THE 
MINUTE ANATOMY OF THE TEETH 
IN THE LIGHT OF THE 
BIOPLASSON THEORY. 
BY /s' 
GAEL HEITZMAKff, M.I)., 
-AND- 
THE MINUTE ANATOMY, 
PHYSIOLOGY, PATHOLOGY, AND THERAPEUTICS 
OF THE 
DENTAL PULP. 
BY 
C. F. W. BODE OK ER, D.D.S., M.D.S. 
[liEPRIpfBD FJWM-THE DENTAL COSMOS.] 
PHILADELPHIA: 
fPtfus's of Patterson & White. 
1882. _ THE MINUTE ANATOMY OF THE TEETH 
IN THE LIGHT OF THE 
B I O PL A SSI) N TIIEOR Y. 
BY C. HEITZMANN, NEW YORK. 
(Address before the New York Odontological Society, February, 1882.) 
Mr. President—Gentlemen of the Society: It was with great 
pleasure that I accepted the invitation to bring before you a subject 
which, it seems, gains more interest from year to year. It is my 
purpose to say a few words about the general bearing of the new 
doctrine which I had the honor to promulgate about ten years ago. 
It was your profession (thanks to noble-liearted men such as Dr. 
Atkinson) which first gave cordial recognition to my work. My 
laboratory was favored especially by dentists, and, without boasting, 
I can say that most of the work in the investigation of the anatomy 
of the teeth which has been done in the last few years, has emanated 
from thence. 
You all knbw, Gentlemen, what the cell theory meant. I don’t 
wish to say much about it. Y’ou all have learned what the cell was 
thought to be. Gradually, however, all the assertions concerning 
the nature of the cell were found not to be in accordance with the 
facts observable under the microscope; so much so that about ten 
years ago Drysdale, of London, said, ‘-A cell is like a gun-barrel 
without a gun and a lock.” It was denied that its contents are 
liquid, then it was denied that a nucleus was essential, and then 
everything was denied; still, one thing was kept—that was the 
name. It seems that later observers, and particularly Germans, 
thought it a necessity to adhere to that word, to which no meaning 
could be attached, for twenty years. 
I wish to commence with the statement made at the beginning of 
the seventh decade of our century,—by Beale, of England, and Max 
Schultze, in Germany. Lionel Beale in 1860 offered a very plausible 
theory concerning the strujfctujre*<3f Hhe ):t|s|iifes. Unfortunately, 2 
however, his microscope, although enlarging very much, showed him 
very little. In his publications, for instance, an amoeba was depicted 
of the diameter of a thumb-nail; there was a central nucleus, and 
all the rest of the amoeba was structureless. A year later Max 
Schultze issued the protoplasm theory; he claimed that the real liv- 
ing part of the cell is not a liquid, but a jelly-like mass—for which he 
proposed the term protoplasm—endowed with a nucleus and exhibit- 
ing granules. In his idea the constituent elements of the cell were 
a semi-fluid mass holding a central nucleus and a certain number ol 
granules. 
In the same year a critical mind (E. Briicke) said that we have no 
right to maintain that a nucleus is an essential part of the cell, inas- 
much as all of us know that there are a great many so-called cells 
that are destitute of a nucleus. The idea developed, especially with 
Strieker, that even the granules were not essential; perhaps these 
were secondary productions, perhaps they were taken into the pro- 
toplasma from outside; everything that was left was the jelly 
endowed with life. 
All these gentlemen, of course, knew that a body devoid of struc- 
ture could not exist; and if said structureless, they meant, in 
all probability, that the structure was not perceptible. Such was 
the condition of things when, in 1872, I took up the study, and, as 
you perhaps all know, started with the most elementary formation of 
life—with amoebae. 
I discovered a delicate reticulum pervading the whole mass called 
at that time protoplasm—a reticulum which, whenever the nucleus 
was present, was ih direct union with it and produced an investing 
thin layer around the amoeba. This layer is by no means identical 
with the membrane of the cell, inasmuch as it admits of a great 
degree of stretching. When I saw this reticulum, with its points of 
intersection, changing its shape, growing, in certain conditions, 1 
said, “Here is a formation in the protoplasm which is possessed of 
all the properties that are necessary for the condition of living mat- 
ter, viz.: motion, change of shape, and growthand I concluded that 
the solid nucleus, the threads emanating from the nucleus, the 
granules serving as points of intersection, and the investing layer 
are the real formations of living matter, while the liquid contained 
in the meshes is destitute of life. 
The mass of the amoeba, as you know, changes its shape by pro- 
truding offshoots, and creeps through the field of the microscope. 
I concluded there was contraction of the reticulum from the fact 
that the granules grew larger at a certain part of the amoeba, the 
meshes became narrower, and the liquid was driven to another por- 
tion of the amoeba, which is inclosed by a continuous layer of living 3 
matter. The liquid driven to the opposite portion produced a 
stretching of the reticulum, which I termed extension. 
All this seemed to me a settled fact, and was published as such, 
but no attention was paid to it, although some observers had seen 
the reticular structure before me, and in different objects. This 
was true of Nasmyth. I was astonished to see his figures, pub- 
lished in 1839, showing this reticulum in the formation which covers 
the crown of the tooth. In 1868 Frommann demonstrated the reticu- 
lum in the so-called ganglion-cells of the brain, as did others in dif- 
ferent places, but none of these observers understood its significance. 
I was the first to maintain that all that which was formerly termed 
protoplasm was endowed with reticular structure. 
When, at the close of the year 1874, 1 left Europe in disgust and 
despair and came to this country, I found here the heartiest support 
and encouragement. The first proof of the existence of the reticu- 
lum was given by J. J. Woodward, who, without knowing anything 
about its presence, made micro-photographs, and these plainly exhibit 
the structure. Dr. Louis Elsberg early expressed concurrence in 
this view, based upon studies in my laboratory; he first proposed a 
new name for the designation of this theory, and that is “ The Bio- 
plasson Theory,” in contradistinction to which means 
something formed, while Moplasson means the forming or living 
matter. 
The word cell after this discovery, of course, became worthless, and 
it was Elsberg who proposed for the word cell the word plastid, or 
bioplast. I give preference to the term plastid; the word, however, 
does not matter if we only know what is meant by it. To-day there 
are two dozen of the very ablest microscopists, both abroad and in 
this country, who have seen the reticulum, and who fully agree with 
me and give me the credit for its discovery, as being the general 
rule in any bioplasson formation. Strange to say, however, from 
certain parties some little opposition is made. 
A microscopist of this city publicly announced that he had never 
seen the reticulum, kindly adding that very probably his microscopes 
were not good enough to enable him to do so. Lately Dr. Lester 
Curtis published an article on this subject, and stated that he did 
not see the reticulum. This is a very modest way to announce 
that one cannot see what another can. If a person publicly con- 
fesses that he cannot play on the piano a master-piece of Liszt’s, 
we are all willing to believe it; but does it follow that others can- 
not play the piece either? What is gained by such a confession? 
Dr. Curtis gives illustratons of what Elsberg and I have said and 
seen, and of what he could not see. I mention this because you are 
all prepared to understand that delicate observations of this nature 4 
are not easily made by every one. A great many look in the micro- 
scope, but very few can see. If one of you who bad never played 
the violin were handed a good violin and told to play a tune, he 
would say, “I can’t.” Let him practice for a few years, and learn to 
play a tune. It is very much the same with the microscope. If 
you look in for but a short time, you cannot see. It required more 
than fifteen years’ application to enable me to see what can readily 
be seen, and if a tyro comes and declares that he cannot see, I do not 
think such assertions should be taken as proofs against facts cor- 
roborated by others more experienced. 
According to the new views, the structure of the plastid is a very 
complicated one. indeed, we are astonished to see that every particle 
of a plastid—its smallest portions, for instance granules thrown off— 
floating about in a liquid, is endowed with all the properties that 
formerly were attributed to plastids; that is, motion and growth. We 
become convinced that it is not the plastid which is the elementary 
organism, but the granule of, living matter; and this is considered 
as elementary only for the reason that our microscopes do not show 
more. If in time to come our lenses shall be constructed of better 
refracting media than glass (of diamond, for instance), perhaps we 
may discover more than we know at present. 
These are the essentials of the new doctrine concerning the struc- 
ture of “ protoplasm.” New views were also obtained concerning 
the structure of organisms ever so highly developed. It has been 
demonstrated that the body is by no means composed of isolated 
elements, so-called cells, as it was formerly thought to be. The 
best observers have held that the body was composed of a great, 
number of individual cells, much in the way that a house is con- 
structed of bricks—put together by cement. The bioplasson theory 
suggests that in the tissues of the body thei'e is no such thing as 
an isolated cell, but that the tissues from the crown to the heel 
are one continuous mass of living matter, mainly in a reticular 
arrangement. Only the closed cavities of the body, the lymph- 
and blood-vessels, contain in a fluid isolated bodies in the shape of 
lymph- and blood-corpuscles, etc. In this view, therefore, the body 
is constructed like an engine in which all parts, though independent 
to a certain degree, are connected with one another so as to build 
up a continuity and render even the organism of man a grown 
complex amoeba. 
In this complex body there are portions of the living matter 
serving in the nerve action; portions in the building up of the 
lungs; other portions serving for motion. There are portions for 
the support of the bodjq such as the bones; others serving as tools, 
such as the teeth. 5 
The new bioplasson view has thrown light upon the mode of devel- 
opment of the organism. Gradually the fact has been acknowledged 
that there are at first three layers or leaves from which all tissues 
arise, the name epiblast designating the upper layer, mesoblast the 
middle, and hypoblast the lower layer. Our best modern embry- 
ologists have asserted that the nervous system, of which the first 
trace is visible close below the epiblast, is a festooning of the epi- 
blast. In this view the outer covering of the body would give rise 
to the nervous tissue, the most active tissue of the body—the brain 
and spinal cord. 
In the bioplasson view the impregnated germ is nothing but an 
amoeba flattened out, as it were. We have an upper investment of 
the amoeba representing the epiblast, and a lower investment, the 
hypoblast, while the main mass of the body represents the m§so- 
blast. 
In the amoeba a so-called vacuole may appear temporarily, which 
is again inclosed by a thin layer of living matter, and we observe a 
closed space in the mesoblast—the first trace of the future heart. 
