PARIS UNIVERSAL EXPOSITION, 1867.
REPORTS OF THE UNITED STATES COMMISSIONERS.

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REPORT
ON
INSTRUMENTS AND APPARATUS OF MEDICINE,
SURGERY AND HYGIENE;
SURGICAL DENTISTRY AND THE MATERIALS WHICH IT EMPLOYS;
ANATOMICAL PREPARATIONS; AMBULANCE TENTS AND
CARRIAGES, AND MILITARY SANITARY INSTITUTIONS IN EUROPE;

BY

THOMAS W. EVANS, M.D.,
UNITED STATES COMMISSIONER.

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WASHINGTON: GOVERNMENT PRINTING OFFICE.

1868.

 

CONTENTS.

PART I.

MEDICAL AND SURGICAL INSTRUMENTS AND APPARATUS.

General remarks---Surgical instruments---Apparatus for public and private hygiene---Artificial limbs, orthopedy, artificial eyes, and bandages---Anatomical preparations.

PART II.

DENTAL SURGERY AND THE MATERIAL WHICH IT EMPLOYS.

Antiquity of dental surgery---Dental colleges and societies---Dental apparatus and materials ---Artificial teeth---Dental instruments and gold foil---Vulcanized caoutchouc, use of in dental surgery---Artificial plates and sets of teeth---Anesthetic apparatus.

PART III.

AMBULANCE AND SANITARY MATERIEL.

Transportation of the wounded---Transportation of medicines and supplies---Hospitals; tents, models and plans; furniture---Surgical instruments and apparatus--- Sanitary supplies---Miscellaneous---Hospital tents---Historical.

PART IV.

MILITARY SANITARY INSTITUTIONS IN EUROPE.

The Prussian Society of Relief for the wounded---The Prussian Sanitary Institution during the combat of Langensalza---The Prussian Society during the battle of Sadowa---Knights of the orders of St. John and Malta---Relief societies in Saxony and Southern Germany-Austrian relief societies---Italian Society of Relief to the wounded---Conclusion---Treaty for the amelioration of the condition of wounded soldiers.

 

PART I.

MEDICAL AND SURGICAL INSTRUMENTS AND APPARATUS

GENERAL REMARKS---SURGICAL INSTRUMENTS---APPARATUS FOR PUBLIC AND PRIVATE HYGIENE---ARTIFICIAL LIMBS, ORTHOPEDY---ARTIFICIAL EYES---BANDAGE-S--ANATOMICAL PREPARATIONS.

 

INTRODUCTION.

The productions comprised in Class 11, which form the object of this report, are very varied in their character, and constitute a complex and important branch of industry. They consist of the numerous apparatus and instruments which are used in the practice of medicine and of civil and military surgery, artificial eyes, legs, and other apparatus pertaining to the prothesis of limbs, anatomical preparations, and also a series of objects tending to the promotion of public and private hygiene, such as the various implements and accessories of gymnastic exercises, of hydrotherapy, and of ventilation.

The fabrication of these instruments and apparatus forms in the present day a branch of industry in which thousands of workmen are occupied. The chief centres of the manufacture are in Europe---the cities of Paris, London, Berlin, Vienna and Bologna, and in the United States, New York and Philadelphia. The materials principally employed in this manufacture are steel, iron, copper, tin, zinc, and also gold, silver, and aluminum. Certain products of the animal and vegetable kingdom are also indispensable, principally woods of various kinds, different gums, caoutchouc to a large extent, horn, skins and ivory.

SURGICAL INSTRUMENTS.

The instruments designed for the use of civil and military surgeons are as varied as the operations for which they are required. Special instruments are used for the diminution and rectification of natural deformities, for the extraction of foreign substances from the body, and for the surgical examination of the organs. Other instruments are employed for amputation; others for operations on the external parts; and others again where the internal organs are to be operated upon.

The Exposition of the Champ de Mars displays a most complete collection of surgical instruments, and among them may be found some very ingenious specimens, which are worthy of being pointed out to the attention of the medical profession. Although the majority of the European states have furnished samples of this branch of industry, not one of those who have exhibited can dispute with France the palm for variety, number and finished workmanship of the instruments. It is to be regretted that England, whose surgical instruments deservedly enjoy so high a reputation, is not represented by a single collection.

Among the French exhibitors the firms which claim notice in the first rank are the celebrated establishment of M. Charrière and that of M. Mathieu. Both have, on this occasion, again vindicated their former superiority by the assemblage of new and ingenious instruments which they have submitted to the appreciation of the public. Some of these instruments have been designed by the manufacturers themselves; others by surgeons of this capital, [Paris;] but all, without distinction, are executed with extreme care.

First-class materials are employed in every instance, and the finish of the work rarely leaves anything to be desired. It does not fall within the scope of this report to enumerate all the instruments shown in the cases of these two firms which commend themselves to the notice of the surgeon, but we may specify the new forceps and lithotritic instrument of M. Mathieu, which permits of the prehension and retention of calculi of the largest size, although they may be introduced into the bladder by an incision of the dimension of three centimetres at the utmost. We will also remark the excellent trocars, both probing and exhaustive, of the same firm, which facilitate operations on superficial tumors, and the special trocars for the operation of ovariotomy. The firm of Charrière, (now Robert and Collin,) which enjoys a great reputation on the European continent, exhibits a series of instruments peculiar to themselves. Their improved tenacula and sounding instruments are of the most practical character. Their instrument cases are compact, moderate in price, and contain a large number of well-assorted instruments. Their apparatus for the extraction of foreign bodies from bones deserve special attention. Some of them have been advantageously used in the removal of projectiles. One of these instruments, as remarkable for its simplicity as for its ingenuity, was successfully employed in the special case of a fragment of a ramrod, or sword blade, remaining embedded in the bony parts. The trephines exhibited by Charrière are very varied, and are chiefly noticeable for the happily ingenious modification of the screw, the teeth of which resemble those of a saw. The instruments for resection and amputation, especially the saws and tourniquets shown in this case, likewise display some ingenious improvements. The saw with a blade capable of being turned in all directions, and firmly arrested in any position, invented by M. Charrière, possesses great advantages, as it can be used in subcutaneous resections.

