ABSTRACT OF

CURRENT LITERATURE

Covering Such Subjects as

ORTHODONTIA - ORAL SURGERY - SURGICAL ORTHODONTIA - DENTAL RADIOGRAPHY

It is th e purpose of this J OURNAL to revi ew so far as possible th e mos t important literature as itappears in English and Fo reign periodica ls and to pr es ent it in abs t rac t form. Authors are re­qu est ed to send ab stract s or r epri nts of th eir papers to the publishers.

Epithelioma of the Buccal Mucosa.No.3, p. 123.

L. Imbert. Marseille-Medical, 1919

Cancer of the buccal mucosa is perhaps somewha t less fr equent than canc erof the tongue, but is not very ex ceptional. It is of extreme malignancy, withextens ive and premature glandular involvement. The primary focu s remain s un­discovered for a long time, it is usually situated behind the commi ssure, but soonsprea ds in the various directions offered to it , as follows : ( 1) Along the enti reextent of the oral mucosa, especially downwards; (2) on the gum s, whence itreaches one of the jaws, preferably the lower ; (3) towards the skin, the tumorulcerating neopl astic proliferation; (4) towards the glands, usually the sub­maxill ary glands.

In the author' s opinion, infilt ration of the max illary bones is relat ively tare,but thi s may be due to his having operated on not very advanced cases ; a few ofth ese, however, had been cons idered as inoperable by other surgeons . The gum swere not invol ved in these cases, so that the underlying bone could be sa fely re­garded as intact. When doubts exi st in this respect, the operator should nothesitate to perform a thorough curettage above and below. \Vith special refer­ence to the teeth, carious teeth are almost invariably present. While the patientcould, of course, be refe rr ed to a dentist before any operative intervention, itseems preferable on the whole to do the den tal extractions in the course of theoperation, any surgeon being able to do thi s work when the buccal cavity has beenso widely opened by a commissural incision. All cari ous teeth and stumps mu stnaturally be removed, but the author regards it as advisable to remo ve all theupper or lower molars as a routine procedure. This precautionary measureguards against the frequent and practically constant recurrences, which can onlybe hastened by contact with the teeth, in a mouth where measures of cleanlinessare necessarily difficult after the operation.

The author never had occasion to perform resections of either maxilla, andthere was no reason to regr et thi s, as recurrence s were invariably noted by himin the soft parts or th e glands. E xtirpation of the submaxillary glands, whenthese are enlarged, is an ind ispensable supplement of the opera tion. Immediate

676 The International Journal of Orthodontia and Oral Surgery

results of surgical intervention in these cases are good, and the patients recoverpromptly, but are exposed to a double danger in the form of constriction of thejaws and recurrence of the neoplasm. The latter may be considered as the rule,the tumor reappearing either in the preserved soft parts, or in the glands, orvery frequently in both these locations together. Constriction of the jaws islikewise practically constant; even when a very large flap has been applied, theabsence of mucosa on its deep aspect gives rise to adhesions which are very diffi­cult to handle. For this purpose, the author employs the dilators in use againstthe constriction following war wounds, especially the wooden wedge which thepatients insert themselves, morning and evening, between the jaws, and with theassistance of which they succeed in preserving a certain degree of opening themouth.

Epithelioma of the Tongue. P. Delbet. Progres medical, 1919, No. 11,p.105.

The patient, an elderly woman, came under observation in the ~ecker Hos­pital in Paris, complaining of a persistent ulceration of the tongue and exagger­ated salivation. On examination, an irregulary outlined gangrenous ulcerationwas seen on the right border of the tongue; on attempting to palpate the ulcermargins, a very pronounced induration was encountered, this infiltration consti­tuting the tumor itself. A series of neoplastic glands could be felt in the sub­maxillary and carotid regions, which must always be explored in similar cases.This case represents one of the most acutely dangerous, inoperable types of lin­gual epithelioma. Some of these tumors assume a protuberant form, the so­called cauliflower growth, which is not the most malignant type, the ulcerativeform as seen in this patient being much more likely to penetrate deeply into theorganism. The gravity of these epitheliomas is explained by the fact of their be­longing to the variety of lobulated pavement epitheliomas which are not ame­nable to radiation-treatment as utilized in the treatment of neoplasms. The dangerto life following operations in these cases was formerly attributed to movementsof the stump which was fastened by a thread to the patient's ear, but thereal cause of sudden death seems to be through reflex irritation of the superiorlaryngeal nerve. These patients often seek advice too late, for what is consideredby them as a simple ulceration of the tongue. Six months previously, this pa­tient could have been cured by means of a harmless operation.

