The diagnosis of syphilis, as you all know, requires at times the utmost skill, as its symptoms may counterfeit and combine the symptoms of various diseases; so that frequently we are only allowed the bare suspicion. Besides, the patient, when conscious, will often place every obstacle in the way to mislead us, willing to acknowledge any other of all the ills to which flesh is heir in preference to syphilis; and in many instances, too, patients, inheriting the disease, are themselves unconscious of their infection.

By the foregoing remarks I do not wish to convey the impression that syphilis does not occasion deformities; but to assert that these deformities are unmistakable or invariable evidences of congenital syphilis is, in my humble opinion, too absolute a statement. The experience of others, as well as my own, warrants the statement that as inherited syphilis is a disease affecting the nutritive processes, thereby interfering with the development, not of the teeth alone, but of the whole organism, it could of itself be a cause; but independent of it any other condition that would likewise arrest development-rachitis, etc., for instance, would produce very similar re

sults.

Mr. Hutchinson asserts that the only teeth to which he could venture to attach much importance are the upper central incisors of the permanent set. Now, as syphilis occasions an interference with the general development, it appears to me that, as this morbid condition antedates birth, the temporary teeth should present deformities as characteristic as those of the permanent set. Why, then, when all the other teeth, both temporary and permanent, are of similar formation and exposed to precisely the same influences during the whole period of their development, should only the upper central incisors of the permanent set present characteristic peculiarities?

I believe they result from the diseases of early infancy, which modify the nutrition of the dental germ. What is the disease? Is the disease diathetic, and does it give a peculiar shape to the malformations of the teeth? In my opinion, there is no special diathetic malady which produces a specific malformation of the permanent incisors. Any grave sickness in early infancy will produce this result. Neither syphilis, nor rachitis, nor chronic enteritis has any different influence. Hereditary syphilis and rachitis cause malformations of the teeth, not as syphilis or rachitis, but as a cachectic condition. It is as the result of a depraved nutrition, modifying the development of the dental germ, that syphilis produces the

alterations of the permanent incisors, and not as a diathetic disease. Consequently, this modification of the dental organisms is occasioned by all the cachectic maladies of infancy. Similar disturbances to those that occur in the dental germ, occur also in the nails, the hair and the bones. The nails become thin, then thicken, presenting the ridges attributed by Bean to dyspepsia, and which, with the return. of health, disappear. The bones enlarge at the margins of the epiphyses, and rarefy, tending to osteoporosis. They soften, bend easily, and can not even support the weight of the child, so that it would rather lie abed, even after it has already begun to walk. The dental germs are subject to the general law and they become altered with the rest of the economy, whatever the cause which affects the general nutrition of the patient. They suffer when all suffer.

Buchat, after a minute and careful analysis of one hundred and fourteen cases of dental malformations, states that when observed in association with hereditary syphilis, the deformity was due less to the syphilitic impression than to the influence of a cachectic condition; also, that of the one hundred and fourteen cases only eight could be attributed to syphilis.

When we consider with what delicacy and care we must conduct the examination of a case where syphilis is suspected, because rashness may not only cause ill-feeling, but may blight the life of the sufferer, we can readily appreciate what difficulties beset a physician in his endeavor to reach a correct diagnosis; so that it is only in a few cases, where parents acknowledge their syphilis and that of their children, or where the physician has had the child under his observation and followed it from its infancy, that any but the merest hypotheses can be made. To regard as syphilitic teeth the teeth of children about whose early life nothing is known, or of children who were not syphilitic but whose fathers once had syphilis, or children whose ancestors were not known but were thought to have been syphilitic, upon the supposition that their parents may have been liable to acquire syphilis, may be very excellent to satisfy some pet theory, but I fear would rather be an obstacle to the progress of science. All hypotheses should be laid aside and facts alone should be brought forth-demonstrable facts. All that is doubtful should be purged from our records or set down in their proper place and called by their proper names,-suppositions, suspicions, assertions,but not facts. Then will we all accept them with the proper reserve. I fear, with regard to syphilitic teeth, that there has been too much

speculation. The alterations of the teeth are neither more nor less, in my opinion, than the result of a cachectic state. Syphilitic, rachitic, scrofulous, intestinal, or pulmonary cachexiæ all interfere with the nutrition of the teeth, as well as of the skeleton in general; likewise, in very young children, a long and painful illness, an eruptive fever, associated with serious complications, or a chronic enteritis, will stop the development of the osseous tissue, causing softening of the bones, swelling of their extremities, rarefaction of their epiphyses, and alterations in the teeth.

