Association of Allied Dental Societies.

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wide range of relationship between disease in the mouth and
disease in other regions and organs of the body, and that in the
case of many of them, either may stand in a causative relation
to the other. Able men recognized some of these relations many
years ago. Dr. Horatio R. Storer was one of those men. He be-
gan his medical practice in Boston in 1855 and became one of
the world's great pioneers in gynecology. The difference be-
tween the eminent man and the ordinary man lies often largely
in the difference with which they look out for what are com-
monly considered little things — the importance which they attach
to what may be influencing circumstances. Nearly a half cen-
tury ago Dr. Storer was insisting that his patients should have
their mouths put in order so that facts within the oral cavity
should not continue to exert their harmful reflexes upon the
pelvic organs.

It was my privilege to know Dr. Riggs intimately in the
later years of his life. Naturally he was more inclined than are
we of to-day to ascribe to the mechanical fact of calculus im-
pinging upon the soft tissues the almost exclusive etiology of
Riggs' disease; but he had a lively appreciation of the per-
niciousness of chronic suppuration in the mouth, and of the con-
stantly flowing current of pus going into the stomach and poison-
ing nutrition at its source.



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246 Journal Allied Dental Societies

Dr. Riggs has had no more earnest and devoted disciple
than my preceptor, Dr. L. C, Taylor, of Hartford. Dr. Taylor
has been especially successful in his treatment by instrumenta-
tion of this infection, and he has many patients whose former
serious condition with disorders of digestion and nutrition and
with rheumatism has been put aside with no treatment other than
setting up a state of health in the mouth.

In our student days we were taught the deplorable mani-
festations which might be made in the mouth through the in-
judicious use of mercurials in the treatment of systemic dis-
ease. Later we learned something of how some of the cases of
mouth disease are consequent upon kidney disease. It is a more
recent discovery, and I think not generally well known, that there
are cases of kidney disease consequent upon chronic suppurative
conditions in the mouth.

Some years ago I had on my office staff a young Scotch lady,
Miss Alice Gertrude Harvie. Subsequently she graduated very
honorably from the Philadelphia Dental College and married
Mr. Max Duden, a German chemist, trained with all the thor-
oughness of the German university. Dr. Duden established a
busy practice in Indianapolis as a specialist in oral hygiene. In
her work, becoming familiar with many of the multifarious re-
lationships between disease in the mouth and disease in other
portions of the body, there came to her mind the question:
" May it not be that chronic suppuration in the mouth stands in
a causative relation to kidney disease?" Dr. Duden set about
finding a competent answer to the question. For the investiga-
tion she enlisted the co-operation of her husband, the skilled
chemist, and of the Indianapolis Medical Society, with the re-
sult that in six months, working together, they had made up a
list of seventeen cases of kidney disease that had subsided in
consequence of effective treatment of the mouth disease. Here
is established truth which, as I said, I believe has not been fully
and generally grasped. I am not putting it forward as universal
law, but as one fact in connection with the subject under dis-
cussion.

During the summer and early autumn I spent much time
and effort in the treatment and restoration of a number of teeth
in the mouth of a lady. Several of the molars were badly brokai



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Allied Societies of Boston 247

down, but I was anxious to save them on account of their being
greatly needed for mastication. The lady had in Newport, a
well-paid position as a trained social worker. She was very
fond of her work and in it, was very successful. Our climate
is one in which much rheumatism prevails, and in the autumn
she acquired the disease in a very painful and disabling form.
The patient was quite the reverse from being reconciled to this,
and she resolved to be relieved of the trouble if any power on
earth could accomplish it. Most regretfully she resigned her
cherished position in Newport, came to Boston and put herself
in the hands of able men, medical and dental. In the investi-
gation of the case the X-ray was used about the teeth and jaws,
and four teeth were condemned to extraction. Two of these
were the molars upon which I had expended so much effort.
They were shown to have blind abscesses. Of course other
treatment was used. The result, doubtless of all the remedial
agencies together, has been that the rheumatism, while not en-
tirely cured, has been very greatly lessened. The pain has been
nearly all gone for several weeks and the patient gets around
with little difficulty, except in going up stairs. I suppose that
a portion of this amelioration is fairly due to the elimination of
suppurative processes which, while not superficially apparent, ex-
isted in the mouth ; and I am convinced that the more we study
such things as Dr. Head and the other speakers have put before
us to-night, the better service we shall render suffering humanity.