Bilateral Syphilitic Parotiditis with Left-Sided Facial Paralysis. A. Le­mierre. Bull. et memo Soc. med. d. hop. de Paris, 1919, No. 18, p. 510.

Syphilis of the salivary glands is a rare disease which the author was re­cently enabled to observe in a soldier 22 years of age, admitted to the hospitalunder the diagnosis of parotid tumor. He promptly recovered under the influ­ence of specific treatment. The trouble began two months ago, without fever ordisturbance of the general condition; the left parotid gland began to swell, fol­lowed three days later by a swelling of the right parotid. The two glands con­tinued to increase in size for a month, the enlargement being progressive, withoutexacerbations, or pain of any kind. At the end of this month, left-sided facial

Abstract of Current Literature 677

paralysis made its appearance. The entire condition from now on remained sta­tionary, the parotids neither increasing nor diminishing in size. A malignant tu­mor was suspected and the patient at this time was referred to the author, who onexamination found a very pronounced swelling of both parotid glands. The facewas enlarged and deformed. The left parotid was slightly larger than the right;on palpation, both glands were uniformly hard, like wood, and regular withoutnodules; their contours were very distinctly outlined. Pressure gave rise to nopainful sensation. The tissues and coverings were normal, without edema or red­ness. On the left side, facial paralysis of the peripheral type was present. The eyecould not be closed, and there was some epiphora. Frowning and wrinkling theforehead was weak and imperfect. The mouth was deviated toward the rightside, and the patient was unable to whistle. There were no glandular swellings,no dysphagia, no trismus, no dryness of the mouth. The orifices of Steno's ductswere normal. No swelling of the submaxillary and sublingual glands was demon­strable. In view of the bilateral character of the lesion and the appearance of theparotids, the diagnosis of tumor was abandoned, in spite of the facial paralysis,in favor of parotiditis. The origin of this inflammation, however, could not bediscovered by questioning or examining the patient. Exploration of the viscera,the nervous system, the skin coverings and mucous membranes, remained entirelynegative. The general condition was excellent, and the patient had not lost inweight. The institution of potassium iodide treatment, in progressive doses (upto 4 grams daily) led to a remarkably prompt recovery. 111 less than eight weeks,no trace of the parotid swelling or facial paralysis was left; and the iodide treat­ment, which had been very readily tolerated, was stopped. The patient left thehospital well and has since remained in excellent condition, without recurrence ofthe local disturbances.

The Osteo-Periosteal Graft in the Treatment of Pseudarthrosis of theMandible Following Gunshot Injury. C. F. Rumsey, British DentalJournal, 1919, xl, No. 19, p. 727.

It is in the cases of mandibular fracture presenting definite pseudarthrosiswith loss of bone that the bone graft holds out the prospect of a cure with thebest functional results. The high claims advanced on behalf of the osteoperiostealmethod by the French school are confirmed by the results of bone-graft operationsin nine cases in the author's personal experience. The technic adopted by himinvolved some small modifications from that practiced by the French, with thefollowing particular advantages: (1) The graft fills the whole gap and not onlythe lower half, as so frequently happens with the other types; (2) it restores thefull continuity of the mandible; (3) no foreign bodies are required for anchor­.age; (4) curvature of the bone is no deterrent, as the grafts are easily bent intothe required shape and then wedged; (5) the operation is performed morequickly.

