However, we may have in such cases a complete destruction of the membrane beneath the end of the root to a point diagonally downward from its point of contact with the root. This relative position of attachment to root and process is due principally to the operation of physical laws. In either event, i.e., whether the periosteum maintains its attachment to the process beneath the end of the root, or, on the other hand, is melted away, you will certainly bear me out in the statement that to secure a perfectly successful re-establishment of, first, contact of periosteum with the part from which it is broken, it is necessary in one instance that there be a gradual development of the process from beneath the periosteum, or a thickening of the latter until its apposition is normally complete with the surface of the cementum; and in the other case, i.e., where the membrane is entirely destroyed beneath the end of the root, that this development of either periosteum, or process and periosteum, take place from the points of attachment to root and process downward and inward toward the apex of the root involved.

This admitted, allow me to call your attention to the fact that still another difficulty, of much graver aspect, must be overcome before the nutrient current between the cementum on the end of the root and the periosteal source of supply can again be normal to the part. I refer to the difficulty of a formerly organized-though now disorganized-tissue again accepting a physiological union with the newly-developed membrane, and by such union re-establishing organization out of non-affinitative and, indeed, we might say, entirely foreign substances.

Now, if it be true that in these most favorable cases there exists such opposition to the return of the parts to normality, such definite and destructive character of forces to be harmonized ere success can be perfect, I ask you what must be expected in cases of alveolar abscess of long standing, in which we would labor to conserve the organ or organs at whose root or roots the lesion is most extensive? I ask you, Gentlemen of this the representative body of our calling in this country, are we not presuming too much at the hands of the so-called mysterious vis-vitæ, and reckoning too little of the chemical, the physical, or chemico-physical possibilities in the treatment of these cases?

IN

SECTION VI.-Continued.

Diatheses and Cachexia.

PAPER BY F. M. ODELL, CHAIRMAN OF THE SECTION.

N the diagnosis and treatment of the various ailments to which we are liable, it has always seemed to me, that however beautifully the practitioner may have been in the habit of lecturing or writing, he not only in his practice often falls far short of carrying out the line of therapeusis that might be expected of him, but absolutely fails to perceive anything beyond or preceding the most prominent symptoms and "physical signs." Indeed, one of our well-known writers replied to me, in speaking of diabetes, "No one has a tendency towards diabetes; you have it, or you don't have it, and that's all about it! You cannot have a tendency that way."

With all due deference to that gentleman, in consideration of his superior age and greater practical experience, I must hold to my preconceived opinion that not only can one have a tendency that way, but that the time is not far distant when medicine must follow in the footsteps of her younger sister, dentistry, and devote the energies of her ablest sons, not as now, principally to the observation and treatment of symptoms, (thus permitting these sons aforesaid to supinely fold their hands while the fell powers of disintegration and darkness carry us rapidly down to an untimely grave), but to the unraveling of that chain of personal or family history underlying and far anterior to these present and conspicuous manifestations; and by personal or family history I do not wish to be understood as intimating that the practitioner should busy himself with the past history of the patient or his progenitors, as individuals, as to whether they lived here or there, well or ill, married or divorced much or little, or with any matters having within themselves more of the elements of gossip and scandal than of scientific research after truth to aid him in a proper estimation of the case under observation, but simply that he should make a proper use of those God-given faculties, which, incited by his course of preparatory studies, strengthened by his practical or clinical training and experience, and directed

by a painstaking desire to use whatever he may possess of judgment in the interests of his patient, shall enable him to not only note evident symptoms and physical signs, so called, but commencing with them as the initial step, to work his way back in those processes of molecular metamorphosis whereby he can deduce not only the inciting causes of the pathological condition before him, but the remote cause or causes which made this pathological condition a possibility. In other words, that medicine must adopt much more of prophylaxis, based upon scientific inquiry, before her disciples can afford to sneer at our efforts in a more circumscribed sphere of usefulness.

Some few of our medical practitioners loom up above the vast majority, and not only pursue successfully an exacting calling, but find time to reason and write upon the subjects of their daily observation and thought; but the vast majority figuratively exclaim with a fellow-student of mine when, the clinical professor having led us up to a diagnosis, and he (the student) having named the malady brought before us for treatment, "At last I am a physician! Now I can practice!" And having reached this sublime altitude, they immediately consider that having learned the trade, they can now sleep upon the field of battle; in the future it is only necessary to follow the regular formulæ, and success is assured;-and to many, unfortunately, so it is; for if the medical pretender be a person of good address, or belongs to the proper congregation, or has the requisite amount of unblushing effrontery, he can generally find more who are willing to be dosed by him for prominent symptoms than his more diligent but less dashing co-laborer can, of those who are willing to be treated upon rational principles.

