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against a tooth, and then the mallet, which was also made of a hard wood, about twelve inches long, was used to hammer the thicker end of the stick. These devices-ingenious '(?) as they thought-were employed to remove, or rather knock out, diseased teeth, much to the annoyance and discomfort of the patient.
"For pyorrhea alveolaris, opium (konronsan, mixed drug') is said to have been used."
Dental practitioners in the first instance appear to have been men of means, or knights who had abandoned knighthood for the profession, and were consequently respected by the public, but the status of the dentist seems to have experienced a fall, and the respected professional man to have been superseded by the quack. As a consequence, dental education was of a rudimentary kind, and the art was learned by apprenticeship, the first step being the extraction of temporary teeth with the finger and thumb. Fillings were unknown, but artificial dentures were made of ivory, metal, or boxwood. The advance of civilisation brought about a change in the old system of dentistry, and in 1883 a regulation was adopted by the Government compelling dental practitioners to pass examinations in order to obtain a license in dentistry, and confining the old-fashioned dentists to extracting teeth and making artificial dentures.
The examinations, thus regulated, consisted of two parts, written and oral. The former comprised six subjects, namely, Anatomy, Pathology, Materia Medica, Physiology, Prosthetic and Operative Dentistry, and the latter was to test the candidates with regard to their practical knowledge as well as their acquaintance with the art of dentistry.
In the absence of books on dentisty and of teaching institutions, apprenticeship was the only course open to those who desired to become dental surgeons, and owing to the difficulties of acquiring knowledge without books or school, the number of licensed practitioners remained, for the first six or seven years after the date of the first examination, very small.
Meanwhile much progress was being made in other departments of medical science, the advance being in striking contrast to the condition of affairs in regard to dentistry, and it was owing to the exertions of Dr. Takayama, who returned to Japan in 1878, after pursuing his dental studies for two years at San Fransisco, that the profession of dentistry was lifted out of the rut into which it had fallen, and the education of students was facilitated by the establishment of a dental school. The Takayama Dental College, the first dental school of Japan, and the predecessor of the Tokyo Dental College, was founded in 1890, the Faculty being composed of seven instructors, the majority of whom were former apprentices of Dr. Takayama, and who were all reputable practising dentists at that time. The founder himself occupied the presidential chair. Only nine students were enrolled at the opening of the college, but the number was increased during the same year to forty-five. Paucity of funds and the absence of text-books appear to have been the two chief obstacles which stood in the way of the success of Dr. Takayama's efforts, and a large amount of money to meet the expenses of the college came from his own purse.
Finally, in 1895, text-books were writted by the Faculty in the Japanese language on the following subjects: Dental Metallurgy, Operative Dentistry, Dental Surgery, Prosthetic Dentistry, Materia Medica, Anatomy of the Fifth Nervc. Copies of the lectures in the class-room were published monthly in the
form of a magazine, for the convenience of outside students who could not attend the college regularly.
The first difficulties being conquered, further improvements followed, and since its establishment the Tokyo Dental College, together with its predecessor, the mother college, has sent out fifty-eight graduates, and 254 students have passed the license examinations of the State Board.
In January, 1900, Dr. Chiwaki assumed the control of the college, as Dr. Takayama was too busy with his practice to look after the business of the institution; the college was moved to the present building at Misakicho, Kanda, Tokyo, which was purchased at his (Dr. Chiwaki's) expense. There is as yet no dental course or department in connection with the medical colleges of the Imperial Universities of Tokyo and Kyoto, and thus the Tokyo Dental College is the only institution for the teaching of dentistry in all Japan.
In spite of the advances made, the writer still deplores the immaturity of dentistry in his country. There are altogether 576 dentists in the empire, some of whom were only licensed in virtue of doubtful knowledge acquired as apprentices.
"Granting," he says, "that all of them are capable of attending to the teeth of the nation, we must remember that Japan has forty-five million inhabitants. This means only one dentist for every 78,125 persons. No wonder that so many Japanese suffer from caries, and consequently from dyspepsia." He concludes with the hope that the Tokyo Dental College may in course of time be able to turn out at least 150 graduates annually, instead of the present insufficient annual total of about forty.
Narcosis with Bromide of Ethyl.
By WILHELM LORENTZ, Assistant of Professor Piergilli.
