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SECTION VII.

PHYSIOLOGY AND ETIOLOGY.

REPORT BY W. C. BARRETT, CHAIRMAN.

HE members of Section VII. note with pleasure the increased attention which etiology is receiving from the profession. Those matters which are nearest to our eyes look the largest to us, and we may, therefore, be excused if we urge yet further study in physiology and etiology as the most important subjects which can engage the attention of the dentist. Physiology is the study of the laws which govern function, and the sole end of medicine is the attempt to regulate disordered systemic action. Do we, then, overrate the significance of this section of our work, when we claim that it is the foundation upon which all departments of medicine rest? that a thorough knowledge of physiology is requisite to the proper practice of any branch of medical science? that, in truth, all the several departments of actual medicine, surgery, practice, obstetrics, ophthalmology, otology, dermatology, dentistry, etc., are but the continued study of normal or diseased function, and, therefore, only distinct branches of physiology?

We are too apt in our essays upon, or discussions of, practical subjects, to pre-suppose in our hearers an acquaintance with the laws which govern systemic action, when the truth is that comparatively few are competent to appreciate a technical paper, because of their ignorance of the advances in physiological knowledge. Nay, more. Our literature is full of articles by authors who propose methods and prescribe remedies that evince an almost total lack of knowledge of the basal principles upon which medicine rests. Membership in Section VII., and a thorough study of the principles which it is its duty to consider, would greatly benefit most of the members of this Association, while it could harm none of those who might be comprised in the small remainder.

Etiology is fitly linked with physiology in this Section. If any man expects to practice intelligently and successfully, it is necessary that he understand, not only what normal function is, but what is the point of aberration and degeneration into diseased action. who does not know the source and origin of any abnormal action, can but prescribe empirically, if he prescribes at all. How can one make a diagnosis or prognosis if he does not comprehend the nature of the disease; and how can he become acquainted with its character until he shall have learned its origin? In that disordered condition called pyorrhea alveolaris, for instance, the profession has not settled upon any distinct, determinate practice, because there is a diversity of views concerning its origin, or rather an ignorance of its nature in the minds of the great majority of practitioners of dentistry. Of dental caries the most antagonistic views are held by men of eminence in the profession, and, as a consequence, we are at work empirically on the cut and try principle. Some of our best known dentists fill teeth specifically; that is, they have one specific remedy for all dental caries. They use nothing but gold, or employ only amalgam; but for this exclusiveness they are not able to render a physiological reason. What one of those who pretend to practice eclectically can exactly prescribe the pathological condition in which he always uses gold in his operations, or can intelligently describe the precise state of function which demands gutta-percha, or a mercurial filling? We are all at sea upon this subject, because of our ignorance of the etiology of dental caries.

But during the past year or two, dentistry has undoubtedly made greater advances in this direction than for a whole generation previously. At the International Medical Congress, held in London, in 1881, the cause received a great impetus, and this has been followed up by the studies and observations of a number of devoted men, nearly all of whom we may be proud to claim as American dentists. Their researches have not led all of them to the same conclusion, but in the diversity of views presented we find the best indication of the comprehensiveness of the investigations. Progress has been made, and if we cannot claim that the end has been reached, we are very sure that we are much nearer to it.

Among the views which have been urged by American etiologists the principal ones are, the chemical theory, first propounded by Mr. Robertson, of Birmingham, England, and ably advocated by Dr. Watt and others in this country; the chemico-vital theory of John Tomes; the inflammation theory, first propounded by Fox, but

modified by Abbott and Bödecker, to accord with the bioplasson doctrine of Carl Heitzmann; the bacteria hypothesis, as advocated by Leber and Rottenstein, by Underwood and Milles, and by what may be denominated the Springfield school, in this country; and the electrical theory of Mr. Bridgman, of England, which has been adopted-in part at least-by what is known as the "new departure" school of etiologists in this country.

