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In addition to the above, he says, “in reply to your question as to the advisability of dental appointments : " The Bureau of Medicine and Surgery does not think it advisable, or in the interest of the government, to have a separate corps of specially educated dental surgeons. That the necessity does not exist is shown in the reports of the Surgeon-General of the Navy for the years 1879 and 1880, where, in 23,875 cases of disease, there were but 59 of odontalgia and other troubles of the teeth. This very small fraction is due to the fact, that in all physical examinations of aspirants for appointment in the navy, persons with defective teeth are rejected.
According to the report for 1878, the percentage of dental diseases would be 1 in about 281, showing a slightly increased tendency among sailors. For the years 1879 and 1880 the percentage of dental diseases was as 1 to about 404.
Truly, if these reports are to be relied upon, military or naval service is the very best prophylactic treatment that can possibly be adopted, and it would become our duty, as the guardians of the public health, to advise all of our patients and friends to enter at once one of these branches of public service. But the observation and experience of every gentleman before me would suggest the unreliability of such reports. Do not, however, understand me as casting the reports away altogether, for they are valuable so far as they go. Why, then, is there this wide difference between the statistical reports and actual experience ? Simply this: Cases of dental diseases—especially caries—are, in the estimation of most surgeons, of such small moment, as compared with other diseases, that they are almost entirely overlooked, and, consequently, no mention is made of them whatever in a large majority of their reports. With such a showing as is made with these reports, it is no wonder the chief officers of the medical and surgical departments have not seen the need of such appointments.
The universal opinion, however, among officers who have served in the late civil war-so far as I have been able to ascertain their views,-has been that there was great need of some means being adopted to save the teeth of both officers and men; for dental caries, with its sequelæ, were very common.
The same opinion is held to-day among a large number of our military and naval officers.
The Dental Cosmos for May, 1882, contains a communication
from W.F. Hutchinson, of the United States Army, that corroborates the above opinion, namely, that dental surgery in the army and navy is something very much needed. He says:
“... I have been in the army for the past four years, and have done a good deal of dental work, but have met with a great many difficulties: among them the want of a suitable place in which to perform the work, and the having so many other duties to perform as to preclude the possibility of giving it the necessary time and attention. But, throwing all difficulties aside, I have accomplished much good, especially in my own company, where I can have the men under my care every day. I have impressed on their minds the great necessity of saving the teeth, by providing tooth-powders and mouth-washes best suited to each case, distributing Dr. White's little panphlet, The Mouth and the Teeth, filling decayed teeth that would otherwise have to be extracted, etc. The men are all willing to pay for the work, but I think our government should form a special department in the medical departments of the army and navy, and provide it with the necessary material and appliances, for the benefit of its soldiers and sailors.. The troops stationed on the frontier fare much worse than those close to cities and towns. They cannot have these operations performed at all, for there are no dentists, probably, within three or four hundred miles, and, consequently, an aching or decayed tooth has to be extracted, often by inexperienced hands.”
The following quotations from a personal letter, by an officer on the frontier, adds still a little more light to our subject. He says:
“There is, I suppose, among soldiers, as much need of dental surgery as among the same number of men anywhere else; but, as a rule, soldiers are recruited from the lowest walks of life, and are such as pay very little attention to the preservation of their teeth.
“ Army surgeons are supplied with most complete sets of instruments for extracting teeth, and they are kept at every post hospital. The surgeons and hospital stewards usually do all the extracting. Officers and their families, as a rule, so arrange to have all work necessary on their teeth done by their regular dentist when they are East, on leave of absence. Army surgeons never attempt to fill teeth. They merely extract them."
In a letter recently received from Major-General Hancock upon this subject he says: “ Both officers and men of the military and naval service need professional skill in the care of their teeth. Whether the surgeons and their assistants are competent to deal with their necessities, or to relieve their sufferings, or prevent them until they reach civil assistance, is a question which I am not prepared to answer. However, I think a fair discussion of this subject before your Medical Society would'throw needed light upon it.”
Admiral Porter, in reply to a letter written him also upon this subject, said to me: “I am in favor of anything that will enable the "old salt' on shipboard to eat the hard tack' and tough beef furnished by the government,” and closes by saying: “If we had had dentists in the navy, I should not have been compelled to live on soft food to-day.”
With such evidence before us, gentlemen, there would seem to be no doubt about the need of some means being provided for the treatment of dental diseases in the army and navy.
