THE TREATMENT OF PULPLESS TEETH.

737 care of the The technique of the method is easily carried out For example, in and was first described by Potzl of Prague. Ten the case of the Port of Manchester, the fact that in to 15 c.cm. of venous blood are withdrawn from a the neighbourhood-but by no means adjacent to patient suffering from malaria fever and allowed to the docks-there are at Salford Royal and at St. run into a sterile glass flask of 30 c.cm. capacity, Luke’s Hospitals V.D. treatment centres, is of little containing 10 to 15 small glass sterile beads. The These places are neither open flask is closed with a sterile cork and the whole gently or no use to the sailor. all day nor every day. Most other ports are similarly shaken for ten minutes, at the end of which time the blood becomes defibrinated and partially situated-the sailor is not catered for. When I referred to my ideal treatment centre being heemolysed. The serum is then gently poured into " exclusively for the use of sailors " I was thinking a sterile test-tube, corked, and placed either in an of it being actually within the dock boundaries. ice-chest or a thermos flask containing ice at 0°C. It would have expressed my idea better to have used The latter apparatus is convenient where it is required " the term " especially " rather than exclusively," to send a sample of blood by train to some distant as I wished to indicate that the centre would not be town or hospital. Blood has been sent in this way for the use of the general population but for those to London, Liverpool, Birmingham, and Cheadle whose work involved their presence inside the (Cheshire). or who lived in the immediate vicinity. My experience of this method of inoculation dates Preventive treatment-in every sense ’. of the term- from Nov. lst, 1924, since when a series of 12 cases is, I consider, essential in dealing with venereal have been treated. The amount of blood injected diseases. The whole question is a public health one, varied from 2 to 6 c.cm. and was given to the patient and must be tackled along public health lines. I am by the subcutaneous or intramuscular route. Up to aware of all that has been urged against this view, the time of writing I have been able faithfully to but that controversial aspect need not be discussed reproduce the fever in ten cases with specimens of here. One would only point out to Dr. Hanschell blood kept at 0° C. outside the body for a period up that at the present time-as for centuries past- to 66 hours. Again, I have been able to stain blood aged men are signed on who have risked infection, they tertian parasites in iced defibrinated 7 days.-I am, Sir, yours faithfully, are neither " cleansed nor injected," they proceed to sea, and a high proportion of them develop V.D. J. D. SILVERSTON, M.B., B.S. Durh., Senior Assistant M.O., County Mental Hospital, Owners, masters, crews, passengers, medical officers, Whittingham, Preston. March 28th, 1925. all know it, and that the chance of such men developing disease is a very high one. Whether or not preventive treatment would increase the number of THE TREATMENT OF PULPLESS TEETH. exposures is beside the point; it would assuredly reduce the number of infections. The fact that a To the Editor of THE LANCET. man " agrees or confesses to a chance of developing SIR,-This letter is occasioned by the leading V.D."-i.e., admits exposure to infection and is treated article in THE LANCET of Feb. 7th on this subject. on that-practically ensures that chance vanishing. There are two minor points to which I take partial Preventive treatment efficiently applied and the correct time does prevent the development of exception. These relate to (1) the interpretation of the results of the bacteriological examination, and syphilis and gonorrhoea. The certificate of prophylaxis which I mentioned (2) the economic feasibility of such an examination. my last letter need not, of course, be attached to the In the first place, you write : " The ideal treatment man’s papers. He might retain it himself. The former should logically include cultures from the root canal method was suggested to lessen the chances of the ! to ascertain when they were free from infection..." certificate getting lost, and the man suffering any This statement implies that it is possible to ascertain unjust penalty on the grounds that he had neglected when root canal (periapical) infection has been to avail himself of preventive treatment. Again eliminated. On the contrary, infection may be one would express the hope that port authorities who present in spite of a negative culture, which consehave neglected to do so, will, in the immediate quently does not ipso facto give the dentist warrant future, make arrangements for the prevention and to proceed to the definitive occlusion of the canals. treatment of V.D. in the areas administered by them. A positive culture, however, means emphatically that the canals are not yet ready for filling. In this I am, Sir, yours faithfully, lies the chief usefulness of bacteriological examinaE. T. BURKE. March 1925. 28th, Manchester, tions in root canal work. Further on the economic aspect of these examinaMALARIAL TREATMENT OF GENERAL tions is brought up. " As a practical addition to PARALYSIS OF THE INSANE. private practice it is scarcely feasible, for it would add so much to the cost and length of treatment ICE METHOD OF INOCULATION. as to make it prohibitive except to a favoured few." To the Editor of THE LANCET. This I do not believe is necessarily true, as will SIR,—The ideal and most practicable method of appear in what follows. For a number of years infecting general paralytics with tertian malaria bacteriological, as well as roentgenographic, control fever consists in the subcutaneous injection of 12 of root canal technique has been routinely pursued to 3 c.cm. of malaria-infested blood withdrawn from in the clinics of the Dental School of the University the vein of a patient suffering from the disease. of Pennsylvania. Our practice is first to have a smear The procedure is likely to be attended with success made on a glass slide from a dressing which has been where the inoculation is carried out immediately sealed in the tooth. This is not done until the clinical and when the donor and recipient can be brought experience of the operator indicates that the root canals are ready for filling. This smear is stained together. The impracticability of employing infected mosqui- and examined with an oil-immersion lens. If bacteria toes owing to relapses in conveying infection to cases or extremely large numbers of polymorphonuclears of G.P.I. and the difficulties encountered in the are found the conclusion is drawn that infection cultivation of Plasmodium via-ax outside the body persists. Treatment may be continued or recourse beyond a definite length of time, have prevented may be had to apical curettage, root amputation, or many hospitals distant from a malaria-donor from extraction. If bacteria are not found and if polyadopting this method of treatment, and it ismy morphonuclears are few or absent, then a culture is purpose in this note to acquaint your readers of a taken. If this be negative 48 hours later, and if no method that has been devised and tried which will clinical contra-indications appear in the meantime, enable a patient residing in any part of the British the canals are definitively filled. Isles to acquire the disease irrespective of the When I last went over the records 937 cultures distance between donor and recipient. had been made. Before each there had been a direct