Another Parisian exhibitor, M. Galante, has distinguished himself by his extensive and intelligent employment of vulcanized caoutchouc in this department of French industry. He displays a fine collection of useful and ingenious instruments, in the manufacture of which this substance is advantageously substituted for webbing, wood, ivory and metals hitherto used for this purpose. Some of these numerous instruments are incontestably superior to the old apparatus they are designed to replace. Such, for instance, is a small instrument adopted for the extraction of foreign substances front the nasal cavity. For this purpose, pincers or a blunt hook are generally applied, and in serious cases Belloc's sound is employed covered with a pellet of lint. But this instrument, the use of which is difficult to the operator and painful to the patient, rarely succeeds, and frequently produces vomiting. The caoutchouc tube and pellet invented by M. Galante is easily introduced, and being compressible it assumes, as it enters, the form of the cavity, and causes no pain to the patient. The pessaries of vulcanized caoutchouc, constructed by the same exhibitor, must be ranked among the most useful surgical apparatus, and constitute a great advance upon the older instruments of this class. They are compressible between the fingers and assume an elongated form, which facilitates their introduction, and when entirely introduced they expand and adapt themselves perfectly to the parts they are intended to support. I confine myself to these notices, although it would be easy to point out a number of other articles in the show-case of this exhibitor, all of which bear irrefutable testimony to the great importance which vulcanized caoutchouc has attained in the manufacture of surgical instruments and apparatus. Herr Leiter, of Vienna, has also employed this substance for the same purposes, and with much intelligence. His instruments are solid, light, and free from liability to deterioration; and are, notwithstanding, much cheaper than the same instrument would be if constructed in metal.

One example will suffice to substantiate this assertion:

Pravaz's syringe in metal costs from 20 to 25 francs; while the same instrument in vulcanized caoutchouc can be delivered to the trade at 8 or even at 7 francs. The same maker's winch-pump, with caoutchouc tube, is based on a remarkably simple principle.

His cases of instruments for operations on the eyes and ears and for amputations are well arranged, and his model of a resection saw with lever handle is commendable for the facility with which the blade can be extended.

M. Luer, of Paris, exhibits a collection remarkable for its richness, variety and beauty. An ingenious instrument in this case attracts attention: It is a sound for probing gunshot wounds, with an electric bell which strikes as soon as the probe touches the metal projectile. If the firm of M. Luer vies with the largest and oldest houses of Paris in the high finish of its productions, it is not inferior in the zeal and care displayed in maintaining itself on a level with the latest American and European inventions in its class. This firm excels in the instruments employed in dental surgery, and with a view to improvement its head has resided for some time in the United States for the purpose of studying this specialty. In the Italian gallery Mr. Lollin exhibits some fine instruments, among which an excellent forceps may be prominently noticed. Mr. Nytrop, of Denmark, sends some very noteworthy herniary bandages; and Mr. Pischel, of Prussia, a number of carefully constructed instruments, principally, those employed in the galvano-caustic process. In the American gallery the instruments of Mr. Tieman, of New York, exhibited by Mr. Barnes, Surgeon-General of the Army of the United States, are distinguished by their variety and their approved utility. It is to be regretted that this branch of industry, which has attained so high a pitch of development in the United States, is not more fully represented. There is, however, in the United States gallery a splendid collection of instruments specially designed for the use of dentists, to which I have referred in my report on dental surgery.

APPARATUS FOR PUBLIC AND PRIVATE HYGIENE.

The different objects that are treated of in this paper belong, if not to the domain of medicine, at least to that of hygiene, which is closely allied to it. In the first rank of these articles I will notice the bath apparatus and the therapeutic instruments which have rendered so much service to the lower classes. France is the most creditably represented country for this class of industry in the whole Exhibition. The firm of G. Charles, of Paris, has exhibited a fine collection of baths, with very ingenious apparatus for heating them, and their shower baths and douches for the spinal column are very practical. Bouvillon, Muller & Co. have likewise a very complete show of hydrotherapic apparatus. Their hip-baths, with which any kind of douche can be administered, are particularly noticeable.

The firm of Mathieu has constructed an elegant table supplied with a number of jets in such a manner that several persons can separately but simultaneously inhale one of them, the liquid being sprayed, and saturating the air of the apartment. M. Lefebvre, of Paris, has designed an ingenious portable apparatus for vapor baths and the fumigation of beds without damping.

The gymnastic apparatus are rare but they are very remarkable, and we may cite those sent by Messieurs Burlot & Vian, of Paris, Mr. Rein, of London, and particularly that sent by Prince Oscar of Sweden.

Among the hygienic apparatus the excellent systems of ventilation in the machine gallery must be mentioned, and above all the ventilator of the Palace itself is very interesting and remarkable, as applied to the aeration of large public establishments. Subterranean passages branch all through the ground on which the Palace is constructed and converge to the centre, and the air passes into the galleries through a number of wooden gratings. This system, devised by M. de Mondeser, is based on the principle that when a stream of air is thrown with great speed into a tube open at both extremities, it produces a slow movement of the whole column of air contained in the tube. The air is introduced through large circular apertures, covered with iron gratings, by blowing machines worked by steam. Before each aperture streams of water are disposed and, carried forward by the current of air they turn into spray, spread about the inside of the pipes and cool the interior space.

ARTIFICIAL LIMBS, ARTIFICIAL EYES, AND BANDAGES.

In examining the galleries devoted to the instruments and apparatus treated of in this report, the observer is especially struck by the considerable progress that has been made of late years in artificial limbs, both in respect to their natural form and the excellence of their manufacture. The advantages which have been rendered to this class of industry by the application of caoutchouc may here be particularly noted, and it is my conviction that future improvements will be based principally on the application and use of new materials. Orthopedic apparatus, and especially artificial limbs, are very numerous at the Exposition of the Champ de Mars. The firm of Mathieu, of Paris, exhibits excellent artificial arms, one in particular, similar to that constructed by them for the eminent singer Mr. Roger, whose forearm had been amputated. With the resources at present at the disposal of science, it would be difficult to make a more complete and more ingenious article of this kind. The tractions are so well combined with the movements of the shoulder and of the body that the artificial forearm may be bent back to the shoulder, over the chest, and can be moved backwards, and over the head. The fingers and the palm move with facility. The extreme lightness of this apparatus has been attained by the combination of aluminum and steel with the lightest wood.

The artificial arms exhibited by the firm of Robert and Collin are light and well articulated. Their apparatus employed in dislocations of the hip allows the patient to sit down without inconvenience or pain.

In the English section the collection shown by Mr. Masters, of London, commands attention by its display of crutches of extreme lightness, and artificial limbs which vie with the most perfect productions of French manufacture.

I would also call the attention of practitioners to the artificial hand, constructed by Mr. Masters, with which a pen, playing cards, &c., may be held This manufacturer also exhibits a table-service of great ingenuity, and well adapted for artificial hands.

An artificial foot, made of cork, for elevating a short leg, is a striking object in the show-case of Mr. Norman, of London.

Mr. Leiter, of Vienna, exhibits an excellent apparatus in hardened caoutchouc for club foot.

The artificial arms made by Messrs. Selpho & Sons, of New York, rank among the best productions of this class. They possess the quality of extreme lightness, and are of superior finish.

The artificial legs made by Mr. Marks, likewise of New York, are distinguished by similar qualities; they are carefully made, light, and well articulated.

