MONTHLY REPORT OF CASES TREATED AT THE DENTAL HOSPITAL OF LONDON,

FROM MARCH 1ST TO MARCH 31ST, 1881.

MONTHLY REPORT OF CASES TREATED AT THE NATIONAL DENTAL HOSPITAL,

FROM MARCH 1ST TO MARCH 31ST, 1881.

British Journal of Dental Science.

LONDON, MAY 1, 1881.

THE question as to whether or not Dental practitioners are entitled to prescribe for their patients, though it may possess in the abstract some interest for members of the profession, is, we believe, practically a matter of very little importance. Still, as a well-known member of the Odontological Society considered it his duty to protest strongly at the last meeting against what he believed to be a dangerous innovation, the point may perhaps be worthy of a little consideration.

Whether a Dental surgeon actually has a right to prescribe could only be decided by ascertaining whether he could recover payment for such services in a court of law; and that is a question which, so far as we are aware, has not yet arisen, and which, if it should arise, will not be without its difficulties. Even in the case of medical practitioners the question is not without its complications. Thus, it has been decided that a practitioner who holds only a surgical qualification cannot recover for advice given in a purely medical case, and learned county court judges have arrived at some rather strange conclusions regarding what are, and what are not, medical cases. It is probable that this would hold good in the case of the Dental surgeon, and it might be held that he was entitled to payment for prescribing sulphide of calcium in a case of alveolar abscess as being clearly surgical, but that as neuralgia was medical, having cured a patient with gelseminum gave him no legal claim.

But, granting the right, we are rather inclined to agree with Mr. Hutchinson that Dental practitioners will generally find it best to avoid prescribing as much as possible. We do not mean by this that they should not recommend a saline purge to a patient with threatened periostitis, or a dose of gelseminum to one who is suffering from a reflex neuralgia, but that in cases where Dental troubles are obviously caused

or complicated by a morbid constitutional condition, it is generally better either to refer the patient at once to his medical attendant or to treat him in conjunction with the latter. We know that patients sometimes appear to resent being thus disposed of, and that there is rather a temptation, especially to a young man, to show that the advice was not given on account of ignorance or from inability to do what was expected. But in most instances the practitioner will find that the patient's real idea is economy, that he thinks he can get advice gratis from his Dentist instead of paying his doctor, and our young friend will find himself saddled with a patient who will prove a source of trouble rather than profit.

Although we do not wish in the least to underrate the importance of constitutional treatment, it must be evident that the reputation of a Dental surgeon must always rest mainly on his technical skill. A skilful operator will obtain much better results if he pays due attention to the constitutional tendencies of his patients, but no amount of attention to these details will bring success to one who is not skilful. What is really required is that the Dental surgeon should be capable of recognising the signs of these morbid tendencies when he sees them, and should thus be able to decide how far the resources of his own art will suffice to give relief or to recognise the cause of an occasional failure.

The point to which Mr. Hutchinson specially directed attention is also worth considering. Even if our connection with the medical profession is not quite as intimate as that which exists between the solicitor and barrister, still it is always worth our while to cultivate friendly relations with our medical neighbours, and to avoid anything which may give rise to any feeling of suspicion or jealousy. But apart from this, we believe it to be a fact that, as was pointed out recently in this, Journal by a highly respected contributor, that the longer a man has been in practice the less inclined is he to meddle actively with " apothecaryism and physicking," and that this is a proof that to attend to one's own business pays best in the long run.

Literary Notices and Selections.

ON THE VALUE OF CERTAIN REMEDIES USED IN THE CONSTITUTIONAL TREATMENT OF INFLAMMATORY CONDITIONS OF THE VASCULAR TOOTH STRUCTURES, AND OF NEURALGIA ARISING THEREFROM. Abstract of a paper read before the Odontological Society of Great Britain.

By JAMES STOCKEN, L.D.S. Eng.,

Dental Surgeon to the National Dental Hospital, &c.

MR. PRESIDENT AND GENTLEMEN,-The subject to which I am privileged to call your attention this evening is one of interest, and well worthy our consideration; for I cannot but think that, in the past, we have too much neglected to avail ourselves of the assistance which remedies acting through the system afford us.

The remedies to which I especially desire to direct attention are chloride of ammonium, sulphide of calcium, and gelsemium. I have selected these because the knowledge of their action is not so general as that of many other agents. I have used these medicines alone and conjointly, and have found them of the greatest service in cases of periostitiseither dental or alveolar-of affections of the pulp, and of neuralgia of dental origin. As these several pathological conditions are pretty well known to you all, it is not necessary for me to do more than briefly refer to them.

In the words of Mr. Tomes, "As to neuralgia, when pain is felt in a tooth, we describe it as odontalgia; but when the tooth is free from pain, or the suffering in other parts is so great as to distract attention from the localised pain in the tooth, we speak of it as neuralgia. From a pathological point of view, the disease neuralgia probably has no existence; it is but a symptom indicative of a lesion at some point, which may be discoverable, or may be hidden from our view; and it is not indicative of any one particular lesion, but of a great variety of morbid conditions. Nor, from a pathological point of view, are we justified in separating odontalgia and neuralgia from one another, seeing that the two arise oftentimes from precisely the same cause."

In treating neuralgia, we as Dentists have chiefly to deal with the trifacial nerve, and particularly with its second and third divisions. But it is necessary to keep in view the

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territory of the peripheral ramifications of other nerves, the points of their origin, together with their numerous peripheral, ganglionic, and central communications, in order to appreciate fully the complicated morbid phenomena of nervelife.

It is very generally supposed that no morbid changes in the nerve can be recognised in the majority of cases of neuralgia; but Wedl, in examining some nerves which had been resected by Schub, found disordered conditions both in the neurilemma and in the nerve-tubes. In the former, an hyperæmic swelling occurs, and the interstitial connective tissue of the nerve-tubes acquires a finely granular cloudiness; in the latter, a finely granular metamorphosis of the medulla is observed. In old chronic cases, pigmented granular spots were found; and in one case he distinctly made out that the axis-cylinder was in a measure obliterated by strongly refractive masses. These were entirely soluble in hydrochloric acid, and therefore were calcareous grains. They were also found interspersed in the interstitial connective tissue.

We may, then, divide these disorders of the nerves intodisorders of sensibility without local disease; inflammation of the nerves; and, thirdly, a disintegration or degeneration. In all these pathological conditions the first cause appears to be an excessive blood supply. One or more of the remedies to which I hope presently to direct your attention have the power to modify or suppress that supply, and thus help to restore the parts to their normal condition.

The causes for these conditions may be ascribed to almost every diseased condition which affects the teeth, including periostitis in any of the bony canals through which the nerve trunks pass, or inflammation of the mucous membrane, or of the periosteum of the antrum.

Presently I shall speak of the physiological and therapeutical effects, as also of my experience of the medicines under observation in this paper, and I think we shall find in them agents to meet those pathological conditions, so far, at all events, as irritability and inflammation of the nerves under consideration go.

We have next to deal with morbid conditions of the pulp. Under this head we include irritation, acute and chronic inflammation. With the causes which produce these conditions it is not within the scope of this paper to consider.

In selecting our remedy it is very necessary to distinguish between hyperesthesia and inflammation, always remembering the difficulties attending the recognition of an idiopathic inflammation, and especially those cases in which there is