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first molars perfect for some distance from the cutting edge or grinding surface towards the gum, and then you will find a row of pits around the teeth, while below these again the teeth will be perfect quite to the neck or gum, showing that nutrition was normal up to the period of the attack of scarlet fever, abnormal during the continuance of the disease, and again normal after that until the completion of the crowns.

Wherever you find mal-nutrition, whether from scarlet fever, measles, whooping-cough, or any other condition, there you will find that handwriting on the teeth.

If no interruption to nutrition occurs until after the crowns of the incisors are fully calcified, but does take place while the second permanent molars are in process of calcification, then the same markings will be found on these latter teeth, indicating the condition of health of the child during that time.

If any one is observing and notes the correspondence between health and development, by a little inquiry he will soon learn to say to the mother, "This child was sick during certain months or certain years of his or her age." I can bring to mind now a child which came to me with the second permanent molar defective, and I said to the mother that the child at the age of four years suffered some systemic disturbance. She said, "Yes, he had scarlet fever at four years and was very ill for months." There the second permanent molar was badly marked; so I say, by a close observation we arrive. at a knowledge which enables us to designate within a few months the age at which the child suffered from ill health sufficient to interfere with calcification of the tooth-structure.

Dr. ATKINSON: Dr. Peirce rather gives the go-by to the idea that we must understand the minute elements of an organ to comprehend whether it is in a healthy or diseased condition. He has completely confirmed what I wish to say. Being acquainted with the law of the evolution of the teeth enables us to say that at such a number of months, in a general way, the child had some sort of skin disease. This is simply the knowledge of the mischief, but not of the seat of the mischief. I only desire to stimulate the young men to study minutely embryology and histology, so that they can get at the comprehension of these things. I have seen as fine structures of teeth as I have ever known, with this exception,-marked with these lines across them, where the cause was simply interruption of the process of the deposit of lime-salts that formed the enamel and the den tine, at the time they were in a soft condition. I simply wanted to

make this point in advocacy of getting at bed-rock,-the foundation principle for which this body was established,-that we might be able to scientifically justify our procedure with the cases that come before us.

Dr. PEIRCE: There is no difference in sentiment between Dr. Atkinson and myself, excepting that I felt that he did not appreciate the object of the essayist, which was simply, as I understood the paper, to correct an erroneous impression in the profession. The writer did not attempt to go into histology at all.

I fully agree with Dr. Atkinson that we are coming to be better instructed, by getting deeper down, or nearer to the beginning of things. Yet the paper was written to correct a superficial impression, and I think it has done it very admirably; at least, it has brought the subject up in a very intelligent manner before this body.

Dr. DARBY: I have been much interested in the paper just read. It seems to me that the value of the paper lies in the fact that it endeavors to correct a general but erroneous impression. The impression is too general that the deformed teeth which we frequently meet are the so-called Hutchinson's syphilitic teeth. Physicians often ascribe a syphilitic origin to teeth the deformities of which are not due to such taint, and dentists make the same blunder. Some years ago a physician of prominence came to my office with a child, accompanied also by its mother. He called me into another room, and said to me that I should be careful in questioning the mother about the character of the child's teeth, for he thought them to be syphilitic teeth. I had known both father and mother for years, and believed them both entirely free from anything of the kind. The teeth were simply malformed; the sixth-year molars and incisors were alike defective in development, showing that at the time of their calcification there had been imperfect nutrition. The physician had evidently been tracing back the ancestry of the child, hoping to find syphilis in one or both sides of the family.

I am very glad that Dr. Friedrichs directed special attention to and emphasized the difficulty of correct diagnosis and the mistakes that are so frequently made by medical men and even by dentists. We are entering a delicate sphere when we question parents upon the supposition that their children's teeth bear marks of syphilis inherited from them. In my opinion, we rarely meet with syphilitic teeth in our practice.

One of our prominent Philadelphia dermatologists has been work

ing up this matter of late, and by the aid of my assistant has obtained plaster models of many cases from among the poorer classes. He has been exceedingly careful to take none except such as he is sure proceed from syphilitic parentage. The value of his investigation lies in the fact that the evidence is indubitable.

Dr. KINGSLEY: What is the appearance of the teeth in those cases which are undoubtedly congenitally syphilitic? Is there any peculiarity of the teeth in those cases?

Dr. DARBY: I cannot say they are materially different from many of the malformed teeth that are frequently met with in practice, except that the teeth are more stunted in development. Instead of having the notched or serrated edges which are so frequently seen in cases of interrupted nutrition, they have a more stunted and undeveloped appearance throughout.

Dr. KINGSLEY: It has been my fortune during the last twenty-five years to have seen a great many cases of the children of those who were undoubtedly syphilitic. But in no single instance have I seen any markings upon the permanent teeth, such as have been described as syphilitic markings. There has been no peculiarity in those teeth in any cases that I have seen, whereby I could pronounce positively that the patient was congenitally syphilitic.