In the collection of the American societies for the relief of the wounded we find some artificial legs, constructed by Dr. Hudson, of New York, which are perhaps the most successful in the whole Exhibition. In the same class Count Beaumont exhibits some artificial limbs, the extreme lightness of which, and their cheapness, must commend them to public notice.

The construction of artificial eyes has been much developed of late years, and in Paris, especially, vast progress has been made.

Those exhibited by the manufacturers of the French metropolis, and particularly those shown by M. Coulomb Boissonneau, are distinguished by the excellence of their color, which approaches closely to the natural tints. Another Parisian manufacturer displays a curious collection of artificial eyes of both men and animals; and M. Boissonneau, jr., sends a collection which possesses high scientific interest. This collection represents the various pathological conditions of the cornea, the iris, and the crystaline fluid.

While the construction of artificial eyes has been thus improved, we must also in justice add that, on the other hand, the fabrication of instruments, specially adapted to the surgical examination and treatment of the eye, has made great advances in the hands of certain specialists, thanks being due to the intelligence of the instrument makers. MM. Mathieu, Galande, Luer, Collin & Robert, of Paris, and M. Stille, of Stockholm, who exhibit many pieces of apparatus of this description, particularly M. Stille, who has, in the Exposition of the Champ de Mars, brilliantly maintained his high reputation.

The majority of the exhibitors of surgical instruments have distinguished themselves by their designs for bandages, which are occasionally of great excellence. Some of these pieces of apparatus are intended to convey a supplementary aid to surgical operations; others---such as waist belts, stockings---to sustain feeble or defective parts of the body. Others again must be considered as appertaining rather to the domain of hygiene than to that of medicine or surgery. In this paper; however, we shall not discuss them separately.

The herniary and compressory bandages exhibited by M. Charbonnier, of Paris, possess great flexibility. M. Galante has constructed abdominal belts and elastic stockings which may be recommended to the notice of the medical profession.

The apparatus and bandages of M. Le Perdriel, of Paris, are Justly held in high estimation. They compress and sustain the limb affected, without any exaggeration of the pressure.

The herniary trusses and bandages shown in the Italian gallery are very light and exhibit great ingenuity in their construction. The chest protectors of Mr. Marsden, of London, merit notice for their strength and the good quality of their material.

Other French and foreign exhibitors have also signalized themselves in this branch of manufacture; but to enumerate them would be to convert this report into a lengthy catalogue.

ANATOMICAL PREPARATIONS.

It would be, I think, superfluous to mention here the great importance that should be attached to anatomical preparations in the medical profession and in the general study of the natural sciences; but I may say, that very few branches of industry require such a profound knowledge of the chemical properties of substances as this, or call for more care, delicacy and precision of manipulation.

Although anatomy is somewhat scantily represented at the Champ de Mars, the specimens are highly creditable and of an incontestable importance, and I question if there are among the whole range of exhibited objects any more worthy of the attention of medical men. Methods of preservation unknown up to the present time can here be seen, and all the pieces are executed in a remarkably perfect manner.

The preparations of Dr. Brunnetti, of Padua, must rank the highest in their class for their novelty and the excellence of the process employed. His invention is quite novel, and I think is destined to produce a great influence on the study, or rather the teaching, of anatomy. It is to be regretted, on account of the importance of the invention, that this method of preservation is not yet known to the public. Thanks to it, the membranous linings can be made stiff to such a degree as to keep the primitive form intact. The color of the pieces exhibited is of a light gray, and on account of their rigidness they can be cut up into thin slices with more facility than any others prepared by a different method. They are remarkably light, quite inodorous, and, according to the inventor's word, remain incorruptible. The small branches of the arteries, the ducts of the gland, the digestive mucous membrane, and, in general, the most delicate and even microscopic organic parts, are perfectly visible.

In Dr. Brunetti's collection the pieces showing the kidney in its normal and its pathologic state are specially remarkable, for with the aid of an ordinary magnifying glass the most slender corpuscules of the cortical substance can be easily distinguished.

The anatomical preparations exhibited by Professor Hyrtl, of Vienna, are as remarkable as those of the Italian professor, but from quite a different point of view. If the manner of preparing them is not entirely new, they are at least prepared with all astonishing skill, parts generally considered inaccessible to the scalpel being beautifully dissected. These pieces are quite worthy of the great reputation of their author. The labyrinths of the ear of different mammiferous animals exhibited by Mr. Hyrtl are some of the most curious and difficult things the anatomist can prepare.

Mr. Teichmnan, of Cracovia, has exhibited a remarkable collection of mammiferous skulls which call for special attention, from the exactitude and perfection of their getting up. In the same case is found a curious collection of the olfactory organs, the preparation of which must have required an immense amount of labor and care. Mr. Tiechmann has also succeeded in injecting into the lymphatic vessels a substance that is capable of hardening, instead of the mercury generally used.

The French exhibitors show some fine wax-models. M. Talrich's collection is very fine, and there is a handsome model, by him, of the spinal cord. M. Yasseur's collection is likewise admirable, and includes a large sympathetic nerve and spinal column, very delicately prepared. M. Auzoux, the indefatigable popularizer of anatomy in France, shows some fine pieces of comparative and elastic anatomy.

 

PART II.

DENTAL SURGERY AND THE MATERIAL WHICH IT EMPLOYS.

ANTIQUITY OF DENTAL SURGERY---DENTAL COLLEGES AND SOCIETIES--DENTAL APPARATUS AND MATERIALS--ARTIFICIAL TEETH---DENTAL INSTRUMENTS AND GOLD FOIL---VULCANIZED CAOUTCHOUC. USE OF IN DENTAL SURGERY---ARTIFICIAL PALATES AND SETS OF TEETH---ANESTHETIC APPARATUS.

 

RISE AND PROGRESS OF DENTAL SURGERY.

Few branches of science have offered in their developments a more curious and instructive spectacle than that presented by the history of dentistry.

While its origin may be traced to the most remote epochs, it must be admitted, however, that it remained stationary for ages, and it may even be added that it has only become a real science within modern times, when an interest was first manifested in gathering together its scattered traditions and in connecting buccal operations with other medical and surgical studies, particularly with physiology and anatomy.

Four centuries before the Christian era, Hippocrates, relying upon experiments made long before his epoch, recommends the use of artificial teeth, and even teaches the manner of fastening them by means of wire. Observations of the same kind maybe seen in other ancient authors. In Egyptian tombs mummies have been found whose hollow teeth had been filled by an operation analogous to that employed at the present time; it is proper to remark, however, that it would be difficult to determine whether this operation had been performed during the lifetime of the individual or after death, at the time of embalming the body.

Until towards the close of the 18th century artificial teeth were made solely of ivory or the teeth of the hippopotamus; but, in 1794, a French chemist conceived the idea of manufacturing them of porcelain, and succeeded in producing some which were light and of a tolerably suitable grayish tint. From the time of this invention the dental profession made remarkable progress in France, Germany, and England.