As in the amoeba, the vacuole contains a number of isolated granules, 
—the first-formed blood-vessels, containing the blood-corpuscles. It 
is the mesoblast only which holds blood-vessels; the epiblast and 
hypoblast and their derivations will never show blood-vessels. In 
this view, therefore, the entire body is constructed of only four kinds 
of tissues, three of which, viz. : the connective tissue, the muscles, 
and nerves, arise from the mesoblast. 
The connective tissue, among other functions, gives support to the 
whole body in the shape of the skeleton, and serves in the process 
of mastication in the shape of teeth. 
The elements of the epiblast and hypoblast are called epithelia, in- 
vesting the outside of the body and the cavities which are in direct 
or indirect communication with the outer world. 
If you compare, Gentlemen, the bioplasson doctrine and its de- 
velopments with what Beale has said, you will at once see the differ- 
ence. 
Beale claims that in the fully-developed organism the greater part, 
or. at least, a very large part, of the body is destitute of life. He 
asserts that the living matter is represented mainly by the nucleus, 
whereas the tissues are formed material, and not alive. He claims 
that the most active tissues of the body, such as muscles and nerves, 
are formed material. This is the very objection that Bastian has 
raised against the teachings of Beale. In my view, every tissue is 
alive except the horny material, epidermis, nails, and hairs. We 
cannot conceive of a part of a living body destitute of life. Even in 
the comparatively inert tissues of the body, in the connective tissues, 6 
the bone, and cartilage,—the whole is pervaded by a reticulum of 
living matter. 
The new bioplasson theory suggests that there is the greatest 
amount of living matter contained in this mass. We readily 
understand by examining the muscle the reason why it moves; it 
is essentially upon the plan on which the amoeba moves. The 
nerve-tissue, Beale suggests, is formed material. We say it is 
living material of a very concentrated form, and thus we under- 
stand and get an insight into nervous activity, which is based 
entirely upon the motion of this delicate reticulum. The new 
doctrine suggests a number of facts, so far in full harmony with 
all our observations. The connective tissue is characterized by 
the presence of what is formed, or the glue-yielding substance. 
Not every variety is glue-yielding. Some of these substances seem 
like glue, and others, upon being boiled, give a gelatinous liquid, 
but not sticky; these are only special varieties of one and the same 
substance. 
The new theory suggests that the inert basis-substance arises 
from the liquid present in the meshes of the bioplasson reticulum, 
which, although concealed in the basis-substance, remains unaltered. 
The four varieties of connective tissue are the jelly-like myxoma- 
tous, the fibrous, the cartilaginous, and the bony. All these varie- 
ties have their representatives in the tissues constituting the tooth, 
and in the tissues attached thereto. The myxomatous tissue, the 
best representative of which is the umbilical cord, is present in the 
pulp of the tooth. The fibrous connective tissue, the best repre- 
sentative of which is tendon, being dense, firm and striated, we 
find about the tooth in the pericementum and periosteum. The 
cartilaginous tissue is not directly involved in the formation of the 
tooth, but it gives rise to the jaw-bone, and plaj-s an important 
part in the formation of the jaws; while the bony tissue is of the 
greatest importance, inasmuch as it furnishes the sample of the 
structure which, with some variations, is found in the formation of 
the tooth. 
In 1873 I first asserted that all the various connective tissues are 
provided with living matter. So great was the surprise of the 
learned world at these assertions that several years afterward 
Frey, of Zurich, who wrote a book, tried to ridicule the whole 
thing and to kill me off by placing me in a foot-note in bis book. 
Of course, it is easy enough to ridicule assertions so long as we are 
not satisfied that they are correct, but if they prove to be correct 
such practice becomes very dangerous. 
Strieker, of Vienna, in whose laboratory I executed much of my 
work in 1873, saw most of m37 specimens, although I did not care much 7 
for his opinion. He was slow in accepting my assertions, but four 
or five years ago he published an article claiming that the reticulum 
was present in the nucleus. Last year he surprised me with a copy 
of his latest publication at that time, wherein he corroborated the 
presence of the reticulum in salivary corpuscles; more than that, 
he asserts that the reticulum is present in the cornea of the eye, 
and that where at one moment is protoplasm, after a while basis- 
substance will be seen, and, in the place of basis-substance, after a 
while will be seen protoplasm. 
In Strieker’s laboratory Spina, two years ago, made the won- 
derful discovery that this reticulum existed in the cartilage,—some 
thing that I published in 1872 and 1873. He discovered a new 
method for its demonstration,—namely, treatment Avith alcohol, 
a method so simple that to-day even a child can see the reticulum 
in cartilage. 
Meantime, I have not been idle. In the past seven years I have 
demonstrated all that to hundreds who were desirous to learn some- 
thing about the new theory. It seems to me that what we have 
done in the past seven years in this country carries us quite ahead 
of the old world ; Ave ha\re become the leadei’s in this line of inves- 
tigation. 
As regards the bone-tissue, the idea was prevalent for a number 
of years that there Avere in it spaces filled with liquid, but nothing 
was known about the seat of life in the bone, for this reason: that 
a discrimination between the living and dead (necrotic) bone was 
impossible. 
VirchoAV thought that the cells, which at that time were identical 
with the lacunae, were the seat of life, although in his view the cells 
contained a liquid. With our modern views, it is hardly necessary 
to say that a liquid is never endowed Avith life. In 1870, in Strieker’s 
laboratory, it Avas first found that the lacuna) of the bone-tissue held 
protoplasm. In our present vieAvs the bone is not only supplied with 
living matter, with plastids in the lacuna), but also the offshoots of 
the lacuna?,—the canaliculi,—contain delicate filaments of living 
matter connecting the plastids; thus the bone-tissue is rendered 
an uninterrupted reticulum of living matter just as is any other 
tissue. 
And now a few Avords concerning the minute anatomy of the 
teeth. 
The manner of examining the tissues of the teeth in former 
times Avas like this: the tooth Avas allowed to dry ; it was then split 
into thin lamina) by means of a saw ; these Avere then ground down 
by means of a stone. In specimens thus obtained the lacunae of 
the cement, the canaliculi of the dentine, necessarily looked black, 8 
owing lo the presence of a little air and some extraneous matter, 
but not the least idea could be obtained in this way as to the 
contents and the formations of living matter which enter largely 
into the construction of the tissues of the teeth. The first neces- 
sity, therefore, of research in the new direction was to devise 
a new method of preparing specimens for investigation, and this 
was found in the use of chromic acid for softening the teeth. This 
proved to be a powerful reagent for extracting the lime-salts of 
the tooth and for preserving, at the same time, its soft parts. It 
Avas introduced by H. Muller, in 1868, for preparing bone. All pre- 
vious observers were satisfied to examine dry hone as Avell as dry 
teeth, forgetting that such dried material could not he useful for 
study, as it merely showed the frame of the former tissues, and 
not the tissues themselves. If. on the contrary, the soft parts he 
preserved and retained so as to be visible with high amplifications, 
they are in the best possible condition for the observation of new 
■facts concerning their structure, which is the case with the speci- 
mens prepared by the use of chromic acid. Enamel, however, 
never could be softened by this means. For the study of enamel 
we took a freshly-drawn tooth, and, keeping it moist in order to 
preserve the soft parts, ground it thin by means of the way for- 
merly adopted. The new facts obtained by this simple way are 
to-day well established. 
All sensible dentists must have been aware of life in the tooth ; 
the simple fact that eating a sour apple AA’ould produce a certain 
effect upon the teeth—“setting them on edge’1—has occupied the 
attention of thoughtful men for a long time. Some lia\re spoken of 
the chemical action of the acid on the enamel, others of the conduc- 
tion of the acid down to the pulp-chamber: but all that was unsat- 
isfactory. Certainly every dentist must have observed that the 
living dentine is endowed with a high degree of sensibility, espe- 
cially in certain places; for instance, at the boundary line between 
the dentine and enamel at the neck of the tooth. Many other facts, 
the reaction upon filling, the so-called solidification around a filling, 
could not be explained by the former view. Tooth was considered to 
be cartilage Avith infiltrated lime-salts in which there AA’ere canaliculi, 
holding central fibers, the nature of which Avas not known. The 
enamel, even in the eyes of the best obserArers, was thought to he 
a crystal, a calcareous mass epithelial in its origin. The later re- 
searches sIioav that the tooth is peiwaded by a bioplasson reticu- 
lum in the same way as an amoeba. It does not creep out of the 
mouth like an amoeba, on account of the infiltration Avith lime-salts 
in the lifeless portion of the tooth, i.e., the original liquid, which 
has become a solid basis-substance, while the reticulum remains 9 
unchanged, not only throughout the dentine, but also through the 
enamel. 
We have learned, through the researches of Bddecker, that the 
fibers present in the canaliculi are living matter. These first had 
been depicted in Richard Owen’s celebrated work by the draughts- 
man employed by him. In the picture we see the fibers, while no 
mention is made of them in the text. Tomes was the first to describe 
the fibers, and he thought they were probably nerves. This ap- 
proaches our views, for we can prove living matter proper and nerve- 
tissue to be one and the same thing; and we can trace the ultimate 
fibrils of nerves to direct or indirect connection with the dental fibers. 
Any irritation of the dentinal fibrils is transmitted to the nerves 
which are present in the pulp-tissue. 
It has been demonstrated that the so-called cartilaginous basis- 
substance is pervaded by a delicate reticulum, and, although this can- 
not be directly seen, we have to assume its presence from facts obtained 
in the study of embryology, and in the study of the different appear- 
ances of the teeth in caries, as shown by Frank Abbott. 
The enamel proves to be a live tissue, and supplied with a cer- 
tain amount of living matter,—scanty, it is true, but in structure 
akin to dentine. Although its first stage is epithelial in nature, 
Bodecker’s studies have shown that this epithelium is in turn 
changed into medullary tissue, which gives rise to the enamel—a 
complicated course which, however, is known to occur in the thyroid 
bod}’. 
The enamel-rods interlace in different directions, have interstices 
between them, and here is found living matter, which, as a reticulum, 
pervades the whole enamel. In the earliest formation of the tooth 
in the fetus, when the structure of the enamel is identical with that 
of the dentine, we can see the fibrils with great distinctness. 
We have obtained an idea about the life of the enamel and the 
dentine, and, of course, the cementum ranks among the living tissues, 
as does bone. 
The last question to be settled in this study was the nature of the 
pulp-tissue, and I dare say that to-day the character of this tissue 
is plain, both physiologically and pathologically. Dr. Bodecker’s 
specimens have enabled me to say so. 
