ance of its members has been fickle. It is with regret that we are compelled to say it has not received at all times that support and encouragement which it has deserved. Why that sympathy and support have been withheld it would be difficult to tell. Its aim has been to advance the interests of the profession in every possible way, and the work which it has accomplished has been such as to command the respect of all. In seeking for a cause of this dearth of interest we naturally turn first to its organization, but a careful scrutiny of its constitution fails to reveal any apparent defect. Its condition of membership is certainly not unreasonable. It has ever manifested the most liberal spirit, and has received into membership all worthy delegates from local societies. Nor has it been intentionally lax in its requirements. Occupying, as it has, the most critical place in the profession, it has endeavored to maintain a dignified and honorable attitude with relation to other societies. Fault has sometimes been found with its plan of membership, some contending that an association seeking to be national in character, and made up of delegates from State and local societies, ought not to have a permanent membership, but should be simply a delegated body, changing from year to year, as these societies may elect. Whether such a plan would work better than the one now in existence could only be determined by experiment. Complaint has also been made that our present methods are faulty, and that the Association cannot accomplish its maximum of good until others are adopted. Most present are probably aware that prior to 1879 the work of the Association was under the management of standing committees, and, while these seemed to accomplish much, there was an earnest desire on the part of some that a new method should be adopted. Accordingly, the plan in vogue in the American Medical Association was suggested. The permanent membership of the Association was divided into Sections, comprising seven, each having its chairman or head, and the work of the Society was to be done under these seven Sections. While many of the older members were in favor of this change, there were others who opposed it, and only consented to it with the understanding that it was to be an experiment, and that, if not satisfactory in its results, there should be a return to standing committees. Perhaps it is yet too soon to express a positive opinion as to the wisdom of this change, but your President is not alone in the belief that the Association has not accomplished as much under its present system as it did under the old one of standing committees.

Perhaps there are other reasons than the one just mentioned why

the Association has not been as successful in its work as could be desired, and were your President asked to indicate some of the causes of failure, he would ascribe it primarily to the profession at large. While there is a fair percentage of representative men who are constant in their attendance and faithful in the discharge of their duty, there is still a larger percentage who attend but seldom and who seem to take no active interest in the work of the Association. This latter class constitutes the complaining element which is so damaging in its influence. They will not work themselves, but are ever ready to criticise disparagingly the actions of others. It might justly be denominated the "dog in the manger" element. There is still another class who seem to take a semi-interest in the Association. They allow themselves to be appointed as delegates by their local societies; they come late, attend a few of the sessions, and take their departure early. How frequently it has happened that the sessions of the last day have been rendered unprofitable because of the absence of the majority of the members. It has been urged by some that our time for meeting is unfavorable; that we convene at a season of the year when our physical and mental energies are at the lowest ebb, and that, were we to hold our meetings at another season of the year, the attendance would be larger and the activity greater. The difficulties attending a change of this kind are of such a serious nature that few, I think, would be in favor of it. Men who are engaged in active practice cannot well leave their homes at other seasons of the year, and, although cooler weather might be conducive to greater mental vigor, the danger is that our attendance would diminish rather than increase.

Gentlemen of the American Dental Association, permit me to say in conclusion, and with none other than the kindest motives, that the needs of this Association can be embraced in one comprehensive maxim, more honest work; less carping criticism.

SECTION VI.

PATHOLOGY, THERAPEUTICS, AND MATERIA MEDICA.

Supplemental Report on Treatment of Pyorrhea Alveolaris, with Notes on Eugenol and Sanitas Oil.

BY A. W. HARLAN, CHAIRMAN.

NUME

UMEROUS letters of inquiry asking for more specific details of the treatment of pyorrhoea have shown the widespread interest in this subject which has been awakened by recent contributions to dental literature. These evidences of a desire to accomplish all that is possible by any method of treatment advocated have induced me to continue my labors in this direction. The experimenter must have a genuine enthusiasm, combined with patience and intelligence. The reawakened activity in seeking to restore loose teeth to firmness in their sockets has shown that a new method of treatment was eagerly sought after to control the ravages of the disease under discussion. The writer is gratified to know that his efforts in the past have been so spontaneously recognized, and he here desires to express his acknowledgments for the words of encouragement so freely conveyed.