Similar alterations in the osseous structures can be artificially produced upon birds by suppressing all the phosphates of lime from their food. The same result was obtained in a litter of pigs by premature alimentation and confinement in the dark.

Hereditary congenital syphilis or syphilis acquired shortly after birth can be the cause of dental deformities, but these deformities can also be occasioned by a grave illness; for instance, any chronic disease of the intestines, stomach, or lungs, that may occur in early life. It is this systemic depravity which causes this disturbance in the regularity of the movements of the bony nutrition. The specificity or the diathesis of the case is worth nothing. A disturbance of nutrition is the starting-point in all these alterations. Therefore, while the deformities claimed to be diagnostic of and peculiar to syphilis can result from syphilis, they can likewise be the result and more often are the result of a depraved or weakened physical condition.

SECTION VI.-Continued.

Treatment of Pyorrhea Alveolaris.

PAPER BY A. W. HARLAN, OF THE SECTION.

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N account of the uncertainty in the mind of the dental specialist with reference to the treatment of that variously named and illy defined disease, known as pyorrhea alveolaris, Riggs's disease, alveolitis, phagedena pericementii, etc., the writer desires to offer a few suggestions relating thereto, which may tend to give more confidence to those who have had but little success in their efforts to restore to health the tissues which are so often ravaged beyond repair. It will not be necessary in this report to say anything of the etiology of the disease under discussion, beyond the expression of the belief that it is infectious, and that micro-organisms are at least partially responible for the disastrous results which are sure to follow if it is not checked before the complete destruction of the alveoli.

It is now nearly two years since I became convinced that the methods of treatment advocated by various writers, including that of Dr. Riggs himself, were not the most beneficial to the majority of cases presenting themselves. At that time I was engaged in making some experiments with the essential oils and eucalyptus globulus, to determine their value as antiseptics. During these investigations it occurred to me that iodide of zinc, which then, as it does now, occupied only a few lines in the "Dispensatory" and works on medical chemis try and therapeutics, might be the remedy which would rob the hydra-headed monster of its terrors for the dental surgeon. I procured a sample and at once made solutions of xii. and xxiv. grs. to the ounce of water, and waited for the first case. It soon came. My first experience with it was in the fall of 1881, and the first case was that of a lower central incisor; the gum was loose two-thirds of the length of the root on the labial surface, pus exuding on pressure, and the alveolar process wasted half the length of the root; there was little, if any, deposit on the labial surface of the root, and no salivary calculus on any of

the teeth, except the buccal surfaces of the superior third molars. I carefully cleansed the root and excised the edge of the bone, then dried the pocket, after washing it out with water, and injected into it three drops of the first-named solution. The patient was directed not to squeeze the gum, but to return in four days, and let me see him. When he returned, I dried the gums and applied pressure, and found scarcely any discharge. I repeated the former treatment, omitting the scraping and probing, and when he returned the second time there was no discharge whatever. The pocket had commenced to fill up, and the gum was beginning to re-attach itself to the tooth. The patient returned again after eight days, and there remained hardly a trace of the disease. To all intents and purposes it was cured. After the lapse of more than twenty months the gum remains firm, and is of normal color, without depression or any external evidence of having been diseased at all. The remarkable manner in which this remedy exerted its beneficial influence in this case caused me to practically discard all other therapeutical agents in the treatment of pyorrhea, except as shall be hereafter mentioned. I found from a study of cases that when a patient was suffering from an acute attack of pyorrhea the pockets should first be packed with iodoform and eucalyptus, iodoform and oil of cinnamon, or be thoroughly syringed with a one to three-grain solution to the ounce of water, of chloride of alumina, which is a good disinfectant and astringent, and also an excellent bleacher for discolored, pulpless teeth; but the method of using it in such cases will be dwelt upon in the discussion on operative dentistry. This method of treating the pockets in acute cases relieves the patient of present suffering, and also reduces the swollen gums to their normal size. In three or four days the sanguinary deposits may be removed and the edges of the alveoli scraped or burred off. The pockets should then be syringed with peroxide of hydrogen, which will cleanse them perfectly, and at the same time bring into direct contact with the diseased pocket a germdestroyer and antiseptic not less potent than any which can be named. After drying the gums, the pockets should be injected with the previously named solution of iodide of zinc, one, two, or three drops, or more, in each pocket. When the patient returns on the fourth day the gums must be dried carefully, and a fine cone of cotton or bibulous paper be moistened with peroxide of hydrogen and gently pressed into each pocket. If there should be any effervescence, it demonstrates the presence of pus, and each pocket must be again injected with the iodide of zinc solution. Peroxide of hydrogen, for