In the light of the new views, Dr. Frank Abbott has studied the 
process of caries, and has shown that it is an inflammatory process 
which, owing to the scanty supply of living matter, is limited in its 
effect. While all tissues supplied with blood-vessels, if inflamed, pro- 
duce something new, an outgrowth of new tissue, caused by increase 
of the inflammatory corpuscles (which are essentially the same as 
embryonal) in tissues destitute of blood-vessels, such as cartilage, 10 
the inflammation stops at a certain point, mere dissolution of the 
basis-substance takes place, the living matter reappears, but no out- 
growth from that matter will occur. It has been proved that this 
process takes place in caries of the teeth. The first step in the pro- 
cess is that the lime-salts present in the meshes of the reticulum are 
melted out, the glue-yielding basis-substance is liquefied by means 
which we do not yet fully understand, and then the reticulum is re- 
established. The whole decalcified mass, still endowed with life to a 
certain extent, at last divides into medullary elements. Here is a 
stand-still, and new formation of living matter does not take place. 
The soft material becomes the seat of growth of leptothrix, and 
represents a decayed mass, which, constantly irritating, leads to a con- 
tinuance of the caries. 
The next important fact, theoretically at least, is the inflammation 
of dentine in its middle and inner portions, inducing secondary den- 
tine, which Dr. Bodecker has shown to be of regular occurrence 
with advancing age or whenever irritation takes place. He found 
that this irritation, proceeding from the periphery to the center, led 
to a new formation of the tissue, which was proved to be secondary 
dentine in its three main varieties: with irregular canaliculi, with 
laminated structure, and structure kindred to bone. 
Our specimens demonstrate that the secondary, like the primary, 
dentine is permeated by living matter, which, by a process of inflam- 
mation starting in the pulp-tissue, breaks down into medullary ele- 
ments in globular fields or territories. 
A subject which has been studied for two years in my laboratory 
by Frank Abbott, but which is not yet fully ripe for publication, is 
that of the melting of the enamel, caused by the same process which 
melts down the cementum and the dentine in deciduous teeth. There 
is in Tomes’s book an illustration which shows that such a melting of 
enamel does take place, but, as we trust only to our own observations, 
we must postpone everything concerning this branch of the subject 
until we have trustworthy specimens. What we have seen is that 
a process of melting occurs on the plan of a slow inflammation ; first, 
a liquefaction takes place in the basis-substance; afterward, decal- 
cification, and then dissolution of the glue-yielding basis-substance. 
Thus the living matter becomes freed. Abbott found peculiar excava- 
tions. which are the territories of the tissue of the cementum. 
Kolliker, in 1874, first drew attention to such excavations on the 
surface of growing bone. At that time nothing was known as to 
the presence of living matter in cementum, and we should not be 
surprised that he was of opinion that these excavations and the bodies 
seen in them were something penetrating from the outside. So great 
was his respect for these bodies that he gave them the name of 11 
“ bone-breakers.” Reference was made by him to the melting- 
process in temporary teeth. What we have seen does not confirm 
this bone-breaker theory at all. We say that the lacteal tooth, 
so long as it is connected with the soft surrounding tissue, must be 
endowed with life; therefore, the appearance of excavations filled 
with bioplasson is nothing but the reappearance of the original 
embryonal condition. The more surprising fact is that from this 
newly appearing tissue filling the excavations of lacteal teeth regular 
bone may arise. 
This is only an outline of what has been done so far. I am about 
to publish the results of ten years’ labor in the shape of a book. I 
have endeavored to reproduce all the work done in my laboratory by 
a number of gentlemen during the past seven years, in order to show 
what has been performed in America. My idea just now has been 
to give a mere sketch of the bioplasson doctrine, for two reasons: 
first, to render the future papers of Dr. Bbdecker (and, I hope, also 
those of Dr. Abbott) clear and acceptable to you; and, secondly, to 
caution you against rough treatment of the teeth. Some of you 
have been accustomed to work upon the enamel as if it were 
worthless stuff,—calcareous matter void of sensibility. My studies, 
although theoretical, I think, have some value to the dental prac- 
titioner, in having demonstrated that all dental tissues are alive, 
and I cannot believe that the removal of any part of these tissues 
can be done with impunity. The punishment will come, sooner or 
later, if you deprive the tooth of its best protector.—the hard, solid 
enamel. 
Dentine, apparently an inert tissue, reacts upon everything we do 
with it; a perfect revolution takes place in the dentine if you fill a 
tooth with any material. You have to regard the conditions sur- 
rounding the filling and the reaction which will follow upon its 
introduction, and much depends upon how you do your work and 
the material which you use as to what this reaction will be—whether 
beneficial or the source of new suffering to the patient. 
I announced a year ago that, from my theoretical stand-point, I 
should not insist upon filling temporary teeth with gold. I was mis- 
understood at the time. I did not mean that gold would do harm, 
but meant that it was unnecessary; in the lacteal teeth, so poorly 
provided with lime-salts, a slight protective filling does all the work 
one may expect. 
A great many other points are attached to these new views. 
We know that all scientific research is at first of little practical value, 
but such an application of the theoretical knowledge must come with- 
out question. A great many practical questions are involved in the 
study of the anatomy of the teeth generally. 1 often say that a 12 
dozen dentists could be kept busy for a dozen years in finding out 
new facts based upon the revelations of the bioplasson theory. The 
interest in the subject will gradually increase, especially if the right 
kind of practitioners will continue to assist me as they have so suc- 
cessfully done hitherto. THE MINUTE ANATOMY, PHYSIOLOGY, 
PATHOLOGY, AND THERAPEUTICS OF THE DENTAL PULP. 
C. F. W. BODECKER, D.D.S., M.D.S., NEW YORK, N. Y. 
Methods or Preparing Specimens. 
The best method of preparing pulp-tissue for examination isr 
immediately after the removal of the tooth from the mouth, to place 
it in an aqueous solution of chromic acid of one-half to one per cent, 
in strength. To this mixture may be added, every third or fourth day, 
to hasten the process of decalcification, one or two drops of dilute 
hydrochloric acid. It is important to use a large quantity of the 
liquid—not less than a quart for one or a few teeth—and to renew the 
same at least every six or eight days. After the teeth have been in 
the chromic acid solution a few weeks, the peripheral portion of the 
dentine will become sufficiently soft to be cut by a razor. When 
the hard portions of the dentine are reached by the cutting-instru- 
ment. the extraction of the lime-salts must again be continued in 
the manner described above until the pulp-cavity is reached. 
Another method is to split the tooth as soon as possible alter its 
extraction from the mouth with a strong pair of excising-forceps. 
The teeth best adapted for this method are the incisors, canines, and 
bicuspids. By an experienced manipulator the pulps of molars can 
be extricated from their inclosing walls, but with less success than 
in the teeth before mentioned. In splitting, put the cutting-edges 
of a sharp pair of excising-forceps in the longitudinal direction near 
the apex of a single-rooted tooth, then make a sharp and quick pres- 
sure, when, as a rule, the tooth will split into halves with the pulp- 
cavity exposed. Immediately moisten the pulp with a solution of 
chloride of sodium in water, of the strength of about one-half per 
cent., and then remove the pulp. The greatest care must be taken, 
in removing the fragments of the tooth from the pulp-tissue, to 14 
avoid tearing the organ, which greatly alters the microscopical 
aspect of nerve-tissue. If the pulp is to be stained with carmine, 
haematoxylon, fuchsine, hyperosmic acid, picro-indigo. or chloride of 
gold, etc., place it in the staining-fluid immediately after its removal 
from the hard parts of the tooth. 
Among the reagents mentioned I have found but one of consider- 
able value, viz.: the solution of chloride of gold of the strength of 
one-half per cent. This reagent can be applied to fresh pulps as well 
as to very thin sections obtained after hardening in chromic acid. 
These specimens, however, must, as a matter of course, be carefully 
washed with distilled water before adding the chloride of gold solu- 
tion. This reagent may be allowed to remain in contact with the 
specimens for from twenty to thirty minutes, when they should again 
be washed in distilled water and exposed to daylight. In a few days 
fresh specimens will assume a bright violet color, while sections which 
have previously been in a chromic acid solution become brownish- 
violet. Osmic acid, in solution of one per cent, in strength, renders 
the contours of the constituent tissues, and es})ecially those of the 
medullated nerve-fibers, more distinct, as it stains the nerve-fat dark 
gi’een. Both fresh and chromic acid specimens be treated with 
osmic acid. Thin sections do not require more than an hour’s expo- 
sure to this reagent, while whole fresh pulps may be left in it for two 
or three hours. Except the ammoniacal solution of carmine, which is 
known to be excellent for staining certain parts of the tissue, I would 
not lay stress upon applying any of the other reagents mentioned. 
If we wish to examine the pulp, together with the inclosing den- 
tine, or a pulp-stone, the specimen previously softened by chromic 
acid must be imbedded in a mixture of paraffine and wax, which is 
best done in the following manner: place the softened tooth in abso- 
lute alcohol for about twenty-four hours; then prepare a box made 
of rather thick paper, somewhat larger than the specimen; warm 
the imbedding mixture, which consists of about eight parts of paraf- 
fine and one of white wax, until it is barely liquid; pour enough of 
it into the paper box to about half fill it; then take the specimen 
out of the alcohol, and as soon as it begins to dry place it in the 
paper box and pour over it some more of the paraffine and Avax, so 
as to C0Arer it completely. But care must be taken not to have the 
imbedding mixture too hot, as it may injure the Irving matter. The 
specimen then, after the mixture has become sufficiently hard, is 
ready for cutting, when very thin sections can easily be obtained. 
If a fresh pulp is thin enough it may, immediately after its removal 
from the split tooth, be transferred to the slide, with the addition of 
an indifferent fluid, such as the solution of chloride of sodium, etc. 
But a slight and careful pressure upon the co\Ter is necessary in order 15 
to spread fresh specimens. The fresh pulps of lower incisors, being 
the thinnest, are the best adapted for examining the system of blood- 
vessels. In a short time, however, these blood-vessels fade away, and 
the specimen becomes unfit for preservation. Isolated pulps may 
be placed between two plates of velvet-cork, and thus cut into thin 
sections with the razor. I would recommend dilute glycerin as the 
best preserving-fluid for pulp-specimens. 