By narcosis is understood that particular condition which most resembles physiological sleep, but distinguished by its origin and a profound insensibility of the nerves in general, and of the sensorium in particular.
Amongst narcotics here in Italy bromide of ethyl is little known. Its formula is C, H, Br. It is a clear, colourless liquid with a slight and agreeable odour. Boils at 38.3°; has a specific weight of 145; does not easily ignite; burns with a green flame; may be used without danger near a thermo-cautery and with artificial light.
Bromide of ethyl may be used also locally as spray.
The first to use bromide of ethyl in surgery was Nunnely, in 1849, and later Fournville and Lewis in Philadelphia. In 1877 Percier and Freillon presented it to the Medical Congress in Amsterdam, and then in 1879 it was used by E. Rose. Since 1880 bromide of ethyl has become well known as a substitute for other anæsthetics, including nitrous oxide.
Bromhydric ether, like chloroform, sulphuric ether, carried to the respiratory organs under the form of gas. into the blood, acting upon the nervous system.
and nitrous oxide is From them it passes
Bromhydric ether being almost inodorous does not excite the terminations of the trigemini ; does not cause cough, nor disturb the patient in the first stage. Excitement is rare, although in some cases, and especially in drunkards, it is
In the course of narcosis we have at first illusions of perception, and a slight diminution of sensibility generally. Respiration and circulation are evenly sustained, and in a few seconds there is deep sleep.
pupil seldom happens.
Dilation of the
Now, although the physiological effects of chloroform and of bromide of ethyl are apparently analogous, closer examination shows them to be very different. Curves taken during narcosis with bromhydric ether are almost the same as those of the same patient in a normal condition, except that there is a slight rounding of the apex of the curve; while, instead, in chloroform narcosis the curves have the apex very much rounded. Moreover, in bromhydric narcosis the pressure of the blood is very little reduced, which clearly proves that with this drug the changes in the action of the heart are less than in chloroform narcosis.
Chloroform sometimes kills by syncope; sulphuric ether and bromhydric ether cause only a slight cardiac depression, which cannot cause death. They can cause death only by paralysis of the respiratory centre.
Bromide of ethyl, being very volatile, is quickly absorbed and eliminated whence it follows:-
(1) That bromhydric narcosis happens very rapidly.
(2) That the pupil hardly ever contracts and the corneal reflex does not always disappear, nor even very often diminish.
It may be counter-indicated solely for practical reasons, as for operations demanding complete muscular laxity for a long time, as in heavy drinkers, &c. If we compare bromide of ethyl with other narcoctics, we ought to allow that in short operations, and especially dental operations, this narcosis deserves pre-eminence. Over nitrous oxide it has the advantage that with equal rapidity it provokes more profound narcosis; and that it does not require extensive preparation. For these reasons we have the right to place it foremost among narcotics in dentistry.
Bromide of ethyl is applied with the usual chloroform mask; 5 to 15 grms. are poured into the mask, the mouth and nose are covered with this, and deep respirations made. In ten seconds the patient already sleeps, and respiration becomes deep, regular and tranquil. If the arms are relaxed, it is permissible to operate. In special cases the cornea reflex must first disappear. Vomiting is rare. On the contrary, the patient often moves, imitates flying, dancing or riding; with occasionally excitement. The contraction of the masseter is not rare, and may be overcome by a common dilator.-Translated from Rivista Italiana Di Odontoiatria, August.
[See comments in Annotations on p. 642.-ED.]
A NEW form of regulator or thermo-stat in gas heating is described by T. S. Patterson in the Journal of the Society of Chemical Industry, xxi., p. 456, consisting of a rubber drum stretched over a tube containing mercury or other expanding liquid, and close under an orifice supplying the gas. A side tube and tap enables the amount of liquid and temperature to be adjusted.
We do not hold ourselves responsible for the views expressed by our correspondents.
The Students' Number of the Journal.
to the editor OF THE "JOURNAL OF THE BRITISH DENTAL ASSOCIATION." SIR,-May I ask whether the Educational Number could not be published somewhat earlier than the third week in September?
Surely any intending student or his advisers would decide upon the Hospital and School he would attend, involving frequently the question of his residence, long before he could consult the Educational Supplement? That being so, it is difficult to see what object is served by the laborious collection of so much valuable information.
September 19, 1902.