Dr, Ned A. Stanley, New Bedford — The subject of inter-
stitial gingivitis — Riggs' disease, pyorrhea alveolaris, or by what
ever name it may be designated — will always be found to be a
live wire, and the energetic activity of this doughty opponent is
of such a nature that, after we think it has taken the count, it
often comes back for another round, and finally gets the decision.

I was particularly interested in the paper of Dr. Head and
the discussion of Dr. Leary, who laid great stress upon the im-
portance of thorough surgery in the successful treatment.

This, in fact, is about the only treatment I use, and is what
the case first demands and without which a restoration to func-
tion and comfort — ^a cure — need not be looked for. Vaccine
therapy may be an adjunct to the treatment of instrumentation.
but I have not found it necessary in my cases.



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248 Journal Allied Dental Societies

Any irritant that will destroy the integrity of the gingival
margin may lead to pyorrhea. Within a week I have seen a
case where a well defined pocket had developed from an unusual
cause, on the labial surface of the upper left central. A year and
a half or so ago the patient had a gold filling put in which ex-
tended slightly under the free margin of the gum. The rubber
dam did not quite clear the edge of the cavity and was caught
between it and the gold. Upon the removal of the dam a little
piece was left under the gum, and was still there and somewhat
elastic when I saw it.

We don't always find pus in every little pocket, though there
is a destruction of tissue, but the treatment called for is the same.
]t is only a difference in degree, according to the stage of de-
velopment.

And a mighty important function it is for the dentist to
detect and treat this affection in its incipient stage, for if you
realize what this leads to, you know it is the beginning of the
end of that tooth — ^the foundation of the dental structure is being
attacked.

The peridental membrane serves to attach the tooth to the
socket, and any portion of the root denuded of this membrane
loses that much support, since this tissue does not reproduce
itself. I take it then, a cure means to arrest the progress of the
affection and preserve as much of the membrane in a healthy
condition as possible.

And this leads me to ask the essayist, through what mediimi
the extraordinary phenomenon of the peridental membrane re-
attaching itself to the root surface takes place?

Dr, M, C. Smith — I am proud of the fact that I belong to
the dental profession, and can look back with pleasure on what
we have accomplished and the stimulus we have given the medi-
cal profession during the last twenty-five years. Many of the
men of the dental profession realize the importance of infections
from the mouth, and have done much to clean out the oral cavity.
I will refer to just one condition, and that is enlarged glands of
the neck. While our medical brothers are wont to call it tuber-
cular adentitis and give a very grave prognosis, we call it infec-
tion from the mouth and feel that it can be cleared up with
due attention to the oral cavity. I am fully convinced that 90



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Allied Societies of Boston 249

per cent, of all enlarged glands of the neck are due primarily
or secondarily to infection in the mouth or jaws. I see much
less infection in the neck now than I did years ago, and
attribute it to the improved condition of the mouth. To-day,
if any of my small patients have enlarged glands of the neck I
feel that I am to blame ; it is my fault, for I have not kept their
mouths in proper condition.

I am a firm believer in vaccines and am using them con-
stantly with satisfactory results, but realize with vaccines we are
working in the dark. While the men in Europe and in the Soitth
have found the staphyloccocus and the streptococcus to be the
predominant micro-organisms in pyorrhea alveolaris, we, here
in New England, have found pneumococci to predominate. Why
this difference? Even at best we know that the infections that
we are able to get from pyorrhea cases are only secondary in-
fections, and possibly they are acting as scavengers at that. We
cannot expect much success with vaccine therapy until we have
found the primary infection, whatever it may be, whether slow-
growing bacteria or some undiscovered micro-organism. Per-
sonally I am inclined to think it will be treponema.