The Minute Structure of Normal Pulp-Tissue. 
If we examine a thin longitudinal or transverse section of the pulp 
with low powers of the microscope (200 diameters), we recognize a 
large number of blood-vessels and bundles of medullated nerve- 
fibers. The majority of these blood-vessels are capillaries; the veins 
are less numerous, and arteries are scarce. In many pulps we find 
no arteries at all, in others a limited number, very often in the midst 
of the medullated nerve-bundles. The medullated nerve-bundles 
mostly run in a longitudinal direction, but not infrequently we 
observe smaller bundles, or single medullated nerve-fibers, diverge 
from the longitudinal direction, running obliquely through the pulp- 
tissue. 
In transverse sections of the pulp we meet with arteries, veins, 
and capillaries, the first cut across, the others distributed in all 
directions. The bundles of medullated nerve-fibers are seen most 
distinctly in transverse sections. They often hold in their inter- 
stitial tissue capillary vessels and arterioles, which also appear in 
transverse sections. In very thin sections it often happens that the 
nerve-fibers fall out, and then we see a roundish empty space bounded 
by the sharply defined external perineurium. The absence of an 
endothelial coat renders such spaces easily recognizable in distinc- 
tion from blood-vessels. 
The main mass of the pulp, as seen with low powers, is composed 
of a delicate fibrous reticulum, containing a large number of bright 
shining corpuscles. Longitudinal sections in many instances exhibit 
delicate fibrous bundles scattered throughout the reticular structure 
of the pulp, mostly in the neighborhood of large blood-vessels and 
nerve-bundles. Pulps composed of a fibrous connective tissue only 
are rather exceptional, and, as it seems, are without any relation to 
the age of the person. They are probably the result of morbid 
processes. Toward the outer surface of the pulp the reticular 
structure is, as a rule, denser than in the middle portions. This 
peripheral part is surrounded by a wreath of elongated formations 
arranged in a radiating manner all around the pulp—the so-called 
“ odontoblast layer.” 
Higher powei-s of the microscope (500 to 600 diameters) reveal a 16 
minute reticular structure, consisting of delicate fibers or anasto- 
mosing bioplasson cords, with very small oblong nuclei at their 
points of intersection. The mesh-spaces inclosed by this reticulum 
either look pale and finely granular throughout, or there is, besides 
the pale granular substance, a bright yellowish body, either homo- 
geneous or granular, of the size and aspect of a nucleus. The 
number of the latter formations varies greatly in different pulps. 
Where bundles of a fibrous tissue traverse the reticulum, there the 
latter blend with the former. In the fibrous bundles, besides the 
delicate fibrillse, we see scanty and small oblong nuclei. 
As mentioned before, the 
fibrous connective tissue 
prevails at the periphery 
of the larger blood-vessels 
and n e r v e-b u n d 1 e s. In 
transverse sections these 
nerve - bundles invariably 
exhibit a distinct fibrous 
sheath containing oblong 
nuclei — the so-called ex- 
ternal perineurium. The 
nuclei imbedded in the 
sheath do not project above 
the level of the sheath, 
as is plainly observable 
on empty ones where 
the fibers have fallen out, 
while the endothelia of 
blood-vessels of any de- 
scription invariably pro- 
trude toward the inclosed 
space, thus affording an 
excellent means of distinc- 
tion between blood-vessels 
and empty nerve-sheaths. 
The arteries are charac- 
terized by the presence of 
a layer of smooth muscles, 
outside of which is seen a slight fibrous coat. The layer of smooth 
muscles necessarily thickens the walls of the blood-vessels, thus 
rendering them easily recognizable in transverse sections. The veins 
are marked by their large caliber and a fibrous coat, being at the 
same time filled with blood-corpuscles. The capillaries are composed 
of a single endothelial layer, which is separated from the adjacent 
Fig. 1. 
Fig. 1.—Segment of the pulp of a first molar tooth. Longi- 
tudinal section. 
ilf, myxomatous connective tissue ; V, vein ; C, capillary 
blood-vessel; N, bundle of medullated nerve-fibers; F, term- 
inal non-medullated nerve-fibers; B, bioplasson layer, con- 
taining the terminations of the nerves; 0, layer of medullary 
corpuscles, termed odontoblasts. Magnified 200 diameters. 17 
reticulum by an extremely delicate light rim. They are either found 
empty or containing a few blood-corpuscles. 
In longitudinal sections the medullated nerve-fibers show the 
well-known fluted double contour of considerable refraction (the 
sheath of Schwann). Inside of this is the myolin (nerve-fat) con- 
cealing the central axis-cylinder. Schwann’s sheath exhibits delicate 
oblong or spindle-shaped nuclei, and external to this we observe a very 
delicate layer of fibrous connective tissue-—“ the internal perineu- 
rium.” In cross-sections of the nerve-bundles a more or less circular 
group of medullated nerve-fibers is seen, each of which in its center 
exhibits the ax.is-cylinder in the shape of a roundish, glistening- 
dot, the single nerve-fibers being separated from one another by the 
delicate internal perineurium. Not infrequently capillary and arte- 
rial blood-vessels are met with between the nerve-fibers which, at 
the periphery of the bundles, blend with the nucleated sheath of the 
external perineurium. 
As to lymphatics of the pulp, I can say that in some specimens I 
have seen branches of vessels of the size of veins without an adven- 
titial coat, being composed of large, flat, slightly-protruding endo- 
thelia. These vessels I believe to be tymphaties, as they contained 
a finely-granular coagulated albumen, scanty granular corpuscles, 
and a very limited number of blood-corpuscles. As to the distribu- 
tion of lymphatics, I must abstain from positive statements. 
At the periphery of the pulp the delicate reticulum constituting 
the pulp-tissue is very dense, and its small meshes are supplied with 
numerous corpuscles looking like nuclei. In this layer we meet 
with only very narrow capillary blood-vessels. The outer surface 
of this layer is bounded by radiating rows of shining corpuscles of 
the size and appearance of nuclei. These rows are separated from 
one another in a longitudinal direction by light rims in which deli- 
cate film Use can be frequently observed. 
In chromic acid specimens stained with carmine, or, still better, 
in those treated with chloride of gold, high powers (1000 to 1200 
diameters) reveal an extremely minute reticular structure pervading 
all formations of the pulp-tissue. It is this structure, that of bio- 
plasson as well as basis-substance, that C. Heitzmann discovered in 
1873. (“ Untersuchungen fiber das Protoplasma, Sitzungs-Berichte 
der Kaiserlichen Academie in Wien.”) Starting from the center of a 
mesh-space, we see a body like a nucleus, either homogeneous and 
apparently destitute of structure, or with the appearance of a vesicle 
with a distinct, bright wall. Inside the hollow nucleus we see a vary- 
ing number of bright granules, interconnected with one another as 
well as with the inclosing wall by means of delicate filaments. 
Around the nucleus a minute light rim is seen, which again is 18 
traversed by radiating filaments connecting the nucleus with the 
extremely delicate, grayish reticulum pervading the light basis-sub- 
stance contained in the mesh-spaces of the fibrous net-work. The 
delicate reticulum in the basis-substance is recognizable, even though 
the central nucleus be absent. The fibrous or bioplasson net-work 
which incloses the mesh-spaces also shows a delicate reticulum in 
connection with the nuclei at the points of intersection. Thus, all 
coarser reticular structures, as well as the fields of basis-substance, 
are traversed by an extremely delicate reticulum, which C. Ileitz- 
mann claims to be living matter proper. In this view I fully concur, 
and. so far as my experience goes, I would mention* that inflamma- 
tion in general, as well as that of the dental pulp, cannot be under- 
stood unless the presence of living matter throughout all formations 
of bioplasson as well as basis-substance is admitted. It is this matter 
which grows and leads to a new formation, so strikingly shown in 
inflammation. I may add that fibrillae of living matter are directly 
connected with the blood-vessels by means of delicate offshoots 
penetrating the light rim around the blood-vessels called the “peri- 
vascular space.” 
The formations at the periphery of the dental pulp termed 
“odontoblasts” by J. Tomes, and which by some observers have 
been considered as epithelial-like formations, under high amplifica- 
tions exhibit the following: 
Longitudinal fields, somewhat resembling epithelia, border the 
pulp in a radiatory direction. Such a field may appear in the shape 
of a finely-granular bioplasson or basis-substance in which there are 
imbedded oblong nuclei in varying numbers. The nuclei exhibit 
coarse granules and a dense reticulum of living matter, while the 
elongated fields inclosing the nuclei exhibit pale granules and a 
delicate bioplasson reticulum. Between these latter formations a 
delicate light rim is seen, wherein we observe sometimes broad, 
sometimes delicate, fibrillse in connection with the reticulum of 
neighboring formations, accompanied by delicate conical offshoots, 
which penetrate the surrounding rims at right angles. In many 
instances these formations between the odontoblasts can be followed 
into the dentinal fibers, lodging in the midst of the dentinal canaliculi. 
It is obvious, from what I have seen, that the odontoblasts furnish 
the matrix for the basis-substance of the dentine, whereas the den- 
tinal fibers, being formations of living matter, originate between the 
odontoblasts. When studying secondary dentine I described and 
depicted a specimen corroborating this assertion (Dental Cosmos, 
Yol. XXL, p. 412). 
The manner in which the bioplasson of the odontoblasts is trans- 
formed can be understood only on the basis provided by the researches 19 
of C. Heitzmann (loc. cit.), who claims that the liquid held in the 
meshes of the reticulum of living matter by a chemical process is 
rendered solid and glue-yielding, while the living reticulum itself 
remains unchanged, and merely becomes invisible because it has 
nearly the same refracting power as the basis-substance. Where the 
refracting power varies enough, the formations of living matter 
remain distinctly perceptible. Such is the case with the dentinal 
fibers and their transverse conical offshoots within the dentinal 
canaliculi. 
In sufficiently stained chloride of gold specimens of a nine- 
months’ foetal pulp I have observed that the medullated nerve-fibers 
upon approaching the periphery of the pulp are destitute of their 
myolin sheath, and now, being bare, axis-cylinders split into 
numerous extremely delicate beaded fibrillse—the “axis fibrilla?.” 
They are marked by a dark-violet 
color, and run in the light rims be- 
tween the rows of the odontoblasts 
near the pulp-tissue proper, and are 
connected with the odontoblasts by 
means of delicate conical offshoots. 