Description of modified technic. A crescent-shaped incision was first madewith the horns upwards, the center of the incision corresponding to the area tobe grafted. A skin flap was then reflected upwards and secured. The incision

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was next carried down to the lower border of the bone and a large fat flap care­fully dissected up from the external faces of the bony fragments. This was alsosecured from above. The bony fr agments were then isolated, cleaned, and fre sh­ened with a chisel and the fibrous tissue removed from the interfragmentary area(the most tedious part of the opera tion) . The next stage consisted in separatingthe pe riosteum fr om the inner aspect and upper border of the fragments. Thislatter procedure was fairly safe on account of the attenuation of the bony ex­tremities. Two lamina: of periosteum with subjacent compact bone , of sufficientwidth and length to cover the gap and allowing considerable overlap, were thenchiselled fr om the anterointernal aspect of the tibial shaft. These lamin a: wereof sufficient thinness to curl up somewhat after the manner of wood shavings.One was laid internal and the other externa l to the bony fragments, the endsbeing wedged under the tissues overlying the fragments. The intervening spacebetween the grafts, corresponding to the gap , was filled in with small pieces ofcompact bone chiselled from the shaft of the tibia . The fat flap was then re­leased and suture d in position over the graf ts, forming a thick pad, which heldthe external graft in position, and finally the skin flap was brought down andsutured in position over all.

Free Transplantation of the Rib in the Treatment of Mandibular Defects.E. Redwitz. Korr. Blatt f. Schweizer Aerzte, 1919, No. 39, p. 1493.

T he author discusses the question of grafting in mandibular defects, hispersonal observa tion being strongly in favo r of free costal transplantation.Radiogram s which were taken seven years after the operation in an illustrativecase sho wed that the rib had healed in per fectly, as had also the wire whichserved for the suture. The stru cture of the rib was plainly demonstrable. Thegood cosmetic and functional result proved permanent and underwent no changes.For the substitutio n of the ascending ramus of the lower jaw, the metatarsuswould seem to be the most suitable, in view of its configuration.

Rotation of the Cheek in the Plastic Surgery of the Face. L. Esser. Korr,Blatt f. Schweizer Aerzte, 1919, No. 39, p. 1496.

The method of facial plastics, inaugurated by the author, consists essentiallyin ut ilizing the cheek and the adjacent submaxillary an d cer vical regions for theplastic material req uired in the filling of defects and replacing of changed orcicatricial portions of the skin. Thi s procedure guards against the disad vantageof the plastic skin-substitute being recognized even from a distance as someforeign material, as is true in grafts from the skin of the forehead or arm. Inplastic work on the nose, the disfiguring frontal cicatrices are done away with.According to th e situation of the def ect, a curved circumferential incision is ap­plied on the cheek at a suitable level, the incision pa ssing at first rather horizon­tally, if poss ible in a line with the lower furrow of the eyelid as far as the ear,and from here along the posterior maxillary border to slightly below the maxillaryangle. Smaller defects require proportionately smaller flaps from the cheek.The resulting skin flap, which always contains the external maxillary artery, is

A bstract of Current Literature 679

now undermined to a variable extent, under preservation of the facial nerve andthe mimic muscles, and is then rotated upwards and forwards. This procedure,which has long been applied in plastic surgery , is described by the author asrotation of the cheek. The method is well adapted for the pla stic repair of theeyelids, cheek, nose, lower and upper lip, tissues of the same character being ex­clu sively utilized. Very fa vorable result s were obta ined by its employment ina great variety of .cases,

A Curious Ocular Syndrome of Dental Origin. H. H . Martin. SouthernMedical Journal, 1919, No.3, p. 157.

The unusual features in this case, which concerned a man of 49 years whocame under observation complaining of imperfect vision and a floating opacity inthe right eye were the contracted field, the sharp limitation of exudates to theanterior third of the vitreous, and the startling promptness with which all symp­toms began clearing up on the removal of the supposed cause, which was clearlya dental lesion. The only focus of infection that could be demonstrated was atthe apex of the right up per incisor teeth , which was inanim ate as the result of re­moval of the pulp some years previously. This tooth was extracted and wasfound to contain pu s, the pulp cavity being filled with a thin foul-smelling fluidwith a small ap ical abscess. Three days later , vision in the right eye was verymu ch improved and thi s improvement continued without interruption for aboutseven week s, the left eye remaining entirely unaffected during this time. Abouttwo months later, precisely the same condition recurred in the same eye, and anexamination revealed mark ed tenderne ss over the site of the former dental lesion ,with two minute fistul ous openings through the roof of the mouth just posteriorto the former site of the r ight upper incisor. The dental lesion was exposed andthoroughl y curetted ; a small alveolar sequestrum was found and removed. Thevery next day vision had improved to 20/30, and three days after the operationth e field had been extensively restored. The lesson taught by thi s case is that nofocal infection is too insignificant to cause ser ious lesion s in a highly sensitiveva scular structure such as the eye.