There is one point in the paper that I would like to refer
to; that is that the essayist, in getting his cultures in pyorrhea
alveolaris, went below the infection of the pyorrhea alveolaris
and got into the alveolar abscess cavity. He therefore got the in-
fection of the alveolar abscess instead of the pyorrhea infection,
and consequently got a different infection, which should contain
more staphylococci and streptococci than cultures from pyorrhea
pockets. That may account for the different findings between
here and elsewhere. For the treatment of pyorrhea with vaccines
I depend upon the pneumococci as the curative agent.

There is one feature in the great movement of oral hygiene
which I do not like, and that comes from the medical men.
They are altogether too prone to carry a case along with little
or no improvement until the patient is tired out, and then tell
them that it all comes from the mouth, no matter what the dis-
ease may be. They then tell the patient to go to the dentist, that
that it is up to him to cure them, and they all think it very strange
if he fails to do it. They are trying to make us the scapegoat
of the medical profession.



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250 Journal Allied Dental Societies



FIRST DISTRICT DENTAL SOCIETY, STATE OF
NEW YORK

I

February 2, 19 14. ,

A regular meeting of the First District Dental Society of the j

State of New York was held at the Academy of Medicine, No. ]

17 West Forty-third Street, New York, on Monday evening, Feb- \

ruary 2, 1914. \

The president, Dr. Henry W. Gillett, occupied the chair, and !

called the meeting to order. j

Dr. Thomas B. Hartzell, of Minneapolis, read the paper of ]
the evening, entitled " Secondary Infections Which Have Their
Primary Origin in the Oral Cavity." ^

Discussion on Dr. Hartzell's Paper.

Dr. Robert T. Morris, New York City — One must be im-
pressed through this addition to preventive medicine, by the fact
that all branches of medicine form a sort of interlocking direc-
torate, and the time has come, I believe, when the dentist must
first graduate in medicine. The reason for that is, because when
this enormous amount of new work is being done, we are apt to
lose our sense of relative values. The important thing is to keep
the sense of proportion in regard to the relative importance of a
series of symptoms occurring in connection with any pathological
event.

In the course of development of any cultural period, we have
first the era of superstition, then the era of analysis, and follow-
ing that the era of synthesis. We are now in the midst of the
era of analysis, when numbers of men are developing vast aggre-
gations of facts, but these facts are parallel, and are not carried
through a lens at the present time for focusing upon great prin-
ciples. That is the important thing. We all must get together —
dentists, surgeons, internists, upon some common ground which
will allow us to apply synthesis to available facts like these
brought up this evening.

^ See [)r. Hartzeirs paper In full at p. 166 of the present number of Trb

JOIBNAL.



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First District Dental Society, S. N. Y. 251

I was very much impressed by that point of the transmu-
tation of bacteria; and the way in which Dr. Hartzeli has pre-
sented it makes it of very great value. The germs about tooth
roots are subjected to conditions of varying pressure. At such
times we get a greater degree of transmutation than is likely to
occur anywhere else in the body.

Bacteria are simple growths, morphologically, but highly
organized chemically, because in the course of evolution they
had to become the peers of the body cells. They are the hered-
itary enemies of the body cells, consequently the attacking party.
The microbe, as destructive unit, and the body cell as construc-
tive unit, have been in constant warfare. They have maintained
a fairly good balance age after age, but in the course of decline
of any race, when we are running out of our protoplasmic energy,
the bacterium is forging ahead, and under the conditions de-
scribed by Dr. Hartzeli undoubtedly transmutation occurs rap-
idly, and a species of bacterium is not a morphologic entity, it
divides by fission. Cells which divide by mitosis retain their
character more persistently.

We have recently learned that scurvy proceeds from mouth
bacteria. The captain and the mate, who brush their teeth, may
not have scurvy, while all the rest of the cre>y may succumb to
it. No doubt the protein poison which gives the marked response
of scurvy, causes an allergic process.

In regard to dyspepsia and ulcer of the stomach, being due
to mouth conditions, that is a place in which we are likely to go
astray and lose our sense of relative values. Dr. Lane, of Lon-
don, tells us that all these cases proceed from toxins from the
colon. He has stepped into a large new field of fact and lost hi^
sense of relative values.