In some instances I have observed 
that these axis fibrillae terminated in 
knob-like extremities. But whether 
the nerve-fibers directly anastomose 
with the dentinal fibers I am unable 
to say. That an indirect connection 
of the two is established by the inter- 
vening reticulum of living matter I 
positively assert. 
The results of my researches of 
the normal pulp are as follows: 
I. The dental pulp is a variety of 
connective tissue termed myxom- 
atous, representing an embryonal 
form of it. Pulp-tissue, therefore, is 
a remnant of embryonal tissue, last- 
ing, in some instances, throughout 
life, and kindred to those formations 
termed “ adenoid tissue.” 
II. The myxomatous tissue of the pulp is intermixed with a 
delicate fibrous connective tissue in varying amounts. Pulps entirely 
or nearly built up by fibrous connective tissue probably are not to be 
considered physiological. 
III. The pulp-tissue is traversed by a close system of blood- 
Fig. 2. 
Fig. 2.—Segment of the pulp of a temporary 
tooth, stained with chloride of gold. 
M, myxomatous connective tissue; N, term- 
inal non-medullated nerve-fibers, in a uni- 
formly granular bioplasson layer; 0, rows of 
medullary corpuscles, termed odontoblasts ; F, 
dentinal fibers between the odontoblasts; D, 
dentine. Magnified 1200 diameters. 20 
vessels, viz., arteries, veins, and capillaries. Arteries are not invari- 
ably found in the pulp, but they are by no means of exceptional 
occurrence. Lymphatics in small numbers are also present. 
IV. The pulp-tissue is richly supplied with nerves, which, in the 
shape of bundles of medullated nerve-fibers, traverse the myxomatous 
tissue. Toward the periphery of the pulp they lose their myolin 
sheaths, become non-medullated, and, in the shape of minute beaded 
fibrillse, branch between the odontoblasts. 
Y. The odontoblasts at the periphery of the pulp are elongated 
bioplasson formations with rows of nuclei. They are medullary 
corpuscles such as we see wherever a new tissue arises from a former 
one. They build up the basis-substance of the dentine by solidifica- 
tion (transformation into glue, and infiltration with lime-salts). The 
reticulum of living matter traversing the odontoblasts remains 
unchanged in the basis-substance of the dentine. 
YI. The dentinal fibers originate between the odontoblasts. 
Being formations of living matter, they are in direct connection with 
the reticulum of living matter—first of the odontoblasts and after- 
wards of the basis-substance of the dentine. The connection between 
the ultimate nerve-fibril he and dentinal fibers is very probably an 
indirect one by means of the intervening reticulum of living matter. 
The Pathological Conditions of the Pulp. 
Pulpitis.—I have examined a large number of specimens of pulpitis, 
but have not met with this process except in pulp-chambers more or 
less reduced in their caliber by a new formation of secondary dentine. 
I do not want to say that pulpitis never occurs without this pre- 
ceding formation, but to me it seems quite probable. In caries of 
dentine, or in mechanical or chemical abrasion, long before the pulp- 
cavity is approached, we have known, since the time of John Hunter, 
that, corresponding to the lost portion on the outer surface of the 
tooth, secondary dentine is deposited in the corresponding direction 
within the pulp-chamber. Evidently in pulpitis caused by a sudden 
and severe irritation the production of secondaiy dentine is induced 
before the irritation becomes sufficiently high to develop inflammation. 
If pulpitis does occur without the previous formation of secondaiy 
dentine, it must be a rarity. Where primary dentine is invaded by 
the inflammatory process, traces of secondary dentine scattered 
along the pulp-chamber are visible, and the probability is that the 
secondary dentine to a great extent has been destroyed by the 
inflammation before the primary dentine was reached. 
As I have published in the Dental Cosmos, Yols. XXI. and XXII., 
my researches on the formation of secondaiy dentine and perice- 
mentum, and on pericementitis, in the light of recent investigations 21 
on inflammation, etc., I shall have to say but little on pulpitis. The 
main characteristic of this process is the appearance of a large 
number of inflammatory or medullary corpuscles in the pulp-tissue. 
These corpuscles, the same as in pericementitis, arise from the living 
matter present in the bioplasson formations as well as from that 
hidden in the basis-substance. 
Where before a fibrous reticu- 
lum was visible, containing in 
its mesh-spaces basis-substance 
with central nuclei, in the ear- 
liest stages of inflammation 
numerous bioplasson bodies are 
seen, either closely packed to- 
gether in heaps or separated 
from one another by layers of a 
granular bioplasson. The pro- 
cess of inflammation in many 
instances does not invade the 
whole of the pulp at the same 
time. I have specimens where 
only a portion of the pulp or 
several independent portions 
have been invaded by the in- 
flammatory process, while a 
varying amount of the pulp- 
tissue is left unchanged. The 
manner in which the inflam- 
matory corpuscles make their 
appearance is as follows: Por- 
tions of living matter, of either 
the myxomatous reticulum and its nuclei or of the basis-substance 
(evidently after its liquefaction), grow into a shining homoge- 
neous lump, from which a nucleated mass of bioplasson will arise 
by a differentiation of the living matter into a reticulum. The 
living matter of the nerve-fibers furnishes material for the formation 
of inflammatory corpuscles, which in lower degrees of this process 
are traceable in the shape of longitudinal rows of inflammatory cor- 
puscles, with but scanty remnants of nerve-fibers recognizable as 
such. In higher degrees even this trace of former nerve-bundles is 
ost. The blood-vessels rapidly disappear. Even in the early stages 
of pulpitis we have difficulty in tracing out blood-vessels, as most of 
them are either compressed or made impermeable by a process of 
solidification and splitting into inflammatory corpuscles. Where 
dood-vessels are seen unbroken, they appear considerably dilated and 
Fig. 3. 
Pulpitis.—S, secondary dentine; B, bay-like excava- 
tions filled with medullary or inflammatory corpuscles; 
V, transverse section of a blood-vessel; itf, multinu- 
clear body. Magnified 300 diameters. 22 
engorged with blood-corpuscles. The arteries resist the destruction 
for the longest period of time. Even in considerably inflamed pulps 
we meet with arteries which have retained their essential features. 
An artery in one of my specimens, cut transversely, shows the con- 
centric layer of smooth muscles split up into small lumps of living 
matter, and in its inclosed space a large number of inflammatory cor- 
puscles, evidently sprung from proliferation of the endothelial coat. 
As the process of pulpitis advances, flrst the secondary and 
. afterward the primary dentine becomes destroyed to a greater or 
less extent. The process is essentially the same as the destruction 
of cementum due to pericementitis. The solid basis-substance of 
the dentine is at flrst deprived of its lime-salts, after which the 
gluey portion is liquefied. This liquefaction invariably takes place 
in the globular territories of the dentine, and the coalescence of 
such territories bay-like excavations are seen penetrating the den- 
tine, at first with faint outlines and afterward sharply defined from 
the calcified basis-substance. In consequence of this liquefaction the 
original bioplasson condition of the dentine is re-established. It 
the inflammatory process is a slow one (chronic), it may happen 
that from a former territory of dentine, by a process of recalcifica- 
tion, a territory of bone may originate, in the center of which we 
recognize an oblong, branching bone-corpuscle. This formation, 
however, is rather exceptional. The rule, on the contrary, is that 
the bioplasson filling a baj’-like excavation becomes supplied with a 
number of new nuclei, thus representing the stage of a multinuclear 
bioplasson body. Such a mass splits up into a large number of 
inflammatory corpuscles, which, in the bay-like excavations as well 
as in the pulp-tissue proper, establish a condition termed “ inflam- 
matory infilt rat ion.” 
In milder forms of inflammation the pulp-tissue, although consider- 
ably changed, still remains a tissue as long as the delicate filaments 
of living matter interconnecting the single inflammatory corpuscles 
with one another and with the periphery of the pulp are unbroken. 
At this stage, should the inflammatory process abate, the tissue 
may advance into the original condition of a basis-substance. As is 
known, every variety of connective tissue, once inflamed, becomes a 
fibrous or cicatricial tissue. It is quite possible, therefore, that the 
few pulps I have met with exhibiting the structure of fibroxxs con- 
nective tissue and scantily supplied with blood-vessels ai*e the pro- 
ducts of a former inflammation. It is also probable that further 
advance into other tissues found in the pulp, such as dentine and 
bone, are the results of a slight inflammatory condition which did 
not extend to the stage of hyperplasia or hypertrophy. In a few 
specimens, mostly of fibrous structure, I have seen the bundles of 23 
medullated nerve-fibers transformed into rows of fat-globules. Evi- 
dently here the nutrition of the nerve-fibers has been interfered 
with to such an extent as to allow the formation of fat from the 
nerve-tissue proper. Should the inflammation reach a high degree, 
the inflammatory corpuscles will become separated from one another 
—torn apart—and the result is the formation of pus, which, as a 
matter of course, is no subject for microscopical research, except 
the discoloration of the dentine of the tooth. Of this, for the 
present, I have nothing to say. An intense inflammatory process 
may very soon lead to an engorgement of the afferent vessels and 
their strangulation by pressure. In this instance death and putre- 
faction of the inflamed pulp will ensue, which is known clinically as 
“ gangrene.” Some reliable observers claim that gases of putrefac- 
tion in gangrene may be developed in quantities sufficient to crack 
the tooth. In my practice 1 have never encountered such an acci- 
dent. 
Calcification and Waxy Degeneration. 
Deposition of lime-salts in the pulp-tissue is very common. Tt 
presents itself in the shape of globular, elongated, or irregular form ac- 
tions, having under the micro- 
scope a more or less lobulated 
surface and a high degree of 
refracting power. The age of 
the person apparently has noth- 
ing to do with the calcification 
of the pulp. Some very good 
observers have described it as 
the result principally of caries 
or loss of substance of the tooth 
by mechanical means. I have 
a great many specimens of 
pulps prepared from bicuspids 
and first and third molars of 
young persons, which had to be 
extracted on account of irregu- 
larity or want of room, and 
most of them are externally 
perfectly sound. Some of the 
wisdom-teeth were removed 
when only one or two of their 
cusps had pierced the gum, but 
with only one exception all of 
these pulps exhibit greater or 
less quantities of calcific deposits as well as eburnifications. The 
Fig. 4. 
Calcification.—Pulp of a first lower molar of a 
healthy young man 18 years of age, extracted on 
account of irregularity. 