A short time after the American Revolution, two practitioners, one an Englishman and the other a Frenchman, Robert Woofendale and Dr. Gardette, went to establish themselves in the young republic of, the United States. The former settled at New York, and the latter, Dr. Gardette, at Philadelphia. These two men were the initiators or introducers of dental science and art in America, where it was destined to occupy an important position and to make rapid and decisive progress.

At the close of the last century Dr. Hudson of Philadelphia substituted, for filling hollow teeth, gold leaf instead of lead used previously.

Indeed, it may be said without fear of contradiction that the United States is the centre from which the modern progressive movement of dental surgery starts.

The facts which I am going to report will sustain, I think, this assertion, by proving that, for 30 years past, numerous and intelligent efforts have been made to promote and maintain that scientific character and training which the profession of dentistry requires.

For this purpose several special schools of dental surgery were founded, where those who intended adopting the profession received methodical instruction. The first school of this kind was established at Baltimore in 1840, and was legally authorized to deliver diplomas of competency to those who should follow the courses and undergo the required examinations. Since that period five other institutions of the same character have been founded in different States of the Union. The one in New York is the most recent. This school, founded with the authority and by order of the legislature of the State, in 1866, is to-day entirely organized and highly prosperous. Distinguished and talented professors occupy its chairs, and teach dental histology and surgery, comparative and descriptive anatomy, pathology, therapeutics, chemistry, metallurgy, as well as dental mechanism.

This young faculty is already rivalling those of Baltimore and Philadelphia. The professors in all these schools are dentists, excepting only the professors of chemistry and anatomy in two of them. Physiology, anatomy, materia medica, chemistry, therapeutics, and more especially the physiology of the mouth, and buccal surgery, together with dental mechanism and metallurgy, are taught in the annual courses of these institutions. Like those of the faculties of medicine, the pupils of the New York faculty receive clinical lessons in the hospitals, so that the diploma of surgeon dentist delivered by this college has a value similar to one coming from the faculties of medicine, and the consequence is that most of the graduates of the school of dental surgery obtain at the same time the diploma of medicine.

Independently of these special schools, there exist in the United States numerous societies of dentists; such as the Association of Brooklyn, the Odontographic Society of Pennsylvania, the American Society, that of the Surgeon Dentists of New York, of Pennsylvania, of Michigan Valley, of Philadelphia, and several others.

A great emulation prevails among these associations, and constant and mutual communication contributes powerfully to promote the progress of the science to which they owe their origin.

Outside of the United States no special schools of dental surgery exist. In England, how-ever, a lively interest is awakened to the necessity of establishing institutions similar to the American schools; and lately a fortunate move has been made in this direction. In 1858, a dental hospital was founded in London, which, since that time, has rendered good services, thanks to the zeal of the practitioners connected with it. Although the founders have had especially in view the blessings which such an establishment must offer to the indigent classes, unable to incur the expenses necessitated by ordinary dental operations, the hospital of London approximates in its organization to the American schools of dental surgery in this sense, that those who are destined for the profession find there a vast field for investigation, and can readily avail themselves of the clinical courses which have been instituted for their benefit.

Besides this establishment there are two associations of dentists in England, whose works are remarkable for their variety and solidity.

The Royal Academy of Surgeons of Great Britain, actuated by the laudable desire of maintaining the dignity of the profession of dentistry, does not accord the diploma of surgeon dentist to any except those who, by examination, can prove their claim thereto, after having followed regular courses in schools recognized by the academy, particularly the courses of anatomy, physiology, therapeutics, chemistry, surgery, materia medica, and clinics in one of the hospitals of Great Britain.

In Germany, we find among the dentists a scientific ardor and emulation, particularly in the Society of Dentists Vienna.

In England, in the United States, in France and Germany, journals and reviews, specially devoted to dental science, are regularly published, so that the practitioner can constantly keep himself au courant with the progress of his art and of the collateral sciences.

The succinct account which I have now made of the present condition of dental surgery and of the astonishing progress which has been realized in the last 30 years, will suffice, I think, to show its practical importance. Buccal operations, which are daily made in the great cities, such as London, Paris, New. York, Vienna, Berlin, and Philadelphia, may be counted by thousands. For instance, in the Hospital of Dental Surgery at London, of which I have spoken, more than 78,000 operations have been performed. In New York and Philadelphia alone more than 1,000 workmen are occupied in fabricating different objects destined for the use of the surgeon dentist. It may be readily imagined that a science so generally applied must give birth to numerous trades. The practitioner needs a large and varied number of instruments; he applies sometimes to the chemist, sometimes to the druggist, oftener still to the metallurgists and manufacturers of instruments. He employs gold, platinum, lead, silver, and also, according to circumstances, aluminium, copper, iron, zinc, and tin; all these metals either in their pure state or in different compositions. For his instruments, he makes use the most often of the finest steel; he needs also ivory, porcelain, caoutchouc, gums, acids, perfumes, gases, and chemical preparations. All this gives place to transactions, often considerable, and whose results were necessarily felt at the Exposition of the Champ de Mars, where the products of all human trades were offered to the consideration of the world.

 

DENTAL APPARATUS AND MATERIAL.

Having been a member of the international jury for Class 11, I propose in the present report to call attention particularly to the part of this class devoted to the exhibition of different objects and apparatus belonging to dental surgery.

This special branch of the Exhibition of the Champ de Mars demanded on my part an examination the more thorough since the investigation was to show me the truth or falsity of a principle which I hitherto had considered just. Here is the question which I proposed to myself, and which I now answer negatively: Can or should the surgeon dentist exhibit as an artist or a manufacturer? When the manufacturer exhibits the product of his trade, when the artisan exposes what he has formed with his hand, when the artist exhibits the picture which he has painted, the statue that he has sculptured, they all present to the appreciation of the public things whose merits may be determined, objects which in themselves demonstrate clearly the skill, intelligence, the talent or genius of their authors. But what can the dentist exhibit to the public, to show in an incontestable manner, the superiority of his operations? Does not the dentist who exhibits find himself in exactly the same position as the surgeon who would pretend to prove his professional superiority by exposing the leg which he had amputated by the side of an artificial one which he had furnished to the patient? Even should a dentist exhibit an artificial piece, whose every part was of the most perfect workmanship, and which had been constructed of the most advantageous materials, would this piece prove anything more than the skill of the workman who had executed it, and the taste of the dentist who had ordered it? That which it is essential for the public to know, and which can alone show the merit of the exhibitor, remains unknown: what it is necessary to know in reality is, whether the apparatus has ever been fitted to the mouth of a patient, and, if so, whether the patient found it satisfactory. I might say the same of all the other objects of a surgical nature exhibited by the dentist, for it is not enough to expose mâchoires in plaster, furnished with artificial teeth, or indicating operations more or less astonishing; it would be necessary, before pronouncing upon the merits of the operator, to examine the patient himself upon whom these pretended operations were performed, and it would be particularly essential to know the final result of these operations.