Dr. Gould tells us that they proceed from eye-strain. Dr.
Gould has stepped into such a large field that he also has lost his
sense of relative values.

You who have heard these important new theories of Dr.
Hartzeli must try to keep your sense of proportion. There are
cases in which toxins from the teeth no doubt lead to dyspepsia
and gastric ulcer. What is gastric ulcer? Let me answer that
in my own way. A number of small branches of enteral arteries



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252 Journal Allied Dental Societies

are terminal. Because toxins are thrown off at this point by
selective action of this part of the enteron, in the course of their
excretion, the endothelium of vessels is injured. Exudate blocks
the terminal vessels, and then you have a small anemic area.
This small anemic area is then vulnerable to bacteria and to
digestive processes. You may have the same thing caused by
toxins from the colon, or the same thing caused by the protein
product of a bum of the first degree, no bigger than a dollar, on
the abdomen. We may have ulcer of the stomach produced by
three as widely separated processes as these.

Just mark that well. Do not tell the next patient who comes
into your office with ulcer of the stomach, that you are going to
cure him by caring for his abscess pockets. Treat pyorrhea
pockets; but do not tell the patient that you are going to cure
him of his ulcer of the stomach. There is possibly one chance
in twenty that you will, and the rest of us surgeons are culpable
if we do not recognize that possibility. It is a matter for analysis
and synthesis when we all join in common knowledge of the same
grand profession.

One point more, in regard to the use of strong iodin and the
cautery. That is a point to which the surgeon would naturally
make objection.

If a skilled technician like Dr. Hartzell finds in actual prac-
tise that such is a desirable procedure, well and good ; but theo-
retically from a biologic standpoint the body cell must meet the
bacterium. The body cell disabled by the cautery or any germi-
cide is not able to meet the bacterium. You destroy the bacteria
there for the moment, but within forty-eight hours the disabled
body cells are attacked anew by other bacteria. That is the sur-
gical standpoint which we find brought into opposition to the
idea of using means which disable body cell when destroying
bacteria.

The persistence of supply. Dr. Hartzell said, breaks down
immunity. That is opposed to our idea in general. The accepted
idea is that the more warriors you have the bigger army you
bring out in response. The natural tendency of all disease is
toward recovery. The more disease you have, the longer con-
tinued, so much greater the tendency toward recovery through



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First District Dental Society, S. N. Y. 253

the help of antibodies. That would be opposed to the theory
which Dr. Hartzell has brought forward. The mouth is one of
the protected areas of the body. We get primary union in almost
all our operative work above the mouth because of the presence
of special leucocjrtosis in this region. You will have primary
union in operations about the mouth and anus which is quite re-
markable, for the reason that these are protected areas due to
the persistence of supply of bacteria which do not break down
immunity, but which make it notably strong.

Dk Nathaniel B, Potter, New York City — I feel the same
humility in discussing this paper before your Society that I did
when I was a first-year medical student and read a thesis in
physiology to the professor.

This is a subject which has interested me profoundly for a
number of years, and I think that its very great importance in
all departments of internal medicine is only beginning to be rec-
ognized. I greatly appreciate the opportunity of having heard
so interesting, profitable, and stimulating a paper as Dr. Hartzell
has given us to-night.

A few points have occurred to me while following cases of
dental sepsis, in connection with my colleagues in your specialty :
During the last two years I have been making an effort to find
out if we could determine whether joint affections, kidney or
some other medical diseases, depend upon a streptococcus infec-
tion, be it of the teeth roots, the tonsils, or elsewhere. I have
been in hopes that a test similar to the gonococcus fixation test
or to the Wasserman test could be used to determine the exist-
ence of active streptococcus infection. With the assistance of
Dr. McNeil and his co-workers at the New York City Health
Department we have been making a series of tests upon patients
of urine affected with dental or tonsillar infection ; we have done
something over one hundred cases in the last year, and thus far
the results have not been very satisfactory.