C, calcified masses composed of irregular lumps, 
probably former medullary corpuscles; M, medullary 
corpuscle unchanged; P, central plastid free from 
infiltration; F, capsule of fibrous connective tissue. 
Magnified 300 diameters. 24 
same conditions 1 have observed in pulps derived from the teeth of 
old persons. 
Pulps containing a larger number of calcified spieula, as a rule, 
exhibit more fibrous connective tissue than myxomatous. Invaria- 
bly around the calcified masses a dense layer of fibrous connective 
tissue has formed, ensheathing the calcified masses. Where these 
masses have fallen out an empty fibrous sac is left behind, in which 
there are neither endothelia, so characteristic of blood-vessels, nor 
oblong nuclei, which we see in the external perineurium of the 
bundles of medullated nerve-fibers. The presence of this envelope 
may convey the idea (especially if the calcified masses are elongated 
and appear like small lobulated sausages) that an obliteration has 
first occurred in the blood-vessel by a process which in other vascu- 
lar systems, mainly that of the lungs, is known as “fatty embolism.” 
The application of different reagents, especially osmic acid, has, 
however, convinced me that neither of these formations is a fat em- 
bolism. and I am unable to observe any positive connection between 
the blood-vessels and the calcified masses. Sometimes it looks as if 
a capillary blood-vessel were attached to the space containing the 
calcified mass, or it may occur that a capillary vessel is suddenly 
dilated like a small aneurism, and in this widened portion we notice 
pieces of a calcified mass. The idea that the plasma of the blood 
laden with lime-salts accumulates in the capillaries of the pulp, and, 
unable to escape behind, deposits its lime-salts, I do not accept. 
Much rarer than calcification is a peculiar change of the pulp- 
tissue which I have observed,* both with and without calcifications. 
It consists of a transformation of the myxomatous tissue into a 
shining, nearly homogeneous mass, devoid of a distinct demarkation 
between it and the unchanged tissue of the pulp. In this homo- 
geneous mass, which may greatly vary in extent, we recognize 
granular, stringy formations, and not infrequently smaller bundles 
of nerve-fibers not noticeably changed in their structure, traversing 
the homogeneous fields. In some instances the nerve-fibers within 
such fields look dark and coarsely granular, as if composed of crumbs. 
All I can say as to the reagents applied is that the homogeneous mass 
readily stains with carmine. 
Changes of tissue of this character are very common in different 
organs, especially in the spleen, the liver, and the kidneys. They 
always indicate a low degree of nutrition, and are said to be gen- 
erally caused by syphilis. This change bears the name of “ amyloid 
or waxy degeneration.” Its nature, however, is yet far from being 
known. 
Dentinification, Ebirnification. and Ossification. 
It was necessary to make a new word for the designation of a 25 
process which, although known for many years, has never been 
fully understood. I refer to the new formations of dentine in the 
midst of the pulp-tissue independent of the dentine composing the 
walls of the pulp-chamber. It is the formation of the so-called 
‘•pulp-stones” which by some observers are announced as the result 
of a process of calcification, but by John Tomes, Ulrich, Iiohl, Brack, 
Baume, and Witzel, have been described as formations of a variety of 
secondary dentine. So-called pulp-stones, as is well known, may 
be found either connected with the dentine proper by means of a 
peduncule, or loosely imbedded in the connective tissue of the pulps. 
Most of these formations are composed of dentinal tissue in the form 
termed secondary dentine. Barer occurrences are those constructed 
exclusively of a laminated bone-tissue. Somewhat rarer are combi- 
nations of both dentine and bone-tissue. The rarest are new forma- 
tions of dentine strictly identical with primary dentine. 
1. So-called “ pulp-stones ” of the character of secondary dentine. 
The most marked characteristic of these specimens is the presence of 
dentinal canaliculi irregularly 
scattered throughout the cal- 
cified basis-substance. Some- 
times the canaliculi assume a 
tolerably well marked radia- 
tion ; at others large masses of 
calcified basis-substance are 
destitute of canaliculi, which, 
in scanty biindles, are found 
toward the periphery of the 
pulp-stone. All the three varie- 
ties of secondary dentine which 
I have described in the Dental 
Cosmos, Yol. XXI., are found 
in these formations. Portions 
of the basis-substance, especi- 
ally toward the periphery, 
may exhibit delicate concentric 
laminations. In the midst of 
an apparently homogeneous 
basis-substance small lamina- 
ted territories may occur, con- 
taining a central corpuscle with 
branching offshoots, somewhat 
resembling a bone-corpuscle. 
In sections of one pulp-stone I have found numerous concentrically 
laminated territories, more or less distinct, and either one or two 
Fig. 5. 
Eburnifi cation.—Section of a pulp-stone of a lower 
molar. 
L, lamellated secondary dentine, traversed by radi- 
ating dentinal canaliculi; C, C, globular masses, ex- 
hibiting a concentric striation. Magnified 300 diam- 
eters. 26 
protoplasmic formations in their centers, the tissue between the 
territories was partly granular and composed partly of a tissue like 
secondary dentine with irregular canaliculi. Here and there medul- 
lary spaces were seen traversing the tissue from which evidently 
the new formation of the territories had started. This variety is 
the regular osteo-dentine. 
2. So-called “pulp-stones” composed of regularly developed lami- 
nated bone. I have, as mentioned before, pulps composed almost ex- 
clusively of a dense fibrous connective tissue, the bundles of which are 
interlaced in all directions so as 
to establish a regular cicatri- 
cial connective tissue. Scanty 
nerve-bundles and blood-vessels 
traverse the dense connective 
tissue, which in some places 
appears to be more or less 
crowded with medullary or 
inflammatory corpuscles. In 
such fibrous pulps I have seen 
smaller or larger masses of 
fully developed bone-tissue, 
composed of more or less regu- 
lar lamellae, or of calcified fib- 
rous lamellae. In these a large 
number of irregular branching 
bone-corpuscles are seen, ar- 
ranged in rows or chains, where 
the basis-substance shows a 
more fibrous character. Some- 
times the bone-tissue appears 
in lamellated islands, sharply 
marked from the surrounding 
fib rous tissue. No formations 
of secondary dentine were combined in these cases with the bone- 
tissue. 
3. So-called “pulp-stones” composed of a mixture of regular 
bone and dentinal tissue. In rare instances I have met with 
pulp-stones partly composed of secondary dentine and lamellated 
bone in such a way that irregularly bounded masses of bone 
contained a few large bone-corpuscles, alternately surrounded by 
a basis-substance, which contained only irregular, wavy, dentinal 
canaliculi. 
4. So-called “pulp-stones” composed of dentine with the features 
of P rirnary dentine. I have examined a large number of pulp-stones; 
Fig. G. 
Ossification.—Section of puli' of upper lateral. 
L, longitudinal, T, transverse, bundles of cicatricial 
fibrous connective tissue; B, spicula ot lamellated 
bone. Magnified 500 diameters. 27 
one of them, amass about the size of a pea, was built up of dentine. 
The canaliculi of this dentine are perfectly parallel, and between 
these a finely reticular basis-substance, arranged in the same way 
as we see in the primary dentine of temporary teeth of children, 
which teeth are generally poorly 
supplied with lime-salts. In this 
specimen, too, the dentinal cana- 
liculi are very wide, the basis- 
substance between them, on the 
contrary, narrow. The dentinal 
fibers are relatively bulky beaded 
formations with numerous large 
conical spokes penetrating the 
peripheral space of the canaliculi. 
This regular dentine toward the 
periphery of the pulp-stone is 
bounded by a slightly fluted con- 
tour, a narrow zone which ex- 
hibits the structure of eanalic- 
ulated secondary dentine. This 
zone blends with a still narrower 
one, which is composed of an in- 
distinctly lamellated bone-tissue, 
wherein bone-corpuscles, large in 
size but few in number, are imbed- 
ded. This layer is followed *by 
the bounding layer of the speci- 
men, exhibiting a granular ap- 
pearance containing a few an- 
gular or spindle-shaped protoplasmic bodies and a few dentinal 
canaliculi. 
As to the development of dentine and bone in the midst of pulp- 
tissue, I have to say only a few words. Carl Wedl thinks that these 
formations arise from an invasion of the odontoblasts into the midst 
of the pulp-tissue, he assuming that dentinal canaliculi can only be 
formed by that layer. My own observations demonstrate that the 
odontoblasts are nothing but medullary corpuscles arranged in 
rows. In the present stage of our knowledge we have no reason to 
assume that the medullary corpuscles of' the periphery of the pulp 
are specifically destined for the formation of dentine. It is just as 
reasonable to assume that the blood-vessels in the pulp furnish a 
certain variety of pabulum to the medullary corpuscles termed 
odontoblasts, under the influence of which nourishing material they 
are transformed into the tissue of bone. 
Fig. 7. 
Dentinification.—Section of pulp-stone of upper 
molar. 
I’D, primary dentine; SD, secondary dentine; 
0, irregularly lamellated bone-tissue; G, granular 
layer toward the pulp-tissue. Magnified 500 di- 
ameters. 28 
Should medullary corpuscles, in consequence of a slight irritation 
or an augmented afflux of nourishing material, arise in the midst of 
the pulp, they may just as well produce dentine as bone. The laws 
which control the new formation of tissue are as yet far from being 
understood, and it seems to me that very little can be gained by the 
assumption of a specific function for the medullary corpuscles. 
II.—History. 
A great deal has been written on the dental pulp. From the 
time of Prochaska (1780) to the present many essays have appeared, 
or have been read before dental societies, but the number of those 
who have advanced scientific knowledge in this direction is very 
small. J. Tomes, E. Albrecht, Heider, C. Wedl, R. Hold, Boll, j. 
Brack, R. Baume, and A. Witzel ought to be especially mentioned as 
having contributed very much valuable information to our knowledge 
of the dental pulp. The literature of the subject is too voluminous 
to allow me to mention all who have written upon it, and I will 
therefore only make short extracts from a few of the most prominent 
authors. 
The earliest treatise on the dental pulp which I have been able 
to trace is by Galen (“Systemisehes Handbuch der Zahnheilkunde,” 
von Georg von Carabelli; Wien, 1844), who was born A.D. 131. He 
said, “ I felt the pulsation in a tooth that was aching in the same 
way as in other inflamed soft parts. I wonder that a tooth can be 
inflamed. But when I again suffered from toothache I distinctly felt 
that this was not caused by the tooth, but the inflamed gum. By 
having had both kinds of pain, I positively know that the seat of 
the one pain was in the gum, but the other was in the tooth.” He 
was also the first to observe that the teeth are provided with soft 
nerves. 