If, upon the European continent, most practitioners have decided to exhibit artificial pieces and specimens of their operations, it is not the case with English and American dentists. We rarely see them figure among exhibitors, and in the present exhibition we find but a few isolated names of American and English dentists.

What is the reason of this singular contrast, to be observed between the practitioners of the continent and those of England and the United States? Why have the dentists of the latter countries admitted the principle of the impropriety of exhibiting, while the practitioners of the continent seem to seek with eagerness every occasion to make a public display of their different products and artificial pieces? I think the reserve of the English and American dentists, may be attributed to the influence exercised upon them by the instruction which they receive in the special schools of dental surgery; schools where the sentiment of the value and dignity of their profession has been inculcated.

Nevertheless, as much as I believe the principle, that dentists should not appear among the exhibitors, to be well-founded and just, I find it quite right that those who produce the material employed in dental surgery should expose their products. These are objects which bear evidence of their proper value, without its being necessary to resort to other researches in order to appreciate them.

But since dentists have exhibited at the Champ de Mars, I shall conform to the established custom by examining, in this report, the objects which they have displayed, after I have passed in review the much more important exhibition by the producers of dental material.

ARTIFICIAL TEETH.

Among the most indispensable objects for the surgeon dentist, artificial teeth take the first and foremost rank. To produce or manufacture good teeth is an undertaking much more difficult than is commonly supposed. On the one hand it is necessary that, by the choice of the substances employed in the manufacture, the teeth should he of sufficient solidity; and on the other, it is necessary that, by their form, their transparency and color, they should offer a living resemblance to the natural teeth. They must also be light, must resist the variations of temperature caused by the heat to which they must be exposed, and be so arranged as to adapt themselves easily to the different conformations of the maxillaries. To thus combine grace and beauty with solidity and durability is a problem which but few manufacturers have known how to solve.

Therefore, practitioners have, up to a recent period, willingly inserted, on account of their form, lightness, and color, human and animal teeth in place of those that were missing; but the high price of such teeth, and also the facility with which they decompose, together with the fetid odor which they engender, have caused their abandonment in favor of incorruptible artificial teeth. Teeth have been made of the tusks of the elephant and the teeth of the hippopotamus; but as these also deteriorate easily, the preference is now given to mineral teeth, when they are light, solid, and well tinted. Of all the mineral teeth so far invented, those of porcelain are the only ones that combine these qualities. These artificial teeth are composed of two distinct parts---the, base and the enamel. The base is composed principally of feldspar, quartz, and kaolin, and the enamel is a composition of feldspar with some quartz.

The quartz used in the fabrication of teeth is first heated to a white heat, then plunged into cold water, and lastly, reduced by grinding to an impalpable powder.

The feldspar which American manufacturers employ in preference is a very white variety, and is found in abundance at New Bedford, and in the environs of Philadelphia. Like the quartz, it is first exposed to a high temperature and then dipped in cold water; after which it is broken in pieces as regular as possible. It is then separated from foreign substances, and the pieces are reduced to powder in a mortar, or, still better, in a mill. This powder is very fusible, and when baked with quartz or kaolin infiltrates itself as a subtile paste into the mass and renders it translucent. The kaolin used in the manufacture of teeth is first carefully washed; after the coarser part has settled on the bottom of the vessel, the water charged with the finer part is poured into another vessel, to be left there until all the kaolin is deposited, and then the water is thrown off and the precious dust is dried in the sun. Sometimes certain varieties of clay, such as that found in the neighborhood of Baltimore, are advantageously employed as substitutes for kaolin. In preparing the paste, particularly that destined for the enamel, care must be taken that parcels of injurious dust are not introduced into the mass.

When the teeth have been moulded, they are placed in the furnace, and exposed to a temperate heat, which, without vitrifying them, renders them sufficiently hard to receive the enamel. To enamel teeth well is an operation that demands great care. It is necessary to commence by removing the dust carefully with a very soft brush, afterwards applying the enamel, which must have the consistence of a thick cream. When it is desired to give shaded tints to an artificial tooth, an enamel of any tint whatever, generally yellow, is applied upon the crown of the tooth and then coated with another layer of a light color, taking care at the same time to cover over lightly the other parts of the tooth.

To give to teeth of porcelain those fine shades which make them so much in demand by practitioners, different metallic oxides are used. To obtain, for instance, a clear rose tint, finely divided gold is added to the mass intended for the enamel or the base; to have the blood-colored purple, oxide of manganese is introduced; and to give to teeth that grayish tint with the blue shade peculiar to the natural tooth, an enamel containing platinum in its spongy state is added.

Of these different substances employed in coloring artificial teeth, spongy platinum, finely divided gold, and oxide of titanium are the most important. By mixing in different manners these three essential elements, almost all colors and shades required may be obtained.

Artificial teeth are manufactured in France, Belgium, Germany, England and the United States, but it is in the two last-mentioned countries that the greatest excellence and perfection have been attained in this difficult and delicate operation.

The exhibition of the Champ de Mars gives additional evidence of the perfection of the artificial teeth produced in America.

Among the representatives of this branch of industry, Mr. Samuel S. White, successor of Jones and White, of Philadelphia, holds the first rank. The teeth exhibited by Mr. White are of irreproachable manufacture, and imitate nature in a remarkable manner. Their smooth surface, semi-opaque and enamelled, has not that appearance of vitrification so disagreeable in most artificial teeth.

Their form is excellent: they preserve the distinct character not only of the different teeth of the upper and lower jaw, but also of the right and left sides of the mouth. Their tint is a mixture of brown and yellow at the base and of bright and clear enamel on the sharp part of the tooth. They are at the same time light and solid, and a long practice has demonstrated to me their durability and superiority.

The porcelain gum block teeth, exhibited by this house, are of different sizes, and can be, consequently, fitted to every mouth. Those intended to be mounted upon hardened caoutchouc are provided with a headed pivot which prevents them from being pulled away from the base.

Among the American artificial teeth, those of Messrs. Johnson and Lund, destined to be set on caoutchouc, are distinguished by their natural appearance.

In a small box, of modest appearance, may be seen admirable artificial teeth, which constitute a new invention, and could not be too highly appreciated by practitioners. These are teeth exhibited by Mr. Samuel S. Stockton, of Philadelphia, teeth with mineral pivots and transversal holes, excellent products of this house, established for more than thirty years.

Messrs. Ash & Son, of London, have exhibited artificial teeth that rival in many respects American teeth, of which they imitate the enamel and form, without, however, entirely attaining the same perfection. Their plate teeth especially approximate to those of Mr. White, from Philadelphia, and their gold foil is very remarkable. The establishment of Messrs. Ash readers great services to European practitioners by the considerable assortment of artificial teeth which it places at their disposition.