Cases in which I have found either viridans, hemolyticus, or
pneumococcus, in the tonsils or the teeth roots have shown some-
times a negative and sometimes a positive reaction. There has,
however, been a glimmer of correspondence which has led us to
continue, and we have not fully decided whether this reaction



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264 Journal Allied Dental Societies

may prove to be of some help or not; so that I think that the
clinician in making his original examination of his patient, is
bound to turn the patient over to one of you gentlemen, and in-
sist upon putting the brunt of the diagnosis, as well as the treat-
ment, upon your shoulders.

Even careful radiographs interpreted by the X-ray special-
ist, by the dentist, and by myself, to prove the existence of an
abscess cavity at the root of a tooth, have sometimes been at
fault and been responsible for an unnecessary removal of a tooth.
In other cases I have found a tiny abscess cavity containing a
pure culture of hemolyticus or viridans responsible for the pa-
tient's symptoms, and yet several excellent plates did not show
its existence. I believe, therefore, that just as in most depart-
ments of medicine, no one test, be it bacteriological X-ray, or
even the careful observation upon the part of the clinician and
dental specialist, alone is going to be sufficient to solve this prob-
lem in all cases. The hope that we may find some further sug-
gestive tests is still very keen in my own mind.

If we take cultures of the gums, of teeth roots, or of chan-
nels into abscess cavities, we will almost always get virulent
streptococcus viridans from the cultures; but even in relatively
pure culture they are not always the cause of any infection.

In the last two years we have made a very large number of
cultures in cases of dental sepsis, and in a great many other cases,
and it is rare not to recover a streptococcus which makes a green
tinge; in other words, a streptococci viridans from such a cul-
ture, even when there is no apparent dental sepsis. Those are
some of the difficulties which occurred to me.

I heartily join with you all to commend and praise the
extraordinarily valuable work which Dr. Rosenow has made
recently. I am in hopes that Dr. Rosenow will now clinch the
work he has just brought out and publish his methods, so that
he may get the credit which he deserves for this wonderfully
patient, careful investigation.

Dr. Morris just spoke of infection as being capable of bring-
ing out a rather large army of defense. There is one point I
have noticed — one frequently finds that a series of infections fol-
low a very severe disease. Your reader to-night mentioned a case



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First District Dental Society, S. N. Y. 265

following typhoid fever. Two of the worst cases of oral sepsis
which I have seen, dated the first onset of their tooth trouble
from a severe attack of typhoid fever. I have noted a similar
sequence in a niunber of other infections, especially of staphy-
lococcus infection, and I think there is a certain amount of
immunity which the individual can contribute to fight against
mfection, but overwhelmed by some severe disease, the immunity
response becomes incapable of further stimulation and the fight
is lost. The first weak place, be it a dental cavity, tooth root,
or what not, is attacked ; then comes the long chronic case of in-
fection such as Wright has described, and such as the reader has
just described to us in his case following typhoid fever.

These are the cases which it seems to me the dental surgeons
sometimes leave too long before they remove the teeth. I am
fully in accord with all of you in trying to save and preserve and
do good surgery on these septic conditions, but I have seen in
the last four years two cases where the teeth were allowed to stay
too long, and where only complete removal of the teeth enabled
the disease to be arrested. It is a very nice discrimination to
know where that point comes, but many of you who are thor-
oughly conversant with preventive measures will be able to erad-
icate the disease before this point is reached.

I had the opportunity of discussing a paper before this
Society some years ago in connection with vaccine therapy, and
I think I made the same statement which I will make now, that
I have yet to see a case of dental sepsis in which any form of
vaccine therapy was equal to real good dental surgery, although
I know it helps in some cases.

I was especially interested in your reader's description of
his attempts at excessive treatment on the two cases which he
related.

To my mind that was a very illuminating lesson, It had al-
ready occurred to me in connection with two of my patients in
which the brilliant surgery performed by my dental colleagues
had been so severe and so thorough that it had been far too much
for the patient's health. The reader's reasons are so evident that
it is hardly worth while touching upon it again, but I sincerely
hope that they interested you all as keenly as they did me.



Online LibraryAssociation of Allied Dental SocietiesThe Journal of the Allied Dental Societies → online text (page 24 of 60)