get it through the cavity of decay I plug up temporarily this cavity and drill in through the crown. I aim to drill in such a manner that I shall form a tube about the size and style of a tube for setting a pivot tooth. This tube so formed I make the barrel of a syringe. Out of the remainder of the root I form the nozzle of my syringe-requiring only to see that it is free from solid matter and open at the apex. This is so usual a condition of the root of a tooth having abscess, that I test the working of my syringe with water. If I find it free, I proceed with the treatment; if not, I take a jeweler's hair broach, draw the temper to a spring, pass it up the root, and ream out the apical foramen. If the root canal be too tortuous for this operation, after the first or second trial in forcing caustic through, the opening will in almost every case be found free. To put this extemporised syringe into use, my first effort is to empty and thoroughly wash out the abscess sac; for the pus remaining, prevents the entrance of the caustic, and while it bathes the inner surface of the sac, the entrance of the caustic coagulates the pus on the surface and prevents the full action of the caustic. Hence I fill the root with warm water, apply to the opening a bit of soft rubber, whittle a stick of tough wood for a piston, and force the rubber up the tube formed in the tooth as the barrel of my syringe. Thus the water is forced into the sack, and by the same process the pus is forced out through the fistulous opening and the sac itself on the inner surface left clean for the action of the caustic.

The caustic I usually employ is carbolic acid, a saturated solution of the crystal. After applying the rubber dam to protect other parts of the mouth, I force the carbolic acid into the sac in the same manner as I do the water. When I see it making its appearance at the sinus on the gum, or externally on the skin, I am sure that the sac has first been filled, and that its inner coating has been freely bathed with the caustic. In some cases a single thorough treatment of this sort will effect a cure. But in many cases it will require at least three treatments at intervals of two or three days. Then I leave the case for a week or ten days as a test of the cure, closing up the cavity with some temporary stopping.

This method of treatment can be highly commended for its rational simplicity, for its thoroughness in reaching the seat of the disease and accomplishing all that is possible to be accomplished with caustics, and for its ready adaptation to all classes of teeth molars, as well as incisors, in both jaws.

It is not usually necessary to know on which of the roots of a molar the abscess is located. If the caustic used is well

confined within the tooth, and the piston or plunger be well adapted, the force employed is quite certain at the second sitting, if not at the first, to drive the caustic through the abscess on whichever root it is located.

The treatment of alveolar abscess has in the last few years gained considerable attention by the introduction of a new abscess syringe, adapted to performing the operation through the sinus on the gum, or by an artificial perforation of the gum and alveolar wall. The syringe is a great improvement on those before used. But all operating with the syringe through the external opening I consider unphilosophical and uncertain, when the case is one of true abscess as I have described. When complicated with other forms of disease, such as I have before mentioned, necrosis, ulceration, and deposit of sanguinary calculus, it may be an important aid in treatment.

This latter condition named, leads me, in closing, to call your attention to the distinction between ulceration and abscess. The two are widely different. Abscess has a sac; ulceration has no sac. Abscess has a vascular, organised tube, to drain the sac of pus; an ulcerated tooth has no tube-drain. An ulcer is phagedænic; an abscess is not. An abscess is an organised structure; an ulcer is structureless. In the development of abscess new tissue is organised; in the development of an ulcer normal tissue is disorganised and wasted. Being so widely different, it seems strange that the two conditions should be mistaken the one for the other, or more often considered to be the same disease. Ulceration in connection with the root of a tooth attacks the peridentium and the walls of the alveolus, destroys and wastes away these tissues. The wasting of the cementum by ulceration is often supposed to be absorption of the root. All three tissues may not show the phagedænic character of ulceration in the same and every case. It is plain that ulceration requires a different treatment from abscess.

Here let me also call your attention to a peculiar condition sometimes found on ulcerated teeth-a deposit of calculi. Granules of tartar are clustered about the apex of the root, distributed along the route of the discharge of serous matter. I am not aware that the authors of our text books, or writers for any of our journals, have ever given any account of this peculiar deposit which has distinguished it from other calcareous deposits on the teeth. It seems to have been taken for granted that all calculus found in the mouth, and certainly all deposited on the teeth, has its origin in the saliva, and has therefore been called salivary calculus. We need but to ask the question: how does the saliva reach the

apex of the root of a tooth, and in such quantity that in the slow process of such deposit the calculi could be formed?to see at once that it is impossible. Thus we shall be led to seek some other origin for the deposit. Let it be remembered that all the fluids of the body contain calcareous matter. Hence we have not only salivary calculus, but urinary calculus, biliary calculus, gall calculus, &c. And this is pre-eminently true of the blood. Hence, in the decomposition of blood as in the formation of the serum of an ulcer, the lime salts contained in the liquor sanguinis are freed to seek their affinity, and being in contact with the like mineral composing tooth bone a deposit takes place. Being thus formed from the aqueous portion of the blood, I have called it sanguinary calculus, as indicating its true origin.