Messrs. Ash & Son are entitled to the gratitude of the profession, not only on account of the varied selection which they offer, but also because of the zeal they manifest in constantly perfecting their productions.

Among the French exhibitors MM. Hôpital, Poirier, and Billard have exposed artificial teeth. Those of M. Hôpital, of Paris, imitate American teeth well enough, and possess over them the advantage of cheapness, but have neither their beauty nor solidity.

The teeth exhibited by Lemale, of London, are distinguished by their form and the beauty of their color, and Mr. Crane's artificial teeth made by hand are well worked.

DENTAL INSTRUMENTS AND GOLD FOIL.

Among the objects also exhibited by Mr. White is a case of instruments for dentists, which contains various articles, including some excellent forceps. All these instruments are as elaborate as ingenious; they are even injured by a too great finish, and a luxurious ornamentation which seems to me misplaced. Why, indeed, is it necessary to ornament with fine stones and incrustations, forceps, and other instruments required for constant use by the dentist?

The gold foil and spongy gold of Mr. White are also excellent productions.

The gold medal accorded to Mr. White is, in my opinion, only a just recompense for the excellent services rendered by his house, which employs 300 workmen, has more than 100 agents in Europe and the United States, and has received at home and abroad, at different exhibitions, more than 40 prizes or medals.

As I have just mentioned instruments of dental surgery and gold foil, I add a few observations upon these two articles. The manufacture of instruments of dental surgery offers so many and so great difficulties that few manufacturers have, up to the present time, succeeded in giving them all the desired perfection. In order to prepare the steel it is preferable to employ iron of Swedish production, and to give to the instruments a particular temper according to the use proposed to make of them.

To temper steel it is necessary to first harden it as much as possible, and then to soften, or "draw," this hardness to the degree required by exposing it to the action of heat. The degree of heat differs according to the temper desired and the color which the steel is to possess: at 570° Fahrenheit, a steel well tempered and of a handsome blue tint is obtained; at 400° a straw-colored shade strongly tempered is secured.

Among the instruments used by the dentist the forceps form a specialty in which manufacturers rarely excel. Until lately, the best were produced in the United States; but Mr. Everard, of French origin but established at London, is today manufacturing forceps which rival those of America. Instruments for filling teeth are most delicate articles, and their fabrication demands much caution and attention. They are of varied forms and temper. Some must be very hard in order to cut the enamel; some flexible and elastic to be adapted to special cases, while others must terminate in files or serrated points. Mr. Chevalier, of New York, Mr. Gemerie, of Philadelphia, and several others in America, excel in this kind of manufacture. The instruments of dental surgery which are made in England are well tempered, and the dentists' files fabricated by Mr. Stubbs, of Birmingham, especially enjoy a great reputation. It is proper to add that, since the last Universal Exposition, the French manufacturers have made remarkable progress in the production of certain instruments particularly destined for dental surgery. It may even be said that the French files of the present day are nearly as good as the English.

The dentists' files of M. Romelin, of Paris, are very well made, and deserve to be recommended to the attention of practitioners.

As to the key covered with caoutchouc, which is seen in the show-case of M. Duchesne, I must say that it is a very old invention The hook (crampon) which he exhibits is of a model similar to that of the jaw of the American forceps.

M. Gion, dentist of Paris, exhibits an obturator which appears to me to offer some advantages in operations upon the palate in cases to which it is applicable.

The apparatus for cauterizing, presented by M. Poirier, must offer serious inconveniences in practice. The instruments of dental surgery exhibited by M. Canali, of Pisa, are skilfully wrought.

Cadi Effendi, of Cairo, has also sent some of his products to the Universal Exhibition, but the surgical instruments which he offers for admiration are for the most part out of use to-day.

In dental surgery gold under different forms is used, whether intended for filling teeth or for entering into the composition of the many artificial pieces. For these pieces the operator should employ pure gold, or, at least, never any below 18 or 20 carats. For filling teeth, spongy and shredded gold are often used; yet gold leaf is more frequently resorted to. Of this latter there are several varieties to be noticed, known to the profession as cohesive, adhesive, and non-adhesive gold.

The manufacture of these different varieties is difficult; for it is necessary that the metal, although very soft and malleable under the hand of the operator, should nevertheless offer sufficient resistance and plasticity to adhere while cold, to settle solidly in the cavities, and adapt itself regularly to the sides of the teeth.

There are varieties of gold which are suitable more particularly for the preparation of gold leaf. Gold reputed pure is not, in all absolute degree, always so; for there is a certain license in commerce which, for that metal, varies from one to two thousandth parts; and in gold commercially pure, particles of foreign substances, such as iridium, are found, which are difficult to separate from the gold.

In order to obtain the metal perfectly pure it is necessary to precipitate the gold chemically and remelt it afterwards. The anvil upon which the gold leaf is beaten should present a surface perfectly clean, smooth, and brilliant as that of a mirror. The hammer used should likewise be clean and free from all rust. Otherwise, in beating the gold the oxide of iron would mix mechanically with the precious metal and deprive it of the properties which recommend it to the use of the practitioner. It is proper also to beat gold in a well-aired room where there is no dust which could introduce itself in the metal. Care should be taken in regard to the crucibles used for melting the metal. They should not contain any traces of metals, for the purest gold melted in defective crucibles would lose something of its purity. Preserving gold leaf in tin cases must also be avoided, because they seem to have an injurious influence upon it, rendering it brittle, &c. It is only by following all these directions and observing these precautions that one may succeed in preparing a gold-foil which will answer the purposes required.

Mr. Abbey, of Philadelphia, sustains, by the gold leaf which he exhibits, the old reputation of his house, whose products, for the last twenty years, have surpassed all other manufactures of the same nature. This gold possesses all the essential qualities for filling teeth with success, whether it is wished to employ it without annealing, or to render it adhesive by submitting it to an elevated temperature. It has great uniformity of thickness, tenacity, coherence, softness, and a sufficient ductility.

M. Varentrapp, of Frankfort, also exhibits beaten gold which seems to me to be well prepared.

VULCANIZED CAOUTCHOUC.

After having spoken of artificial teeth, of gold leaf; and some other objects exhibited in the palace of the Champ de Mars, I think it my duty to mention a substance which has been rapidly brought into extensive use in dentistry, and which may be seen in nearly all the exhibiting cases at the Exposition: I allude to hardened or vulcanized caoutchouc. In a special brochure upon the discovery of this substance, and destined to establish my claims and rights to priority in the invention, I explained the good services rendered by it in a great number of buccal operations. I mentioned several cases where I had successfully substituted this substance for inferior and superior maxillary bones broken by fire-arms or other weapons.

I had thought, with all the American dentists, that artificial pieces offering the best conditions of use and durability were those made by means of metallic plates and mineral substances, such as porcelain.