I have long since ceased to place any faith in the idea that the markings which we so often hear called syphilitic markings, by the medical profession, are due to syphilis in any case.

Dr. ABBOTT: I have for fifteen years looked almost in vain for cases of what would seem to me examples of syphilitic teeth. The kind of teeth which Dr. Peirce has described, of which we see so many, are far from them, in my estimation.

Some two years ago I discovered a case in a child about ten or eleven years of age. The teeth were exactly what Mr. Hutchinson describes. At the points of the central incisors they were a sixteenth of an inch narrower than towards their necks; instead of growing broader they became narrower toward the cutting edge. That is one of the special peculiarities of syphilitic teeth, and not this pitting that is observed in so many cases, which is due to a want of nutrition and a cessation of the formation of enamel at a certain time during the process of calcification.

Dr. BARRETT: Whether or not certain marks are indelibly impressed upon the teeth of children born of syphilitic parents is an unsettled question. I have paid some attention to the subject, and have watched as carefully as possible to see whether I could detect

the traces that have been charged upon syphilis. In one family that fell under my observation, and whose physician informed me of the condition of affairs, the older children, who were born previous to a syphilitic infection, had teeth that were regular and comparatively sound, but those born since that epoch have teeth which are very irregular and malformed in shape, the substance of the tooth-bone very soft, and the whole denture very liable to decay and disease. This does not necessarily prove that syphilitic infection caused the latter condition, because the peculiar shape of the so-called Hutchinson's teeth is not present. If there be any marks they are of a different character.

I have seen other cases and am satisfied that if they are from syphilitic infection, if such infection does affect the shape, consistence, color, or contour of the teeth in any way, the changes so caused are not at all uniform. So far as my own observations extend there is no such thing as a true syphilitic type of teeth. That syphilis may leave its impress upon the teeth is quite probable, but I do not believe it has as much effect upon them as many cases of eruptive fevers occurring during the various stages of their calcification.

This summer it has been my fortune to make a study of a large number of skulls of pre-historic American races. I looked especially for syphilitic marks. It is a disputed question whether syphilis was present in the pre-historic races of the Old World before the advent of modern civilization. It is also disputed whether or not syphilis was present previous to contact with the whites upon this continent, but I believe the preponderance of testimony is that it did not exist. In all the skulls that I examined there was but one which showed the least trace of syphilitic affection, and in that there was good reason to suppose it was an intrusion, and had found its way into the burial-place of the pre-historic people at a later day.

DISCUSSION ON DR. HARLAN'S PAPER.

Dr. BODECKER: I have for several years been very earnestly investigating this disease, but have come to a different conclusion than that formed by the essayist. It is as yet an unsettled question that bacteria are the source of inflammation. I am of the opinion that bacteria are rather the result of an inflammatory process and not the cause. Bacteria derived from other sources of inflammation are exactly the same as those derived from pyorrhea alveolaris; at least they appear to me to be exactly the same.

I do not believe that the theory that the germs are directly the cause of an inflammatory process can be maintained, but, on the other hand, wherever these germs are allowed to grow, inflammation will prosper. There is no doubt about that, and therefore antiseptics in pyorrhea alveolaris are of the greatest service; but they should be antiseptics of a non-irritating character. We have antiseptics, such as chlorine, iodine, and bromine, that are exceedingly irritating to the tissue, and by excessive use secondary inflammation is often induced, or the primary prolonged.

In the treatment of pyorrhea alveolaris, if we first use iodide of zinc, which I have been using for a number of years, it is exceedingly valuable, but if continued too long, in some cases it may keep up the inflammatory process, and will not lead to a cure so quickly as some other agents which are of later discovery. For the last eighteen months I have been using a saturate solution of tartrate of chinoline. This preparation is obtained from coal-tar and is exceedingly astringent, non-irritant, and a very admirable antiseptic. I have obtained results with this salt that are simply marvellous. I have seen teeth which were so loose that I could have removed them with my fingers, which by the use of this remedy were within four or five weeks rendered perfectly tight in their sockets. I exhibited one of these cases at the clinic of the New York First District Dental Society two months ago. Another remedy is a solution of boro-glycerole, which has given me a great deal of satisfaction, and I believe it is in certain cases exceedingly valuable. But the tartrate of chinoline I would recommend as the best astringent remedy in this disease.

The treatment which I have generally pursued is, in the first place, to remove all calcareous deposits which are within easy reach without lacerating the gum; I then take a very thin but stiff steel instrument, around which I wind a piece of cotton rather tightly, dip it into the iodide of zinc and rub round the neck of the tooth thoroughly, so as to wipe away all foreign matter that is loose.

In this way I make two or three applications with iodide of zinc, and then begin with the saturated solution of tartrate of chinoline. I use it in the same manner, with cotton wound around a thin instrument, wiping away every trace of foreign matter under the

gum.

Dr. DARBY: I would like to say one word about one of the remedies Dr. Harlan has mentioned in his paper-that is, iodoform. He has spoken of it as an antiseptic. It is both antiseptic and anæs

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