Idiopathic Epilepsy Due to Empyema of Antrum of Highmore. J. C.Keeler. The Laryngoscope, 1919, xxix, No.8, p. 484.

The etiologic factor in a case of epilepsy concerning a soldier 34 years ofage was discove red to be a focal infection in the ant rum of Highmore. Duringthe past five years, the pati ent suffered frequent convulsions, the attacks in­creasing in frequency and severity. Hearing in the left ear was dimi shed toabout one-third the normal power. His gait was staggering ; he had attacksof dizziness so great that he would fall -if not supported. Immediately preced­ing a convul sion , he experienced queer feel ings in his head (aura ) , and he ob­served that after a convul sion there was a thick, light-colored, offensive dischargefr om the nose, which seemed to relieve the head symptoms. Examination of thenose revealed a few drops of pus over the left inferior turbinate, and trans­illumination showed a dark shadow of the left super ior maxillary sinus. The

680 The Internat ional Journal of Or thodontia and Oral Surgery

diagnosis of empyema of the antrum was confirmed by radiography. Irrigationof the cavity, with evacuation of offensive pus was followed by considerable im­provement of the hearing and general health. Irrigation was discontinued threeor four days, when he again became dizzy, his hearing again became impaired,and he was apprehensive of another convulsion. Radical interference was foundnecessa ry, and the so-called Caldwell-Luc operation was performed under etheranesthesia, recov ery after which was rapid and complete,

The Relation of Diet to the Development of Children, with Special Refer­ence to the Teeth. F. B. Talbot, Medical Clinics of North America,1919, ii, No.5, p. 1333.

The author points out that in studying the diet and its relation to th e teeth,the rol e of calcium phosphate in metaboli sm must be understood. It must beconsidered fr om the point of view of the metabolism as a whole and of themetabolism in diseases of the bony str ucture, such as rickets, th e commonest dis­ease of th e bones, and an affection of infancy. Rickets is the disease most oftenassociated with delayed denti tion; it is characterized by a deficiency of calcium inthe skeleton. There seems to be enough evidence to conclude th at certain ab­normalities of digestion may so affect the absorption of calcium that ricketsdevelops even when the food contains a sufficiency of calcium. According to atable prepared by Sherm an , showing the calcium contents of the common articlesof food, beef, polished rice, and bananas are extraord ina rily low in calcium. Themore highly refined wheat is, the less calcium does it contain. Milk, oatmeal , andbeans stand out as containing large amounts of calcium, and obviously should begiven in large amounts when it is desirabl e to feed more calcium to the body.Phosphorus is necessary as well as calcium to form skeleton and teeth; it is de­posited in both structures in combina tion with calcium. An abundance of phos­phorus in suitable forms is most readily and economica lly secured by the f ree useof milk, eggs, vegetables, and such cereal products and breadstuffs as contain atleast a part of the outer layers as well as the inner portion of the grains. Plaincheese, containing all the calcium of milk, should be used much more ofte n thanis the custom in this country.

There are no drugs known th at will affect the growth of teeth. Rickets issaid to be affected favorably by teaspoonful doses of phosphorus and codliver oilin the proporti on of 1 :3000. The for matio n of tartar deposits on the teeth cannot be explained through any principles of biologic chemistry known to th e author,who emphas izes that its formation must be pre vented on the basis of well-knowngeneral pr inciples of dietetics and hygiene , both of th e teeth and the body.

The Practical Use of the Dental Radiograph. Sterling V. Mead . TheDental Cosmos, 1919, xli, No. 10, p. 965.Radiography, now one of th e most import ant branches of dentistry, is doing

more to elevat e the dental pro fession than anything else, and the autho r em­phasizes the great responsibility which is being placed upon denti stry by reasonof the disclosures of the radiograph, a responsibility which th e profession is

Abstract of Current Literature 681

fast proving capable of assuming. The radiograph is a valuable diagnostic aid indentistry when interpreted by one thoroughly schooled in dentistry and one whounderstands what it really shows and who knows its defects and limitations.The variegated uses of the radiograph are concisely shown in the following list:

1. To determine whether the mouth is the focus of infection, producingsystemic disturbances.

2. To determine whether the teeth are the cause of reflex irritation, suchas neuralgia, headaches, etc.

3. To determine whether there is apical or periodental infection.4. To follow the course of a fistulous tract.5. Proving root-canal fillings and locating canals.6. To determine whether or not there is a perforation.7. To determine condition of teeth before filling and when contemplating a

restoration.8. To determine the extent of radiolucent area.9. As an aid in extraction of impacted teeth or unerupted teeth.10. As an aid in locating roots, fusion of roots, etc.11. To determine whether permanent or deciduous teeth.12. To determine the presence of permanent teeth.13. To determine when to extract deciduous teeth.14. To determine whether teeth are fully formed.15. In the practice of orthodontia.16. To show supernumerary teeth.17. To show pulp stones or secondary deposits encroaching upon the pulp.18. To show excementosis.19. Before and after apicoectomy, resection, etc.20. To show fracture of bone.21. To show fracture of teeth.22. To show overhanging fillings.23. To show ill-fitting crowns.24. To locate hidden dental caries.25. To show extent of periodental bone destruction in pyorrhea alveolaris.26. In diagnosis of pathologic conditions of the maxillary sinus.27. To locate foreign bodies.28. To observe planted teeth.

A Protest Against the Reckless Extraction of Teeth. W. Alvarez, JournalAmerican Medical Association, 1919, lxxiii, No. 16, p. 1179.

The author enters a protest against the exaggerated and indiscriminate re­moval of teeth, recommended by the radical group of dentists, and urges moreconservative measures in view of the fact that the most thorough removal offocal infections often fails to cure arthritis and other diseases. Serviceable teethshould be saved whenever possible. There need be no question as to the removalof infected teeth which are loosened, perhaps hanging to wobbly bridges, orwhich have lost their crowns. Conditions are altogether different if the teeth

682 The International]ournal of Orthodontia and Oral S urgery

are st rong and serv iceable, if the areas of rarefacti on are small and quest ionable,and particularly if restoration by bridges will be impo ssible. Such patientsshould be candidly told that the proposed extraction is more or less of an experi­ment. In some cases the bacteria which may originally have entered through thejaws seem to have obtained so firm a hold on the joints, the heart valv es, andother tissues that they will not leave simply becau se their old port of entry hasbeen closed. In other cases ,-irreparable damage has been done, and the jointscan not return to norm al even a ft er the disappearance of the infection. It mu stbe kep t in mind, moreover , th at focal infection is probably not the only case ofarthritis; which in a number of cases is plainl y tuberculous or gouty. The un­satisfacto ry outcome of reckless extraction of teeth could often have been fore­told by an experienced physician, who would have warned the dentist to proceedcautiously and conservatively. Radiograms which were used in deciding whichteeth were to come out have sometimes been secured by th e author, and he wasunable to find more than one or two roots whi ch after years of experienc e hewould call infected. In some, downwa rd projections of the antrum had evidentlybeen mistaken for abscesses. In others, it seemed to him that the physician,quite oblivious to any possible value of the teeth to their owner, mu st haveordered their extraction simply because he believ ed it a panac ea for most dis­eases.

The Relation of Oral Sepsis to Mental Diseases. H. A. Gotton. Journalof Dental Research, 1919, i, No.3, p. 269.

The author feels that he does not overstate the facts when he says that in­sanity can be prevented or cured by a conscientious practice of the principles dis­cussed in thi s paper , and that , in the same way, man y other diseases which in mostcases have a fatal terminati on, can also be prevented or cured if the process ha snot gone too far. The fact has been recogniz ed for yea rs that infections andtoxemia cause mental disease, and a small gro up of such cases has thus beendiagnosed as " toxic inf ectious psych oses." In fect ion is conceded as playing animportant part in the etiology of mental condi tions, but its presence is oftendifficult to establish, because chronic infections often produce neither subj ectivenor obj ective symptoms, and are, therefore, difficult to demonstrate by theordinary methods of examination. The possibility of curing mental dis eases byeliminating in fected teeth was first shown by Upson, in 1908, who repor ted casesof th e so-called fun ctional psychosis as both dementia precox and mani c-depres­sive in sanity, which recovered when impa cted and unerupted molars were ex­tracted, and root infections were eliminated. An active inter est in the teeth oftheir patients, by phys icians, will do much to preve nt occurrence of nervous an dmental diseases. V ery serious trouble may originate in the teeth without beingdi scover ed, and may be allowed to progress to the point where it finally cau sesthe death of the patient , or if not that, a condition worse than death, a life ofmental darkness.

