THE PROVISION OF DENTAL CLINICS.

THH PROVISION OF DENTAL CLINICS.

tube for insertion is a soft rubber urinary catheter (20-24 French scale) with a conical top beyond the aperture, and this can be connected to the ordinary The lubricant should be water-soluble enema top. and is best made of gum tragacanth or Iceland moss. Glycerine should never be used if there is any reason to suspect a raw surface. Olive oil makes subsequent cleaning for operation more difficult. The lateral position is the most convenient posture, he says, for administering the enema, as the parts can be seen and the weight of the abdominal viscera is away from the bowel, so that there is no obstruction to the entrance of the fluid. Opaque enemas have shown that one pint of fluid will pass to the caecum in one minute, and it is unnecessary and generally impossible to pass a rectal tube into the sigmoid without using a sigmoidoscope. When fseces are hard or impacted one part of hydrogen peroxide to two of warm water may be used to disintegrate them, and for the expulsion of flatus a 6 per cent. solution of powdered alum is more effective than turpentine. Dr. Hirschman ends his series of comments by pointing out that there is no

reason

may

to include starch

though glucose, as is usefully be given.

enema,

or

now

milk in the nutrient

generally recognised,

____

THE PROVISION OF DENTAL CLINICS. THE fifteenth annual report of the British Dental Hospital shows that this beneficent institution is now responsible for equipping and maintaining four treatment centres, 12 maternity, child welfare, and tuberculosis dental clinics, and one minor ailment centre. Its object has always been to work in conjunction with borough councils, the hospital providing facilities and skilled treatment while the municipalities provide a sum towards upkeep. In many respects this is an ideal arrangement, and it is not surprising that

an increasing number of advantage of it. The scheme

e

877

care of the teeth is often an essential, regards the removal of septic foci and the provision of artificial teeth for purposes of mastication. In antenatal clinics the need is equally urgent. It has been suggested that dental sepsis may be a factor in the occurrence of puerperal sepsis, whilst H. Waller has shown that maternal sepsis affects the suckling infant. The occurrence of widespread dental disease in young children makes the provision of dental clinics for the pre-school period another urgent necessity. It is refreshing to read this account of an institution which has accomplished so much useful work without any generous assistance from the public.

for instance, both

as

RESEARCH

ON

HEREDITY.

THE hygienic era in which privies and albuminoid ammonia dominated the field has been replaced by one where bacteriologists have had as much influence as they deserve. The next phase of preventive medicine will presumably be mainly concerned with the heritable constitution of individuals, and we shall really get to grips with the question of nature or nurture. It is a welcome sign of the times that Dr. F. A. E. Crew, director of the Animal Breeding Research Department of the University of Edinburgh, has been appointed to give the Milroy lectures next year. and the annual report of the establishment over which he presides with such productive success contains a number of items of interest to human pathologists, as well as material more immediately germane to the objects of the institution, which was founded primarily to make a genetic analysis of farm animals with a view to their improvement. The tassels on the necks of some goats. for example, which are the best available remnant of a cervical ear and have each a little dermoid cyst at their base, are a heritable character and, with qualifications, their presence is dominant to their absence. A study of the pterylosis of the " hackleless " fowls with naked necks shows that the condition is not due to individual disease, but to an inherited defect in the development of the feather follicles in certain skin areas. Male mice treated with alcohol generate proportionately many more male offspring than normal animals, an observation which we hope will not be translated into human legislation without further consideration. An achondroplasia-like disease has been identified in sheep, analogous perhaps to the " bull-dog " calves of Dexter-Kerry cattle. Without going into details of the many other investigations summarised in the report, we may congratulate the International Education Board on finding such a suitable recipient for the 630,000 which they have given to promote the work of the institution.

councils are taking makes for efficiency z, because it does away with all possibility of unwise I interference by the laity in professional matters, and ’, ensures that the staff of dental surgeons are chosen ’, for reasons of professional skill, being elected by members of their own profession who manage the hospital. This eliminates the chance of wire-pulling sometimes associated with appointments in the hands of local political bodies. There is much concern in the dental profession at the present time over the demand of the approved societies that dental clinics shall be established to treat insured persons, for there is some reason to fear that these clinics, being largely controlled by the societies or their nominees, may put economy (at the expense of the dentist) before the real interest of the patients. The British Dental Hospital points out the way in which clinics could be established which would give the best possible treatment to insured A DISCUSSION ON RICKETS. patients and yet allow perfect freedom for the staff in purely professional matters. Although established THE Section of Psediatrics of the Massachusetts to provide treatment for those unable to afford Medical Society recently devoted a session to various ordinary fees, it is not a purely charitable institution aspects of rickets, and a number of well-known like the voluntary hospitals ; fees are charged, authorities expressed their views.1 Dr. J. L. Gamble though they are modest, and on the whole the insti- reviewed the results of experimental work performed tution is self-supporting. Besides offering dental on the blood. As the most likely explanation of the treatment it has always aimed at educating the mode of ossification of normal bone, he accepts the public in oral hygiene and at assisting public bodies hypothesis of J. Howland and B. Kramer that in the provision of dental facilities, and useful work precipitation of calcium phosphate in bone is due to in both directions is being carried out. the concentration of carbonic acid being lower in the It is probable that few medical men are aware of osteoid tissue than in the plasma. There is no reason, the extent of the various dental clinics in existence in however, to suppose that this reduction of carbonic this country. The school clinics controlled by the acid concentration fails to occur in rickets and the London County Council and other public bodies are defective ossification is more probably attributable familiar to all, though the immense scope of their to the demonstrable deficiency of di-calcium phosphate work is imperfectly known. But in addition to these in the plasma. The Ca x P product may be taken there are dental clinics for tuberculous patients as a theoretical measure of the severity of rickets and in connexion with maternity and child welfare and the effect of treatment, but in ordinary cases centres, and in the aggregate the amount of treatment no change is found in the calcium value, and for carried out by means of public funds is very consider- practical purposes it is only necessary to estimate the able, though still pitifully inadequate to the needs phosphorus. A reduction (if the calcium in the of the community. It is certain that the future will plasma occurs in tetany, but it is incidental and see a wide extension of public dental service in B oston Med. and Surg. Jour., Sept. 8th. many directions. In the treatment of tuberculosis,