And this brings me to the underlying thought of my present inspiration, viz: the subjects of diatheses and cachexia. To go into an exhaustive dissertation upon these points would only be to wear out what little patience you have left, and, perhaps, to open an endless and partially profitless discussion; because, among medical writers and speakers, I find the most diverse opinions and assertions in regard to what should be classed as diatheses, and what cachexia; but in general terms I would simply designate diathesis as that weakness or tendency towards disease which is entailed by the law of heredity, and cachexia, as that tendency in the same direction, arising by reason of the circumstances of environment, habit, or experience of the individual.

Authorities (?) differ as to the number and nomination of either; and the innumerable instances of diatheses being crossed in the same

individual, render their pronouncement somewhat difficult at times; but the certainty remains, that the practitioner who has so well studied the physiognomy of disease as to clearly perceive the particular diatheses which he has to deal with, has enabled himself to stand upon the same, or even a higher plane of usefulness than does the old family attendant who has been present at the advent of the patient into this world of trials and tribulation, and has had him under supervision ever since.

In order that you may not accuse me of talking medicine, and ignoring dentistry in these remarks, I will refer to a matter which is particularly within our province, and endeavor to show that we cannot practice as simple mechanics any more than can the regular medical practitioner, without at once giving up all our boasted claims to be considered men of scientific attainment.

In a recent case of recession of the gum, with soreness, dropping of the tooth from its socket, occasional slight points of ulceration, rapidly followed by loss of tissue, little evidence of pus, after cleansing perfectly from tartar, and painting at the extreme limit of contact of gum and tooth, with aromatic sulphuric acid, I found the case growing no better very fast; the neck of the tooth at one side becoming exposed much further towards the apex, and the soreness becoming so intense as to seriously threaten the loss of the organ through the impatience of the patient, I took the patient's measure somewhat more carefully, and concluded that local treatment would be more successful if supplemented by iodide of potash, or a little mercury; and I found that such was the fact when I merely used palliative treatment for the gum, and administered co. cath. pill, with cod-liver oil and tonics, varying the latter every third day in order to better conserve an exceedingly capricious appetite. Result:-in a week, great improvement in hopefulness, etc., and much better condition of gum; attachment having taken place again one-third the length of the tooth below the apex of the root; but with greater hopefulness came less docility, and for three weeks I saw nothing of the patient; then he presented himself with the gum all gone again, notwithstanding his having been very careful to keep it cleansed, syringing three or four times daily with a very weak solution of phénol sodique. A return to aromatic sulphuric for local treatment only made matters much worse, and the hot weather being against us also, I suspended further operations in that direction, and commenced again on iron and quinia in pill, and locally simply washing with weak solution of chlorate of potash. And in this connection

I will mention a dressing for ulcers which is easy of application, and very pleasing in its action. It is to simply drop a little mat of cotton upon the surface of glycerin, and then reversing the cotton, dust over the surface of the glycerin which adheres to it a little salicylic acid, or a little salicylate of soda. Both act well, and are very soothing in their effects.

Another case presenting lately, I did not treat locally at all; because, from the evident rapid retrogression in metamorphosis of tissues in that vicinity, the bony socket having entirely subsided from one tooth, pulp dead, and the triumphal arch of little pustules covering one-third of each adjoining tooth, combined with the little, blinking red eyes of the patient, and their tumefied lids, and the evident eagerness of their possessor to pay very liberally for relief, I at once relegated the tooth to the forceps, and the case to the domain of the cachexia; believing that the regular family practitioner could best meet the indications.

The first-mentioned case I divided for treatment between a diathesis and a cachexia; the former being responsible for the mercurial, the latter for the tonic.

Of late I have involuntarily become much interested in the study and observation of gout in its various manifestations; and without in the least drawing upon imagination, can see the very close relationship existing between gout, rheumatism, hay-fever, rose-cold, diabetes, Bright's disease, and a host of complications under as many different nominations, which all tend in the same general direction, but which in their effect upon the general system, may be compared to the value of stock in one of our great arteries of commerce, which is profoundly impressed, as a whole, if a fluctuation of any magnitude is felt in one of its branches.

It is all very well, nay, sometimes imperative to adapt the treatment to the mitigation of the prominent symptoms, but in order to a radical cure the diathesis must be determined, and a few blows struck in that direction fall with telling effect upon the sequelæ.

In hay-fever, for example, i. e., in true hay-fever, the inciting cause of the temporary disturbance, we may, for argument's sake, admit to be the titillation upon the end organs of the nerves of smell induced by the pollen of plants; but this particular inciting cause being removed, any new irritation of the same peripheral nerves-from the dust of a room or road to the exhalations from an onion or a piece of cheese serves to perpetuate the impression for days and weeks, until, in some instances, it becomes a chronic habit or cachexia, and