It would, however, be useless to petition Congress to make such appointments unless the heads of the medical departments saw the need and made the recommendation. It might, therefore, be suggested that Section “7 ” of this Association appoint a committee of five, whose duty it shall be to arrange a blank statistical report covering all the various dental and oral diseases, and request the surgeons-general of the army and navy to incorporate them in the regular medical and surgical reports. I feel sure both of these gentlemen would give such a committee their hearty co-operation and support. In this way it will be possible to get at reliable statistics, which will enable these gentlemen and all interested to arrive at a positive understanding of the needs as they exist, of appointing surgeons specially educated in dental surgery.
For my own part I am thoroughly convinced that such reports, if carefully made, will prove to all interested that these appointments are absolutely needed for the comfort and welfare of our soldiers and sailors. With such statistical proof in our possession it will be an easy matter to interest Congress in the subject, and secure the appointment of a corps of surgeons specially educated in dental and oral science.
INJURIOUS EFFECTS OF MERCURY AS USED
By EUGENE S. TALBOT.
The subject of mercurial poisoning from the use of amalgam fillings in decayed teeth, has given rise to numberless articles, and has been a source of discussion in dental societies since its introduction into this country. Symptoms of mercurial poisoning have manifested themselves in cases where these amalgams have been employed, causing the scientific members of the profession to investigate these fillings, to determine if these symptoms are due to the mercury contained in its composition. Nor is this investigation confined to men of science; the ordinary practitioner is constantly meeting these symptoms, and by careful observation will be able to diagnose these cases when met with. I will mention two cases which have come under
January 18, 1878, Mrs. W— 29 years of age, had several amalgam fillings inserted by me. At that time, and for the three succeeding years, she was under a physician's treatment for antroversion of the uterus, when she was dismissed by him as cured. During this time she consulted me at intervals in regard to her teeth. For a year past she has complained of trembling at times, coldness, headache, swelling of the limbs, enlargement of the glands, and pain about the jaws, tongue swollen and sore, teeth loose and tender upon pressure, marked salivation, and a metallic taste in the mouth; appetite poor, and bowels irregular; symptoms gradually increasing until six weeks ago she was completely prostrated, and confined to her bed part of the time. Wishing to obtain the opinion of others, I consulted three able physicians, all of whom pronounced it a case of mercurial poisoning. Four weeks ago I removed all the amalgam fillings at one sitting, and replaced them with gutta percha. A slight improvement was noticeable within a week, and a few of the symptoms disappeared. I have refilled some of the teeth with gold, hand pressure being required on account of the soreness. The metallic taste has disappeared, the tongue is normal in size, and where before she was irritable and nervous, she is now bright and cheerful, and gaining steadily in weight.
Miss M a nurse, 40 years old, came to me at the suggestion of her physician, to have her teeth attended to. Soon after her recovery from diphtheritic paralysis of the throat, she had a tooth filled with amalgam. She experienced a disagreeable sensation and some pain immediately after the operation. She suffered greatly from the tooth, and had an excessive flow of saliva. Her taste was impaired, and she felt a paralyzed sensation of the muscles upon that side of the mouth. In nine days she had the tooth extracted. The saliva gradually ceased flowing, but at the time of her visit to my office, four weeks after her tooth was extracted, she had not entirely recovered the normal condition of the muscles. Generally, the poisonous effects of amalgam filling do not manifest themselves immediately after the filling is inserted. Years may elapse before symptoms appear indicative of mercurial poisoning, which fact but adds to the danger of this sort of stopping for the teeth. The suspicions are not aroused to the real cause of ailments, until the system becomes saturated. Occasionally other causes undermine the system, and place persons in a condition susceptible to its toxic influences.
I found the general opinion of writers on this subject to be, on the one hand, that when mercury and alloys formed a chemical union, and the hardening process took place, the mercury could not detach itself from the other metals. On the other hand, that a chemical laboratory must be set up in the mouth, and the mercury converted into some of the toxic compounds, to produce systemic effects. All experiments hitherto, so far as I know, have sought to account for the results by supposing that the acids of the mouth acted upon the mercury of the amalgam. These experiments were made largely, if not wholly, from a chemical standpoint, and the results in all cases were insufficient to explain the cause of mercurial poisoning. These experiments were conducted out of the mouth with the different acids at all strengths and at all temperatures without