When such is the condition of a tooth, to make the diagnostic mistake of calling it alveolar abscess, and treating it as alveolar abscess, inevitably results in failure. I have only to add, in one closing line, mark well the distinctions I have attempted to make.-Missouri Dental Journal.

Hospital Reports and Case-Book.

AN EPILEPTIC SEIZURE FOLLOWING THE ADMINISTRATION OF NITROUS OXIDE GAS AND ETHER.

By G. H. CROWTHER, L.D.S.R.C.S.I.

IN December, 1880, R. B-, aged 25, mineral agent and land surveyor, of dark complexion, medium height, and well built, apparently in good health, came to my surgery for the purpose of having a superior molar tooth on the right side extracted under the influence of nitrous oxide gas and ether combined. As usual, before administering it, I auscultated him for any pulmonary or cardiac defects which might be present, but with negative results. He had been under the influence of this agent on two previous occasions within fourteen months, without ill effects; on being questioned as to his previous health, he said he had never suffered from a day's illness in his life, and, excepting ordinary colds, had enjoyed very good health indeed. I asked him how long it was since he last had anything to eat, and he said the only thing he had taken within the last three or four hours was a glass of brandy and water; therefore everything appeared

favorable for the administration of the anaesthetic. With the assistance of my son, I administered, through a Pedley's apparatus, gas (alone) for forty seconds, and afterwards gas and ether combined for a further period of eighty seconds, or two minutes in all. At the commencement of inhalation there was no excitement, respiration was slow but free, and at the rate of sixteen per minute, pulse 68. Just before the inhalation was completed the patient was breathing stertorously, and completely unconscious, muscles flaccid, and there was complete abolition of sensation. The operation was entirely successful. When he returned to consciousness, he was very pleased it was over and thanked me. Almost immediately afterwards great excitement followed, he uttered a piercing cry, and would have rolled off the couch on which he was lying had he not been prevented; there was a cadaverous pallor of countenance, and then the face turned livid, and was drawn to one side; the eyes were fixed and staring, the pupils dilated and insensible to light. His hands were firmly clenched, and there was general rigidity of all the muscles of the body; the pulse was feeble, skin cold and clammy, foam issued from the mouth, and the tongue protruded; altogether it was a typical case of epilepsy. After remaining in this state a little over twelve minutes he gradually recovered, and when completely himself again was not aware of what had happened, and said he did not feel any the worse excepting being fatigued, and having a little headache; in a short time he was able to walk home unaided. There was no history of syphilis or hereditary predisposition to epilepsy. I cannot recollect having seen published a similar case under the same circumstances. I myself have had over nine thousand cases of extraction under the influence of nitrous oxide and ether combined, and amongst a mixed class of patients varying in age, but never before experienced the same thing that happened in this case. I also bring it forward because it seems rather to uphold the theory of anæsthetics producing epilepsy.

1 Bond Street, St. John's, Wakefield; March, 1881.

QUARTERLY REPORT OF CASES TREATED AT THE DENTAL HOSPITAL OF EXETER.

FROM JANUARY 1ST TO MARCH 31ST, 1881.

Miscellaneous (Irregularities of the Teeth, Scaling, &c.)......... 154

THE fact that a question which has kept the Odontological Society in a state of intermittent agitation for some years past is at last decided, ought to be a subject for hearty congratulations on the part of all who wish well to the Society. And yet, earnestly desirous as we are for its peace and prosperity, we have serious misgivings as to whether the settlement just arrived at is, at this particular juncture, really a matter for congratulation.

The Society has decided that for the future no one shall be eligible for its membership unless he is a "licentiate in Dental surgery, or a qualified practitioner of medicine or surgery, or possesses such a diploma or degree as, in the opinion of the Council, shall qualify him for the membership of the Society." Some of the arguments which were advanced in favour of the resolution were obviously weak; such, for instance, as the assertion that it would raise the tone of the Society and raise it in the estimation of other learned societies, &c. The tone of a society is maintained by the position and attain

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