In the N ew Jersey State H ospital, Trenton, where very favorable reports havebeen obta ined by means of rad ical extraction of all suspicious teeth, the x- rayis utilized to determine the exi stence of alveolar abscesses . Simple inspection by

Abstract of Current L iterature 683

a competent dentist often suffices to determine the exi stence of teeth which needto be extracted. All capped and pivot teeth are extracted, and all fixed bridge­work is removed, as a precautiona ry measure, in the best interest of the patient.The radiogram can not always be depended upon to show infection, for it fails toreveal a type of soft granuloma, especially ju st below the gum where the bonetissue is not involved. Imperfectly filled teeth may also be infected and have tobe removed, even if the radiogram is not decisive.

In about 25 per cent of the Trenton mental cases, the teeth alone seem to bethe sour ce of infection, and with the removal of this source, the patients rapidlyreco ver . ( In speaking of mental cases, the so-called fu nct ional group is meant,for which no definite etiology had previously been found.) In another group,about 2S per cent , both the teeth and tonsils are at fault; in a third group, about50 per cent, the gast rointestinal tract is also involved, with either the teeth or theton sils. or both. Infected teeth, or the bacteria concerned in this infection, havea direct and very important relation to the pernicious acti vity of the colon bacillus.The organi sm principally concerned in dent al infection is a nonhemolytic strepto­coccus known as Streptococcus vir idans. These types, which produce a chronicinfecti on, are nonpus-producing, and therefore their presence is masked , but theyare extremely toxic , and all of the important symptoms are due principally to thi scharacteristic , especially where the nervous system is involved. The complement­fixation fest of the blood for St reptococcu s viridans is very valuable in doubtfulcases, and could be used to advantage by the dentist to determine the necessity forextracting suspicious teeth in the absence of apparent constitutional symptoms.I f th e test proves positive, then all possible sources of infection should be elimi­nated. Thi s meth od, like the \ Vassermann reaction, is not infallible, and will benegative in some cases in whi ch the infection is present. The author emphasizesthe importance of the complement-fixation test of th e blood for the streptococcusgroup as a means of determining whether or not suspected teeth are cau singsystemic disturbance. E ver y suspicious tooth should be extracted before the in­fection has reach ed dangerous proportions.

Roentgen Ray Indications for Tooth Extraction. Byron C. Darling. Jour­nal of Dental Research, 1919, i, No.3, p. 391.

S umm ary of Conclusions: (1 ) The roentgenogram, when interpreted bythe trained medi cal or dental roentgenologist, is one of the most dependablemeans of diagnosis of conditions that may indicate tooth ext raction. It showswhen the condition of an in fected tooth is such that it means the health of thepatient. (2 ) Tooth extraction should be more generally prescribed: at presentno other meth od for the cure of dental absc esses can be guaranteed to removethe focus of infection that leads, or may lead, to systemic diseases. (3) Thetrained medical or dental roentgenologist, and not the dentist, should be the bestand final interpreter of the roent gen plate in the diagnosis of tooth conditions,since the roentgenologist can have (a) neither pride of reputation in the previousdental work, (b) nor any financial interest in th e future dental work, and (c) histraining has been taken for the purpose of interpretation and valuation of x-ray

684 The International JournaJ of Orthodontia and Oral Surgery

evidence. (4) The commercial x-ray laboratory offers unprofessional and un­reliable work and service, and, therefore, should be discouraged. (5) The den­tist should not attempt to do x-ray work himself, since the practice of dentistryitself is so comprehensive that it requires the whole time and energy of the den­tist, allowing little or no opportunity for expert study of the technic and inter­pretation of roentgenology that pertain to his diagnostic survey work. (6) Theadmission of the professional x-ray expert, either medical or dental, as a con­sultant, divides the responsibility for a case among three experts, physician, den­tist, and roentgenologist, with consequent obvious advantages to the patient. (7)The writer offers his graphic chart as a means of convenient and definite ex­planation of diseased conditions of teeth for the benefit of the physician, thedentist, and the patient.