There is another American dentist who has made extensive and original, as well as truly scientific observations-Dr. W. D. Miller, of Berlin-whose writings have attracted wide attention both in Europe and in this country. He has not adopted the views of any of those mentioned, but by a long series of experiments in the laboratories of such men as Koch and DuBois-Raymond, he has arrived at the conclusion that dental caries is not due to any one cause, but is the result of a number of factors, all of which must be duly considered in the solution of the problem. His experiments are not yet concluded, and it is to be hoped that he will succeed in throwing yet more light upon this much-vexed subject.

SECTION I.

ARTIFICIAL DENTISTRY, CHEMISTRY, AND METALLURGY.

SEC

REPORT BY T. L. BUCKINGHAM, CHAIRMAN.

ECTION I. would, in the absence of any formal report, recommend that the following named gentlemen present their views orally on the subjects placed against their names respectively: T. L. Buckingham, chemistry; W. H. Trueman, Richmond crowns; C. S. Stockton, general remarks; N. W. Kingsley, appliance for improving speech; A. E. Matteson, his method of making crowns.

DISCUSSION.

Dr. BUCKINGHAM: We are unfortunately very far behind in the branch of chemistry. We have very little literature, and we know very little about the whole matter. Chemistry lies almost at the foundation of all sciences,-even back before physiology and pathology. Anyone who will take the trouble to examine any work that is published upon the subject of organic chemistry will find how exceedingly vague it is. How do substances act? What are the changes that take place in structures? What is the reason that arsenic sometimes will act and sometimes will not act? What is the reason some other substance will not act as well as arsenic ?

When you come to building up structure, how can you know the whole process of embryology, without knowing something about the chemical changes that take place? Tell us by what process the tooth is first formed. Tell us how it grows from the molecule. Tell us how those molecules combine together. Tell us, again, whether periosteum that has been destroyed can be reformed, and if there is a new periosteum tell us by what process it is built up. These are questions that we want to get at intimately, and that come under the subject of chemistry, and we should study them more thoroughly

than we have. In some inorganic structures we can tell some of the changes that take place, but very few. We know the results. We put nitric acid on silver and nitrate of silver is formed. How does the nitric acid hold the substances in solution? When we deposit that, by what force is it deposited?

These are questions that are difficult to understand,-so difficult that we are not likely to progress very far until we get to the very foundation of the principles underlying them.

Acid, for instance, destroys the tooth-tissue. How does it destroy the tooth-tissue? What changes take place in the acid and in the tooth-tissue? What is the difference in the form of the combination? If we will study properly we may reach a greater degree of knowledge than we have now attained.

These are some of the points that pertain to dentistry, in which the dentist ought to be much more fully instructed than he is at present.

Dr. W. H. TRUEMAN: Within the last few years there has been shown a strong disposition on the part of mechanical dentistry to encroach upon the operative branch. This is probably an outgrowth of the increasing desire of the profession to preserve the usefulness of the natural teeth as long as possible. This is seen in the increased thought given to pivot-teeth; and still more, in the efforts made to dispense with partial plates, and replace them with appliances rigidly fixed to roots, or to the remaining teeth, or to both. It has indeed become a question where to place the dividing line between mechanical and operative dentistry, as these appliances, to be really successful, demand the best skill of both branches combined.

The advantages of a denture that is firmly fixed and leaves the mouth entirely free are very great. It is the nearest approach to the organs it replaces we can obtain; but there are also disadvantages associated with such appliances not to be overlooked. Unless great care is used in their construction, they will prove very temporary and a source of discomfort as long as they are retained. The difficulty of keeping them clean and free from the accumulation of food is a serious drawback to their usefulness. Where roots can be used and the fixture arranged without injury to any of the remaining teeth, there is no question that to make the attempt is good practice. But are we justified in destroying the pulp of a sound vital tooth? Are we justified in even cutting into a sound tooth to secure anchorage for such an appliance? Would it be good

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