adjacent,

is making

no

attempt

at the

seafarer who is the victim of V.D.

docks

.

within

in

738

the

microscopic examination of a smear made from canal dressing, which microscopic examination had failed to reveal bacteria. This negative result was confirmed by 467 of the cultures, and contradicted by 470 of the cultures. In other words, of two negative ROBERTSON, M.A., M.B., microscopic examinations, one will be confirmed and JOSEPH McGREGOR C.A1. GLASG., F.R.F.P.S. GLASG. the other contradicted culturally. These results also emphasise another point which THE medical profession of Glasgow mourns the is in consonance with the spirit of your article. Over loss of one of its ablest members through the death one-half of the root canals, clinically deemed ready of Dr. McGregor Robertson, of 26, Buckinghamfor filling, showed persistence of infection. This terrace, which occurred suddenly on March 17tb, result by stressing the unreliability of clinical criteria after he had addressed a meeting. He had been

Obituary.

alone

stresses the value of

bacteriological checks. suffering recently

from

severe

recurrent attacks of

Assuming for the sake of argument that a cultural influenza, which had weakened his physique, but he examination is not generally feasible on economic refused to take the much-needed rest and carried considerations, this objection cannot hold for the on his work without pause until the end. direct microscopic examination of a stained smear. Dr. McGregor Robertson was born in 1858 and The time required for this is at a maximum five educated at Glasgow University, where he graduated minutes. It is done while the patient is in the chair, M.A. in 1876, and M.B., C.M., with honours, in 1880. and in case of a positive result one can at once return He was admitted to the Fellowship of the Royal Faculty to the treatment. Not only is the time, but what of and Surgeons, Glasgow, in 1892. After Physicians is at least quite as important, the continuity of the graduating, he studied physiology under Du Bois treatment is saved. Reymond, Kronecker, and Christiani in Berlin. As Wherever cultural examination is for any reason a student he was one of the most distinguished men not made, this direct microscopic examination alone of his year, and was admittedly the best speaker in may be used, and it has proved to be an appreciable debate. Then, as always, his clearly defined ideas improvement over current visual and olfactory tests. were emphasised with point and vigour. The wellMany times a dressing, which grossly appears inoffen- known professors in Germany with whom he was sive, will show microscopically the incontestable associated thought him both an able and original presence of bacteria. This direct microscopic control investigator, and united in paying tribute to his in root canal work reaches its maximum of usefulness and unceasing industry. On his return when dichloramin-T or some other lymphogogue capabilities to Glasgow he was appointed Muirhead Demonis used in the treatment. strator of Physiology in the University and, as was customary in those days, he entered private JOSEPH L. T. APPLETON, Jun. practice as a physician. A distinguished academic The Thomas W. Evans Museum and Dental Institute, life seemed assured, but his success as a physician School of Dentistry, University of Pennsylvania, was so rapid that the claims of his private practice March 14th, 1925. prevented him from following the career for which by temperament, talents, and training he was so preTHE