A Contribution to the Study of Fuso-spirillary Marginal Gingivitis. DClewer. British Dental Journal, 1919, xl, No. 20, p. 749.

In the early spring of this year, while the author in his capacity as dentalofficer was stationed at Charleroi, in Belgium, fully 50 per cent of cases attend­ing him for dental treatment came on account of gingival trouble of fuso-spirillaryorigin. So many officers and men have been under his care lately that he hasbeen led to endeavor to trace some abnormal condition that might be regarded asa contributory factor, and which would tend to make the soldier susceptible tothis disease. This factor he believes to be a dietetic one, due to the very markedlack of antiscorbutic vitamines in the normal diet of the soldier on active service.Upon the basis of his investigations, he concludes that there is good reason forpresuming that Iuso-spirillary marginal gingivitis has its origin in the invasionby specific microorganisms of tissues, the vitality of which has been depraved bythe comparative lack of antiscorbutic vitamines in the diet of the soldier onactive service. The condition has been observed in military camps in England,but certainly riot with a frequency approaching that observed in the war zone,and this is probably explained by the fact that, although the amount of vitaminewas restricted there, the soldier usually had facilities for the individual purchaseof fruits and salads. Further investigation may shed some much needed lighton the subj ect, and if the condition is found to take a place among the deficiencydiseases, the war diet of the soldier might be suitably modified with the object ofpreventing what is and must be a serious item in the sick-wastage of an army inthe field.

Reflex Disturbances Originating in the Nose, Throat and Mouth. I. L.Clark. Texas State Journal of Medicine, 1919, xv, No.6, p. 219.

Reflex disturbance from the teeth is caused by: (1) Irritation and infectionof the gums. (2) Decayed teeth. (3) Impaction. (4) Mouth-breathing. (5)Faulty dental work. (6) Lack of attention of cleanliness. (7) Delayed denti­tion. Teeth should be inspected and cleaned every six to twelve months and fill­ings put in early when necessary. One of the most serious things that happenfrom neglect is abscess formation at the roots of the teeth, and if the focus is

Abstract of Current L iterature 685

not properly drained and cured in the early stage, it becomes a most difficultcondition to eradicate. The author does not believe it is possible to cure anabscess at the root of a tooth if of long standing, where the sac is lined withpyogenic membrane, unl ess ·the tooth be extracted. It is possible for the pa­tient to absorb toxic mat erial fr om these blind abscesses without any local re­acti on, such as soreness or pain, to indicate trouble at the root of the tooth. Itis very important to mak e use of the x-ray in the se case", in order to locate the seobscure foci. Impacti on and dentition are other conditions where the x-ray is ofutmost value.

The following conditions can be traced to focal infection from the gum s andteeth ': (l) Rheumatism in all its forms. (2 ) ~euritis. (3) Neuralgia. (4)Ins omnia. Gastrointest inal disturbance. (5) Eye disturbance. (6) Furuncu­losis. Decayed teeth that have not been properly prepared before fillings are putin will cause trouble sooner or later, and this appli es to crowns, also. The posi­tion of wisdom teeth is often faulty, and decay is common. Failure of wisdomteeth to come through is usually due to impaction against the last molar, andthis result s in an involvement of th e reflex nervous system. Free nasal breathingis important for the proper development of the arch.

Morbidity of the Teeth Secondary to Nutritional Disorder. SemanaMedica, May 29. 1919, xxvi, No. 22.

Castilla ha s been making a special study of the relati ons between anomaliesand caries in the teeth and gas tro intestinal derangement . He found that childrenwith a history of nu tri tional disorders frequently had abn orm al teeth , the enamelwas less perfect and tart ar and caries were fr equent. Child ren who seemed tohave kept in good health had much more perfect teeth than tho se with a gastro­intes tinal past , especially colitis. H e noted also that the intensity of the morbidchanges in the teeth were always proportional to the du rat ion and intensity of thenutritional process. These changes in the teeth were found in children of 10 to4 years old. In older children, apparently healthy but with the se changes in theteeth, investigation of th e antecedents nearly always disclosed the same cau sesas in the others. Removal of the tartar only transiently arrests the process.