The mass of the profession are so likely to confound with pyorrhoea alveolaris salivary deposits on the lower incisors, or such deposits on the buccal, palatal, or lingual surfaces of molars, that it seems. necessary to restate the fact-apparent to all close observers-that salivary concretions are only in slight degree, strictly interpreted, the cause of or associated with pyorrhoea, except as shall be hereafter alluded to. In many incipient cases a careful examination discloses the fact that there is only a slight recession of the gums surrounding the necks of affected teeth; in others none at all. In those cases recognized to be of longer standing may be observed a blunting of the septum of gum lying between the teeth, with a tendency on its part

to bleed on slight provocation, especially between the molars and bicuspids. In all cases where the discharge of pus is abundant on pressure being applied, the loss is observed of more or less of the bony process surrounding the root of the tooth, its symmetrical outline disappearing irregularly. This accounts for the varying depth of the pockets. Where the process is thinnest normally there will be found the most extensive destruction of bone.

Pyorrhoea alveolaris is not a disease of old age any more than it is a disease of youth or middle age. I have seen it in at least one case as early as the ninth year, and several times before the sixteenth year. From the number of cases of true pyorrhoea recognized up to this time I am unable to say at what period of life it is most frequently observed. My personal experience leads me to think that more cases are to be found between the ages of twenty-five and fortyfive, but I have no reliable data to establish this. The thoughtless and ignorant extraction of teeth by those not competent to observe, neglect to consult a dentist at the proper time, failure to impress those persons suffering with pyorrhoea by the dentist into whose hands they intrust themselves, lack of means to secure proper attention at the right moment, and other causes not necessary to enumerate, all tend to prevent even an approach to the truth. It is to the future that we must look for statistics of age, sex, and the condition of the general health, the teeth most likely to be affected, etc. Pulpless teeth, even in the few cases I have seen, do not escape its ravages. Users of tobacco are not less liable to suffer than those who do not habitually use it. The worst cases I have seen were those where tobacco had never been used. Long-crowned teeth, slender teeth, teeth with small necks, and teeth which have been separated by files and disks and not properly cared for afterwards, teeth pretty generally free from extensive caries, teeth of mouth-breathers, are the ones most liable to be affected by pyorrhoea. Teeth which have lost their antagonists early are not often affected. After the inception of the disease teeth which are normally even and regular in their appearance change position, become twisted in their sockets, spread laterally, protrude over the lower lip (the central and lateral incisors) and if a tooth should be extracted through thoughtlessness or ignorance, the contour of the mouth may be changed. The teeth may even overlap each other, or a tooth may be pushed out of line. It is not possible without taking too much space to say how many deviations of position have been observed.

The fact cannot be too strongly reiterated that the vast majority

of cases of pyorrhoea are seen uncomplicated with salivary deposits. The writer is supported in this view by such observers as Black, Ingersoll, Witzel, Walker, and others who are well recognized as authorities. I have seen, in a number of cases, salivary deposits on the inferior incisors and on the buccal surfaces of superior molars, yet the remaining teeth were found free from such incrustations and still the patient suffered from true pyorrhea. Several cases have shown a tendency to the deposition of salivary calculus on certain teeth while undergoing treatment. The dentist not in search of these cases will frequently be deceived by the appearance of the gums, as not many cases present an inflamed or thickened margin; few cases are to be seen where the ligamentum dentium has completely lost its hold on the neck of the tooth, and fewer still where the gums present a pale, flabby appearance. Many cases are seen where the gum has a purplish color, of various shades, corresponding to the outline of the pocket beneath. Pockets may be seen on the labial surfaces of the anterior teeth before the destruction of the alveoli has begun. This statement is based on the examination of cases known to be in their incipiency. The writer, having no desire to unnecessarily lengthen this paper, refers his interested readers to the undermentioned papers for various conflicting views on the pathology of pyorrhoea.*

I do not pretend to discuss the causes of pyorrhoea at this time. Later I may have something to communicate on that subject.

TREATMENT.

Instruments. Experience has shown the necessity for possessing three probes of extreme delicacy for examining the pockets: first, for their depth and width; second, for detecting serumal deposits on the roots, and third, to discover the condition of the edges of the alveoli. The probes should be smooth-pointed, so as to not lacerate or wound the gums. Previous to using them the mouth should be thoroughly cleansed by syringing it with tepid water, and the gums dried with bits of paper, fibre lint, or spunk. When the condition

* L. C. Ingersoll, "Alveolar Ulceration," Transactions Ill. State Dental Society, 1880. G. V. Black, "Phagedæna Pericementitis," 1882. A. Witzel, "Infectious Alveolitis," Brit. Jour. Dent. Science, Feb., March, 1882. J. Arkövy, J. Iszlai, J. Walker, W. H. Atkinson, Vol. III., Transactions International Medical Congress, London, 1881. A. W. Harlan, Dental Cosmos, October, 1883. G. A. Mills, Dental Cosmos, 1879, et seq., Missouri Dental Journal, 1882 or 1883, and others of a more or less fragmentary nature.