[The question raised is not unimportant. As a matter of fact some years ago, for the same reasons, the "Educational Number" was published in August. The difficulty found was in obtaining information from the School authorities in advance. The matter, however, will be considered by the Publishing Committee.- ED.]
The Benevolent Fund.
TO THE EDITOR OF THE "JOURNAL OF THE BRITISH DENTAL ASSOCIATION." DEAR SIR,-On behalf of the Committee of the Benevolent Fund, may I be allowed to thank all the members of the British Dental Association who have so ably helped in the matter of Masonic votes. Our effort has been successful; W. E. Richards was elected to the Royal Masonic School for Boys on October 10. The number of votes polled was 4,505. Believe me, yours gratefully,
6, Stratford Place, W.
TO THE EDITOR OF THE "JOURNAL OF THE BRITISH DENTAL ASSOCIATION." DEAR SIR,-Your correspondent "Excavator" regards the exhibition of one's qualifications as a matter of individual taste. Granting this, is not a man who has taken the trouble to obtain his diploma entitled to make use of the term L.D.S. to designate his superiority over those who hold none; and again, is not the man who has taken what is considered to be the best degree, i.e., that of London, entitled to use the term L.D.S.Eng.? Several medical men of my acquaintance use the terms M.D.Lond., M.D.Aberdeen, M.D.Edin., M.R.C.S.Eng., &c., and with no local loss of professional status, and they are certainly not snobs in any sense of the word. "Excavator" is mistaken if he supposes that the majority of the dentists who take the extra degree, whether it be a medical or an American one, or both, do so for the love of the thing; they are taken with the idea of materially benefiting their holders, and as the modern idea of business is to sail around with the wick well trimmed, so
these men exhibit their qualifications to the gaze of an admiring, but unfortunately ignorant, public. If it is snobbery then it is very prevalent and much on the increase. I do not agree with the term L.D.S.London, as this University does not grant a dental degree. I venture to suggest that the reason those holding the American diploma are so anxious to inform the public of the fact is on account of the number of people going to these so-called American dental "Institutes" where, as their pamphlets explain, they can get bridgework, which although in a great number of instances is clumsy and ill fitted, yet does the work required of it, and staves off for a short time the plate which the majority of our patients object to. I think anything which will keep the public from patronising these sham American quacks, and which does not infringe on professional etiquette is quite justifiable. Who has not had a patient come to him, and give as an excuse for having been to one of these "Institutes,"" I did not know you did this kind of work, as I went to Mr. So-and-So, and he said I must have these teeth removed and wear a plate; but a friend who has been to the American Institutes advised me to go there." And with what result? The patient is well pleased even though the life of the bridge will not, as he is aware, be more than a few years, and he has ungrudgingly paid a big fee for it too. With the enormous increase of advertising and quackery within the last few years it behoves us to work together, without petty professional jealousy, to combat this ever-painful thorn in our sides.
G. P. CARDell.
TO THE EDITOR OF THE "JOURNAL OF THE BRITISH DENTAL ASSOCIATION." SIR," Excavator" has a right, I suppose, to his view that the practitioner is guilty of snobbery who indicates by an additional letter or two on his doorplate the college from which he received his diploma; but when he makes use of the Association Journal to announce an opinion which is bound to give offence to a large number of his professional brethren, it seems a pity that he has so little the courage of his convictions as to shelter himself behind a pseudonym.
Granting, for the sake of argument only, that it is not the custom in the medical profession to put any such suffix as the one in question, upon the door-plate, does it follow that a practising dentist may not be allowed a little liberty of choice in such a matter? Or, if we, as a body, are to slavishly follow the lead of the medical man in all such details, would "Excavator" write us down as "snobs" for failing to adopt the red lamp of the suburban medical practitioner ?
Again, "Excavator" must be aware that the character of the inscription on the doctor's door-plate, varies enormously with his geographical distribution, so to what quarter must we look for guidance to the Harley Street consultant, or the sixpenny "visit and medicine" practitioner? Both are members of the medical profession.
Surely, Sir, if "Excavator" thought this subject at all worthy of being raised, it were possible to have discussed it on its own merits.
This opinion of his, only founded, as he is careful to tell us, upon what is, or is not, fashionable among other people, is assailable on grounds that are sufficiently obvious; while his airy employment of the word "snobbery,"