On my arrival in Europe I remarked with surprise that in England and upon the continent most dental practitioners were using pieces of bone, of ivory, or of hippopotamus' teeth. First among the principal qualities of bone must rank that elasticity of fibre very analogous to that of the osseous tissue of the human frame, and also the fact that its specific gravity is less, rendering the contact of the pieces in bone softer to the gums than a composition of metal and enamel. These truths were evident beyond all question, yet at the same time I was compelled to notice faults and defects in its use which seemed to more than counterbalance its advantages. A set of teeth in bone, attacked by the salivary secretions, soon changes color; the substance decomposes, is affected injuriously, and must be frequently replaced.

A comparative study of the advantages and inconveniences of these two systems of artificial work determined me to institute, in the interest of humanity, a series of experiments tending to the discovery of some material which, uniting the advantages of the two systems, should offer a permanent resistance to the action of the fluids of the mouth, while at the same time it should possess the lightness and elasticity of bone in its natural state. One of the substances to which my examination soon led me was caoutchouc. I then sought with perseverance the means of modifying its color and elasticity.

Not knowing then, as I do not know to-day, whether researches similar to my own had ever been made, I devoted to these studies the first part of the year 1848, profiting in that manner by the leisure which the events of that period [NOTE: The revolution of February, 1848.] gave me.

Knowing previously that sulphur is but very little modified or decomposed in the mouth, the knowledge of this fact led me soon, by a very natural induction, to the idea of combining the caoutchouc with sulphur. After different experiments I thought of the application of dry heat, and succeeded in obtaining a substance hard, black, and possessing the elastic properties of horn. One of the first specimens was at that time carefully placed by the inventor in his secretary with the inscription: "I am seeking for ivory; I find ebony." Later, by employing moist heat, then steam or vapor, I obtained still more satisfactory results. In a word, the specimens of the composition which I finally succeeded in producing were in every particular similar to the vulcanized caoutchouc used to-day; the color alone was not so brilliant, and this defect I sought to correct from that time by the employment of different coloring substances.

From 1848 I continued my experiments in order to make advantageous use of caoutchouc in dental surgery. The discovery of caoutchouc, although comparatively recent, has nevertheless rendered surgical operations easier, which, before this discovery, offered remarkable difficulties. In my opinion, this substance is advantageously used when the molar teeth are to be very high, in a set for both jaws; then especially when the alveolar absorption has been very considerable in the under jaw; and, lastly, when, by reason of this absorption, it has become necessary to remodel and to restore the primitive conformation of the mouth and face. The use of caoutchouc is likewise advantageous when, on account of wounds or surgical operations, a fragment of bone has been carried off or removed amid it is necessary to remedy this defect by artificial means.

There are still other cases where the use of hardened caoutchouc has given results which, I believe, could not have been obtained by employing any other substance; those cases particularly where, the bone having been fractured, it is necessary for the operator to replace it with a substance having the consistency of bone, in order to give a sufficient protection and support to the soft parts. Immediately after the Crimean war I had occasion to attend several French and Russian officers wounded at Sebastopol. The left part of the lower jaw of one of these wounded Frenchmen had been entirely fractured, and a large portion of the bone lost. I substituted a preparation in caoutchouc for the maxillary bone; and, owing to the facility with which this substance is adapted to every form, I succeeded entirely in restoring the damaged part, and in rendering to the face its original form.

A similar but more serious case was presented during the Italian war, after the battle of Solferino. While I was visiting the hospitals upon the field of operations my attention was called by the Minister of War to an officer whose maxillary bone of the upper jaw had been completely carried away by a ball. His condition, at first alarming, improved afterwards; but the nature of the wound prevented him from speaking. After the cicatrization of the wound I applied an apparatus in caoutchouc which, supplying the place of the maxillary bone, gave to the face its natural form, offered a protection to the soft parts, and restored to the wounded man the power of speaking. Many other analogous cases having come under my observation I have been enabled very often to employ hardened caoutchouc with success.

Still more recently I had occasion to perform an operation similar to the one I have just cited. During the last Polish insurrection a Russian general, well known, had his jaw badly shattered by a sabre cut. In this case again I succeeded in replacing the maxillary bone by all apparatus in caoutchouc, giving the face its original form, and at the same time restoring to the patient the power of speech.

An application of hardened caoutchouc not less fortunate has also been made in the United States. It is remembered that at the time of the assassination of President Lincoln, Mr. Seward, Secretary of State, was also the victim of an odious attack. He had the jaw broken by the arm of the assassin. After numerous endeavors without satisfactory results, the jaw was at last successfully restored by the application of an apparatus in caoutchouc.

One of the essential advantages of this substance---an advantage which cannot be too highly appreciated in a surgical point of view---is that one may give to it hardness or elasticity, according to the degree of heat to which it is exposed. It is proper also to remark that it is an inoxidizable and incorruptible substance, and consequently remains unaltered by the contact of the flesh, which it does not irritate or envenom like most of the metallic apparatus formerly employed. We cannot too highly praise the fortunate application made of it by a great number of surgeons, especially in America, where this substance is constantly employed for the manufacture of artificial pieces. In these last-mentioned cases hardened caoutchouc recommends itself by a new property in addition to the many others it possesses: that of being easily mixed with coloring matters so as to acquire the appearance of flesh. When colored in this manner an artificial dental piece may be made of it, or it may be substituted, with excellent results, for some soft part, damaged or defective.

The dark brown caoutchouc, hardened, is a compound of 66-2/3 of caoutchouc and 33-1/3 of sulphur; for the red color, 44 parts of caoutchouc, 32 of sulphur, and 23 of vermilion are employed; to obtain lighter or darker shades, zinc and earthy substances are added, according to circumstances.

Another quality which recommends the hardened caoutchouc to the surgeon's attention, in special and difficult cases, is the property it has of taking, by a proper moulding, the exact form of the bones or parts proposed to be replaced. All these properties of caoutchouc have made of it an excellent substance for preparing artificial palates. They were at first made with soft caoutchouc; but recently, and especially through the initiative of Dr. Bogue, of the United States, the lower part---that is to say, the principal part---is composed now of hardened caoutchouc and the upper of the ordinary substance.

These are the principal advantages gained by the use of artificial pieces of hardened caoutchouc. Constantly occupied for many years in perfecting the application of this substance to buccal surgery, I was curious to see what were the improvements made in this material since the day when first I had the idea of applying it to dental operations.

I will say that, after all attentive examination, I have not been able to discover any striking modifications in the composition of the substance, but it cannot be denied that some progress has been made in its coloring. All those who have been able to satisfy themselves of the blessings that the discovery of this substance has guaranteed to all classes of society must feel gratified in remarking that, except a few unprogressive or obstinate practitioners, all the dentists, to-day, use hardened caoutchouc either to replace bones or soft parts of the mouth, or to serve as the base for artificial teeth.

