte cessation of the vital functions asphyxia. Warm baths, friction, brandy, artificial respiration, the inhalation of pure oxygen, have been used with various degrees of success to remedy this condition. Sometimes galvanism has been employed, so as to excite muscular contractions; the two poles of a galvanic battery being applied by means of conducting wires, placed on the sides of the body. Occasionally success has crowned these efforts made to restore vitality; but we must not be astonished to find that we fail in the treatment of asphyxia, when we recollect how very indirect are the means used to oxygenize the blood. I conceive that the direct application of arterial blood to the system, in cases of asphyxia,’by transfusion,’ would be a sure means of recalling the play of the vital organs; and that galvanism should be applied, in the first place, over the region of the heart, by means of pins, con. nected with the two poles of the battery, and introduced into the skin. Should this arrangement not succeed, I should not hesitate to introduce the pins into opposite sides of the heart itself, knowing, as I do, that such an operation is neither painful nor dangerous. If you want to make any muscular organ contract, you must apply the power to the organ itself." seems to be in cases of
____
Artificial Palate.-Employment of Gutta Percha and
Analyses OF
COMMUNICATIONS IN MS. RECEIVED FOR PUBLICATION IN THE LANCET. Strictures on the Destruction of the Nerves in the Treatment
of Carious Teeth.
By J. B. MITCHELL, M.D. &c., London. AFTER remarking that, there is no department of practice in which so many pernicious errors are continually permitted togo uncorrected as that of dental surgery," Dr. Mitchell refers to a report of a case published in TuE LANCET of Nov. 24th last, inwhich the writer states-" I then extracted two. superior molars, and cut across and destroyed the nerves of the four "
incisors." ,upper "
I am perfectly aware" (says Dr. Mitchell) " that the latter of these operations is of every-day occurrence among dentists, hut it is, nevertheless, one that cannot, for a moment, be defended on scientific grounds. In the case detailed, the four .upper incisors were doubtless affected with caries. Now the natural progress of dental caries is from decay of the crown to destruction of the pulp, and gradual wasting of the fang; .the latter process being uniformly accompanied with more or less of morbid action in the periosteum of the socket. The most painful of these several stages is, beyond doubt, that in
Caoutchouc. A correspondent says," I have found the substance, gutta percha, suitable for making artificial palates, very easily moulded on a cast of the mouth into the necessary shape, and retaining its firmness and smoothness unimpaired by the temperature to which it is there subjected. Kneaded out into a smooth sheet, about the thickness of a sixpence or a shilling, and pressed into the proper form,-the edges accurately following the sinuosities of the teeth, and a hooked process or two of the same material adjusted in the usual way,-it will be found to answer very well, being smooth, light, and firm. If required, a slight rint of gold, fitted to a. few of the teeth, may be fixed to the edge of the gutta percha. If care be used to mould the material equably and smouthly, it will be more agreeable in the mouth than a metallic body. When the Schneiderian membrane is too tender to permit the use of the sponge and plate,—a period with some patients of long duration,-this simple, cheap, and effective instrument will be found valuable. It may supersede the use of the soft crumb of bread, soaked dossils of soft lint, &c., which are used as temporary expedients to close the orifice in cases where bones are coming or have recently come away. But even when the membrane has become firm, a palate of this material-with or without a piece of prepared caoutchouc adherent to the upper part of the gutta. percha, so as to press into the exact shape of tie orifice, and form a sort of air-tight valve-will be as agree.