HOSPITAL POLICY OF THE BRITISH MEDICAL ASSOCIATION. To the Editor of THE LANCET.

SIR,-A meeting of the consultant physicians and attending the voluntary hospitals of Birmingham was held on March 20th. The meeting was called for the purpose of nominating members surgeons

for the Local Hospital Committee of the British Medical Association, and for the purpose of discussing the hospital policy of the B.M.A. At this meeting the following resolution was carried unanimously :That, taking into consideration the importance ofmedical

education and the fact that the large teaching hospitals are specially organised and staffed for such work, this meeting is of the opinion that in the scheme of hospital policy of the British Medical Association these hospitals should be put in a class by themselves. I am, Sir, yours faithfully, JAS. M. SMELLIE. Birmingham, March 26th, 1925.

fitted. He diseases and became

interested in eye of the surgeons at the Ophthalmic Institute. Recognising the value of radiology, he was amongst the first to instal an X ray apparatus in his private laboratory, and there, despite the increasing calls on his scanty leisure, he pursued throughout his life extensive research work. As an acute clinical observer, and as an accurate diagnostician, he could command the confidence of his patients. Though in chronic illhealth, he pursued ideals of medical practice which will remain an inspiration to all who had the privilege of knowing his work. During the war he was appointed hon. consulting physician of the Royal Naval Hospital, Bute, and to the Princess Louise Scottish Hospital, and latterly accepted a position as physician in the Stobhill Hospital. In 1921 the Royal Faculty of Physicians and Surgeons of Glasgow selected him to represent them on the board of managers of the

eminently

was one

specially

WesternMcUregor Infirmary. JEtobertson ,

Dr.

-

_

-

..

,

_

was an able lecturer with were well shown his numerous

which by contributions to medical literature. He published in 1884 a treatise on " Physiological Physics," and in To the Editor of THE LANCET. 1887 an " Elementary Text-book of Human PhysioSIR,—It has recently been prominently stated in Jogy," and various papers dealing with such subjects as the lay press that the capture and clinical use the Clinical Examination of the Blood, the Employment of radon (radium emanation) by the Middlesex of Bad Nauheim Waters in Disease, Congenital Pyloric Hospital is a "new discovery." In justice to the Stenosis and the Quality of Freshness in Food and Radium Institute, will you allow me to say that the amount of Light, as related to health and growth. His technique of treatment by radon tubes has been interests, apart from medical practice, were practised here since 1912, and that the method wide and varied, and he took a leading part in adopted was published in the annual report of this Glasgow in all questions of medical politics and Institute for that year. Since that date radon tubes public health. have been supplied in steadily increasing number to He is survived by his wife, four daughters, and one medical practitioners and hospitals throughout the son, to whom sympathy will be widely extended. country, and in the year ending Dec. 31st, 1924, 1067 such tubes were distributed. T am Sir LABORATORY FOR CHILD STUDY.-The McGill A. E. HAYWARD PINCH, F.R.C.S., University, Toronto, has given £10,000 from the Laura Medical Superintendent, The Radium Institute. Spellman Rockefeller Memorial Fund to provide a child 16, Riding House-street, Portland-place, London, W., study laboratory in connexion with the Faculty of March 30th, 1925. Medicine.

literary gifts

THE USE OF RADIUM EMANATION. .