John Hunter says, “A tooth very often wears down so low that 
its cavity would be exposed if no other alteration were produced 
in it. To prevent this, nature has taken care that the bottom part 
of the cavity should be filled up by new matter, in proportion as 
the surface of the tooth is worn down.” 
Georgii Prochaska (“ Operum Minorum Anat. Physiol, et Path. 
Argumenti,” Pars II.; Viennse, 1800) also called attention to the 
fact that when by attrition the teeth on their upper surfaces are 
worn there is produced within the pulp-chamber just as much new 
material as is worn away on the outer surface. 
Rousseau (“Anat. Comp, du Syst. Dent. Chez l’Homme et Chez 
les Pi’incip. Anim.Paris, 1827) found “osteoids” and bony growths 
in the pulp-cavity, but states that Bertin had known this before 
him. 29 
Bertin (“ Uber Neubildungen der Zahnpulpa von Rudolph IIohl;’r 
Halle, 1868) says, “The teeth are not empty, but filled with a soft 
mass, which originated from a lymphatic fluid. This fluid thickens 
by evaporation without obtaining the consistence of bone, although 
sometimes this substance does form hard masses, not in connection 
with the other tissues originally, which, however, later are united 
with the dentine.” 
Thomas Bell (“ The Anatomy, Physiology, and Diseases of the 
Teeth;” Philadelphia, 1830), in speaking about mechanical abrasion, 
says, “We find that, instead of these teeth being the subject of 
absorption, a new deposition of bony matter is, in fact, going on to 
fill the cavities, which would otherwise be exposed. It is first 
deposited in that part of the cavity toward the worn surface, and 
becomes gradually more and more filled as the tooth becomes 
abraded.” 
Raschkow (“ Meletemata Circa Mammalium Dentinum Evolu- 
tionem;” Warsehau, 1835) found stony masses in the molars of 
deer, hares, and pigs. 
A. Nasmyth (“Researches on the Development, Structure, and 
Diseases of the Teeth,” 1849) says, “ Much diversity of opinion has 
already existed respecting the connection of the pulp with the ivory 
of the tooth, and as to whether the ivory be simply a product of 
the pulp or a transformation of its substance. The formative sur- 
face of the pulp displays a regular cellular arrangement. The 
radiating rows of cells are surrounded by a well-defined scolloped 
border, from which occasionally processes are observed to project 
at regular intervals.” This author also, on page 226, plate vi., 
describes and nicely depicts several cases of ossification of the pulp. 
R. Owen (“ Odontography,” vol. ii.) illustrates a new formation 
of osteo-dentine from a bicuspid tooth developed with hair in a cyst 
of the human ovarium. 
F. Ulrich (“ Zeitschr. der Kk. Gesel. der iErzte zu ;” Wien, 1852) 
noticed new formations of the dental pulp, of which he described 
three varieties, viz., the dentinoid, the osteoid, and a mixtiu'e of the 
two tissues in one. 
P. B. Goddard (“ The Anatomy, Physiology, and Pathology of 
the Teeth;” New York, 1854) described the dental pulp as composed 
of granular matter invested by a delicate membrane or epithelium. 
Kdlliker (“ Gewebelehre;” Aufl IV.) noticed new formations of 
dentine and cement on the walls of the pulp-cavities of teeth. 
From L. S. Beale (“ On the Structure and Growth of the Tissues, 
and on Life,” 1865) I abstract as follows: “ The tissue of the pulp, 
it must be distinctly borne in mind, is not converted into dentine; 
neither does dentine, nor the tissue from which it is formed, exhibit 30 
any characters which justify our classifying it with the connective 
tissues. * * * No dentine was ever produced except by the agency 
of the so-called ‘ cells.’ I agree with Kolliker and Lent, that the 
dentinal cells are the only active agents concerned in the formation 
of the dentine, but cannot regard the canals as direct processes of 
the whole dentinal cells, nor admit that the matrix is an intercellu- 
lar substance. The mass of the pulp is composed of a simple form 
of connective tissue, with numerous oval and triangular corpuscles 
(germinal matter) not unlike that of which the mucous tissue of 
the umbilical cord consists.” 
R. T. Hulme (“ On Calcifications of the Dental Pulp,” Transac- 
tions of the College of Dentists of England, 1861) gives a good 
description of the new formations in the pulp-cavity. He names 
four varieties, viz., secondary dentine, dentine of repair, osteo-den- 
tine, and nodular dentine, but he is of the opinion that the term 
“secondary dentine” would suffice for all varieties. He beautifully 
illustrates in two plates ten cases of new formations, one of which 
is copied from Salter, “ Guy’s Hospital Reports ” of 1853. 
From John Tomes (“System of Dental Surgery;” London, 1873) 
I quote, “ The opinion held b}r Waldeyer, Boll, Beale, and many 
others, that every part of the dentine is a direct product of the 
conversion of the odontoblasts. This view is probably the true one. 
* * * The odontoblasts close up to the dentine are in actual contact 
with one another, and there is no room for an intercellular substance. 
* * * The most external portions of the odontoblasts undergo a 
metamorphosis into a gelatigenous matrix, which is the seat of cal- 
cification, while their most central portions remain soft and un- 
altered as the fibrils. According to this view, the fibril, the sheath, 
and the matrix are but three stages in the development of the same 
tissue. * * * Some pulps will be found to contain numerous nodules 
of dentine; in others the greater part of the pulp will be found con- 
verted into secondary dentine. Or the calcification of the pulp may 
be limited to the production of a patch of dentine added to the wall 
of the pulp-cavity. Small isolated calcareous globules are to be 
found in perfectly healthy developing teeth.” 
From E. Albrecht (“Die Krankheiten der Zahnpulpa;” Berlin, 
1858) I copy, as follows: “The principal change of the teeth caused 
by the pulp is the phenomenon of calcific deposits, which are found 
partly on the walls of the pulp-cavity and partly within the pulp- 
tissue. * * * The globular masses in older teeth are not to be re- 
garded as normal but anomalous formations, although sometimes 
the canaliculi of the dentine have grown through them. The 
globular masses show some striped formations with a radiatory 
arrangement, the center of which is occupied by a dark-colored 31 
•empty space of irregular shape, and provided with several offshoots, 
looking like a bone-corpuscle, in which sometimes roundish cell-like 
formations, with nucleus-like contents and offshoots, are seen. * * * 
By the formation of pus in a small place near these globular masses, 
■on the wall of the pulp-cavity, it may occur that some of this sub- 
stance is destroyed and a cavity formed, which later on, by a less 
normal formation of dentine of repair, is separated from the pulp- 
cavity and filled with pus, thus representing an abscess in the 
dentine.” 
From R. Hohl (“Ufiber Neubildungen der Zahnpulpe;” Halle, 
1868) I cite, as follows: “New formations of the dentine are found 
within the soft tissue of the pulp as well as on its periphery in con- 
nection with the primary dentine. The former are present in the 
shape of small hemp-seeds; the latter from their origin are con- 
nected with the walls of the primary dentine, and always grow 
where, on the corresponding outer surface of the tooth, loss of suit- 
stance has occurred. * * * This formation has been called ‘dentine 
of repair,’ and protects the pulp-cavity from exposure. The other- 
formations, however, being found loose in the pulp, are not de- 
signed for any purpose of repair. * * * The free odontomes are 
easily distinguishable by the naked eye; they may, however, be 
mistaken for calcifications, which, in their form, are identical with 
odontomes. * * * The microscopical structure of these formations 
presents the following deviations from normal dentine: their cana- 
liculi run in all directions, especially in those formations found 
loosely imbedded in the pulp-tissue. Now and then the dentinal 
canaliculi enlarge like a sack, or terminate in large holes, which, 
however, ought not to be regarded as bone-corpuscles. * * * Osteo- 
odontomes are mixed formations, and show dentine in one and 
cement in another place. * * * Osteomata are found both free and 
adhering to the walls of the pulp-cavity. The bone-corpuscles are 
found sometimes analogous to those of the cementum; at others 
they are seen as rudimentary formations only. * * * The contents 
of the bone-cells I positively believe to be a clear liquid, although in 
some places it looks granular. In no instance was it possible for 
me to see a nucleus in the cells, and their contents, as mentioned 
before, are perfectly homogeneous and clear.” This work is illus- 
trated by two very nicely executed plates. 
Franz Boll (<£ Archiv fur Microskopisclie Anatomief vol. iv.; 
Bonn. 1868) says, “An examination of a specimen of pulp-tissue by 
five hundred diameters will exhibit, besides the numerous medul- 
lated nerve-fibers, an enormous quantity of very fine, peculiar, silk- 
like. and shining fibrillse, which, upon the first glance, may be 
mistaken for very fine fibers of elastic tissue. Upon closer examina- 32 
tion. however, they prove to be minute non-medullated nerve-fibers. 
The transition of the medullated into the non-medullated nerve- 
fibers goes on quite gradually. At first the axis-cylinder is sur- 
rounded by its comparatively thick myelin sheath, exhibiting its 
characteristic double contour. Soon, however, this myelin sheath 
decreases in thickness, and afterward is seen 011I3’ in some places, 
where it forms the characteristic varicosities. They yet exhibit the 
double contour, but the very thin layer of myelin surrounding the 
axis-cylinder shows only a single contour. At first these intervals 
are small and the varicosities appear in regular succession, but 
soon the former become larger and the latter scarcer, until they are 
altogether absent, The fibers in this place are quite delicate, yet 
exhibit alternate expansions and constrictions in their diameters. 
But soon they lose this characteristic feature, and appear as naked, 
homogeneous axis-cylinders. As mentioned before, these nerve- 
fibrillte look somewhat like fibers of elastic tissue, but their great 
delicacy and little resistance for reagents are proofs that they are 
nerves. * * * In the investigation of the terminations of these minute 
non-medullated nerve-fibers we meet with great obstacles. By the 
usual way of splitting a tooth in a vise and removing the pulp by 
a pair of fine tweezers, we do not obtain the whole of the pulp. 