ARTIFICIAL PALATES AND SETS OF TEETH.

In many show-windows are found specimens of remarkable operations, but the more astonishing I find the models exhibited, the more perplexed am I to judge them. To substitute artificial pieces in place of maxillary bones, to rectify defects of the mouth and jaw, are delicate and difficult operations, but to judge them it is not enough to examine attentively the jaw exposed upon which the dentist has operated. It would be indispensable to know whether these difficult operations were timely and satisfactory,, whether they accomplished the end desired, and, in a word, whether the patient has had cause to congratulate himself upon the result of the operations which he has undergone. Therefore I repeat that in the presence of these facts no opinion as to the merit or success of the operation can be formed.

MM. Jacowski and Debray have exhibited specimens of operations where the maxillary bone has been substituted by hardened caoutchouc, and M. Debray, of Paris, has placed in his exhibiting case a good piece of vulcanized caoutchouc, replacing the maxillary bone.

M. Preterre, of Paris, has exhibited numerous sets of teeth and artificial palates, as well as buccal pieces, very well assorted.

The artificial pieces exhibited by M. Dejardin present a great similarity to those of M. Preterre.

Mr. Nink also has produced some good pieces in hardened caoutchouc.

Mr. Weber, of Paris, exhibits specimens of black caoutchouc, which, being prepared without coloring matter, is lighter, more durable, and elastic. His preparation, which he furnishes to practitioners at moderate prices, is of great service.

M. Paul Boyer has exhibited artificial pieces like most of his confrères of Paris. He has also added to his collection machine tools of his invention. His air-tight furnace for warming, without explosion, the earthen vessels (moufles) which serve to receive the caoutchouc during the process of vulcanizing, is without doubt a very ingenious apparatus, but, I fear, will not render to the practitioner the services expected by the inventor.

The artificial pieces of Duchesne, in gold and caoutchouc, are superior to many other exposed in neighboring cases.

M. Rony exhibits pieces carefully made; still there are too many embellishments in his artificial preparations. What is the good of carving or covering with ornamental incrustations pieces which should be, on the contrary, very simple and plain, since they are to come in contact with the soft parts of the mouth?

But what is the object of the exhibition by M. Trousseau, of Rennes, editor in chief of a journal (the Abeille) devoted to dental surgery? I am astonished, I confess, that the chief editor of a journal pretending to be scientific should determine to exhibit.

As to the dentists of Germany, Austria, Belgium and Spain, the products which they exhibit are in no respect superior to those of their French confrères.

Mr. Eberman, of Prague, and Mr. Peffermaun, of Vienna, exhibit some artificial pieces which, although heavy, are of a tolerably fine appearance. The dental board exhibited by Mr. Antoine Bousquet, of Valencia, in Spain; presents nothing striking; and the artificial work of Mr. Furtado, of Portugal, although pretty, is not superior to many similar productions.

Mr. Genotte, of Brussels, shows sets of teeth without springs, which appear to be of good construction.

Mr. Moore and Mr. Allen are among the small number of the dentists of America who decided to exhibit.

The teeth filled with gold by Mr. Moore do not constitute a new application.

Mr. Allen, of New York, shows pieces of continuous gums which, having to be put upon platinum, become heavy, but are incomparably the most beautiful pieces exhibited.

ANESTHETIC APPARATUS.

In painful operations the surgeon dentist willingly employs anesthetic agents.

Among these, ether and chloroform have been until lately the most often employed. Ether produces upon the nervous system an action similar to that of narcotics, while the insensibility determined or effected by chloroform is largely the result of a suspension of the respiratory function. The inhalation of ether and of chloroform often causes serious consequences, and sometimes produces the death of the patient to whom it is administered. Consequently surgeons, and more particularly those of the United States, have carefully sought some other substance capable of producing local or general anesthesia and free from the dangers incurred by the use of ether and chloroform.

I have observed in the United States collection in the Exposition of the Société de Secours aux Blessés. an apparatus for the production and administration of nitrous oxide gas, exhibited by Dr. J. Q. Colton, of New York. It is but just to observe that through the efforts and researches of Dr. Colton, the attention of surgeons has recently been directed to the protoxide o azote or nitrous oxide gas. To Horace Wells, an American dentist, belongs the credit of having first demonstrated the anesthetic properties of this gas, several of whose peculiar qualities had been previously discovered by the celebrated English chemist Humphrey Davy.

But the discovery soon after of the same properties in ether caused the really original discovery of Wells to be quite forgotten until Dr. Colton had re-established by thousands of experiments the superiority of the protoxide of nitrogen gas over other anesthetics in dental surgery, particularly in operations which may be promptly effected. The gas has recently been even employed with success in Paris under my own direction, in the gravest surgical operations. The protoxide of nitrogen, composed of 36.4 of oxygen and 63.6 of azote, can be inhaled without any danger, when it is perfectly pure, and while breathing it, one feels more or less its agreeable sensations. Much and ingenious apparatus has been constructed in America for the preparation and inhalation of this valuable anesthetical substance.

M. Duchesne exposes apparatus for local anesthesia which appeared to me ingenious and well prepared. I must add, however, that M. Favre, of Paris, manufacturer of surgical instruments, claims priority in the invention; and, besides, this instrument appears to be a modification of Richardson's, of London.

There is still a large number of exhibitions made by dentists at the Champ de Mars, which I have failed to mention; it would be superfluous enumerate all, as the objects which they expose do not offer any notable differences. Here and there are samples of operations more or less authentic, and everywhere artificial teeth. set with more or less elegance; everywhere boxes and bottles containing marvellous powders and waters whose virtues it is impossible for me to state, but there is seldom any important discovery destined to promote the progress of dental science.

While declaring myself incompetent to render a judgment upon the powders and elixirs, which I have not been able to examine closely, I am far from denying the great importance of these articles in the practice of dentistry. The hygiene of the mouth is an essential thing for the preservation of the teeth, and, consequently, of the health in general.

The production of dentifrices and elixirs has lately developed rapidly, particularly at Paris, where it has attained considerable importance, by reason of the quality of alcohol prepared in France and the abundance of the article in the markets. In the manufacture of elixirs and tooth-powders one should have in view the employment of suitable medicinal substances concealed by materials fragrant and agreeable to the taste.

So long as manufacturers do not disregard this principle, one should, for the sake of hygiene, encourage rather than impede this trade.

Such is the dentist's exhibition at the Champ de Mars. I think that all those who study it carefully will agree with me in expressing the opinion announced at the commencement of this report, viz: that the dentist has no more reason or claim to appear among the exhibitors than the physician or surgeon.

Perhaps this report may also have shown how numerous and interesting are the trades connected with dental science. If it has accomplished this much 1 shall have fully attained the end which I had proposed.


Part Three

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