The peripheral portion of the pulp forming the boundary toward 
the dentine is composed of a continuous layer of elongated cells, 
which, by long processes extending into the dentinal canaliculi. 
adhere to the dentine. However carefully the pulp is removed 
from the split tooth, we will hardly ever be able to find traces of 
this peculiar peripheral layer upon the pulp. The outer layer of 
cells, by their long processes, which extend into the dentinal cana- 
liculi, are held firmly to the inner surface of the dentine, appearing,, 
to the naked eye, as a thin mucus-like film. If this film is carefully 
scraped off with a knife and brought under the microscope, we 
observe that, besides the peripheral cells, it contains some of the 
inner parts of the pulp-tissue. To be able to obtain the whole of 
the pulp untorn, I proceed in the following way: I split a fresh 
tooth once in a vise and place the pulp and tooth in a very weak 
solution of chromic acid, of the strength of one-thirty-second of 
one per cent. After one hour I carefully remove the loose frag- 
ments of the tooth, and then, with a thin and sharp knife, go be- 
tween the pulp and the dentine close to the walls of the pulp-cavity. 
Thus, with a little practice and some good luck, I am often success- 
ful in obtaining the outermost portions, Avitli the whole of the pulp 
in position. The peripheral processes of the outer layer of cells, 
which extend into the dentinal canaliculi, are generally torn off 
close to the body of the cells. Sometimes it happens that by the 33 
pull of the knife these fibers come out of the dentinal canaliculi 
in considerable length. * * * On specimens obtained in this way 
enormous numbers of non-medullated nerve-fibers (which b}r their 
division are greatly augmented) are seen toward the periphery of 
the pulp. By tearing such pulps apart with very fine needles we 
will obtain hardly a specimen which does not contain some of these 
minute nerve-fibril la?. A very close net-work of these fibrilhe is 
seen on the boundary between the proper tissue of the pulp rich in 
vessels, and the peripheral cells, which, when removed in the ordi- 
nary way, generally adheres to the wall of the pulp-chamber. 
Some of these delicate nerve-fibers we see coming out of the layer 
below the peripheral cells, making their way between the latter, 
which are closely packed together, and extending above them, 
where they end. * * * We have now to consider the question, do 
the extremities of these minute free nerves extend into the dentinal 
canaliculi or not ? I have spent a great deal of time to prove this, 
but have not been successful. Although I can furnish no direct 
proof, yet I regard the prolongation of the nerve-fibers into the 
dentinal canaliculi as certain. The outer surface of the peripheral 
portion of the pulp and the walls of the pulp-chamber are in abso- 
lute contact, so much so that there would be no room for the ex- 
tremities of these protruding nerves. The direction of the ends of 
these nerves being parallel with the dentinal canaliculi, leaves us to 
think of no other way but that they, as well as the processes of the 
peripheral cells of the pulp have been lifted out of the dentinal 
canaliculi. We have, therefore, to assume two varieties of cana- 
liculi in the dentine near the pulp: those containing the processes 
of the peripheral cells of the pulp, and others which receive the 
minute nerve-fibers emanating from between these cells.’' 
J. H. McQuillen (Dental Cosmos, vol. x.) says, “A very valuable 
specimen was forwarded recently by Dr. C. B. Rising, of West Rock- 
ford, 111., illustrative of that interesting but painful affection known 
as calcification of the pulp, in which the pulp-cavity is either occu- 
pied by a number of nodules or almost obliterated by 
of a structure which, under the microscope, presents a peculiar 
appearance named secondary dentine.” 
S. J. A. Salter (“Dental Pathology and Surgery;” New York 
1875) says, “ is a soft mass which exactly fills the chamber 
in the fang and crown of the tooth. * * * There appear to be no 
lymphatics in the tooth-pulp. * * * A very pale, ill-defined areolar 
tissue, pervaded by numerous round and oval cells or nuclei, occu- 
pies the spaces between the vessels and nerves. The cellular bodies 
toward the surface are enlarged, and assume the form of columnar 
epithelium. From the extremities of these project minute tubular 34 
prolongations, which constitute the animal basis of the dentinal 
tube-wall. * * * Calcification of the pulp must be looked upon as 
morbid in the lowest degree, being to a great extent reparative and 
tbe result of trivial causes, though I believe it never occurs unless 
the tooth has been in some way the subject of injury or irritation. 
* * * The pathological change consists in the impregnation of the 
various tissues of the pulp with calcareous matter, involving more 
and more of the structure of the pulp, and its ultimate conversion, 
under favorable circumstances, into osteo-dentine. * * * The pro- 
cess of lime-impregnation is different from that which occurs in the 
formation of normal dentine and ‘dentine of repair.’ In these 
calcification is superficial, and only involves those elements which 
constitute the animal basis of dentine, namely, the tubular pro- 
longations from the peripheral cells and the hyaline intertubular 
substance. Their calcification, moreover, is ■ globular,’ as already 
mentioned. * * * The relation of these calcified masses to the tissues 
among which they are found is very remarkable. The whole of the tis- 
sues, cells, nuclei, connective tissue, blood-vessels, and multitudes of 
nerves are swallowed up and obliterated by the calcification process.’’ 
From J. Bruck, Jr. (“ Beitraege zur Histol. und Path, der Zahn- 
pulpaBreslau, 1871) I copy the following: “The structure of 
dentinal new formations is identical with that of normal dentine, 
with the difference that in the former the dentinal canaliculi assume 
a radiating arrangement and their course is wavy. These new 
formations are seen not only in carious, but frequently in healthy 
temporary and permanent teeth. Very often these dentinal forma- 
tions are met with in teeth the crowns of which have been worn by 
attrition, and in chronic cases of caries. * * * Calcification of the 
blood-vessels and nerve-fibers may occur; but I do not believe that 
calcified masses are found without being in connection with blood- 
vessels or nerve-fibers. In all my researches I have never found a 
calcified mass loosel}' imbedded in the tissue of the pulp, but always 
was enabled to observe either a dentinal or an osteo-dentinal struc- 
ture in it. I would therefore like to state that all formations 
which previously have been described as depositions of lime-salts 
within the pulp are nothing else than new formations of dentine. 
* * * It is not without interest that I haVe shown that dentinal 
tissue may be developed not only from the odontoblasts (ivory cells), 
but from any cell of the tissue of the pulp. Thus bone-tissue is 
brought one step nearer to dentine, and, as dentinal canaliculi have 
been found in the bone of fishes, this may throw additional light 
upon the subject.” This pamphlet is illustrated by sixteen engrav- 
ings upon two plates, which are executed in the most natural man- 
ner, and are the best on this subject that I have ever met with. 35 
According to Waldeyer (“A Manual of Histology,” by Professor 
S. Strieker; New York, 1872), “ The external layer of the pulp is 
formed by a layer of large cells, of elongated form, and provided 
with numerous processes called ‘ odontoblasts,’ which are arranged 
so as to form a kind of columnar epithelium. Three kinds of pro- 
cesses may be distinguished in these cells: the dentinal process, the 
pulp process, and the lateral processes. The dentinal processes 
constitute the dentinal fibers; odontoblasts with several dentinal 
processes are broad at the end, but as the processes pass on they 
gradually diminish, to form the dentinal fibers. The odontoblasts 
are intimately connected with one another by means of fine, short 
teeth, which the lateral processes of all the dentinal cells form.” 
Prom Carl Wedl (“ The Pathology of the Teeth;” Philadelphia. 
1872) I cite: “The outer surface of the pulp is covered with conical 
cells (odontoblasts), from the broad faces of which, directed out- 
ward, comparatively thick processes extend. The dentinal processes 
enter the continuous dentinal canals, and, like the latter, divide into 
branches and numerous ramifications. * * * The basis-tissue of the 
pulp consists of a loose connective tissue. Bundles of wavy con- 
nective tissue serve to give it firmness. In aged persons the pulp 
is more dense, tenacious, and contains also a larger quantity of 
fibriHated connective tissue. * * * A new formation of dentine, 
which has arisen subsequent to the abrasion of the crown, is 
perceptible upon the abraded surface as a central spot surrounded 
by polished dentine. In these cases there occurs a continued devel- 
opment of dentine within certain limits, determined by an irritation, 
and the new layers are deposited in immediate contiguity with 
the old, and in parts are intimately and organically united with the 
latter. Dentine of this description, which serves as a protecting 
covering of the pulp, is called £ dentine of repair,’—secondary den- 
tine. * * * Thin cross-sections of these new formations present a 
central basis-substance, composed, in many cases at least, of trans- 
parent, diskoid, homogeneous, structureless, nucleus-like masses, 
around which concentric layers are disposed in a manner similar to 
those around the Haversian canals in bone. * * * I have met with a 
few eases only of true new formation of osseous substance within the 
parenchyma of the pulp. They occurred in the pulps of milk-teeth 
which were undergoing resorption. * * * The greater portion of 
the very common osteo-dentinal formations is composed of dentine; 
the bony substance occurs in very small quantity, and may consist 
merely of a group of a few bone-corpuscles. * * * With regard to- 
the development of these isolated encysted new formations, Heider 
and I have maintained the view of the occurrence of an inversion 
of the layer of dentinal cells, upon the following grounds: the 36 
dentinal canals pursue a centripetal course; therefore, the dentinal 
cells, which enter into the formation of the latter, and the develop- 
ment of which proceeds from the periphery of the inverted portion 
toward the center, must have assumed an adequate arrangement. 
* * * The calcareous grains are true concrements, and occur also 
as accessory products in connection with hard new formations, but 
never enter into organic union with the original dentine. They are 
located within the parenchyma of the pulp, and are calcifications in 
the connective tissue.” 
In the “Atlas to the Pathology of the Teeth,” arranged and ex- 
plained by the late Prof. Dr. M. Heider and Prof. Dr. C. Wedl, the 
following figures illustrate new formations in the pulp: Nos. 46. 48, 
49, 51. 52. 53, 54, 55, 56. 57, 58, 60. 61. 63. 64. 65. 66. 67. 68. 69. 70. 
71. 72. 76. 77. 78, 80. 97. 
C. S. Tomes (“ Manual of Dental Anatomy;” Philadelphia, 1876) 
says, “ The pulp may be described as being made up of a mucoid, 
gelatinous matrix, containing cells in abundance, which are espe- 
cially numerous near to its periphery. In it some fibrous connect- 
ive tissue is discoverable. * * * The odontoblast layer sometimes is 
called the £ membrana eboris.’ They (the odontoblasts) are furnished 
with three sets of processes: the dentinal process (which is equiv- 
alent to the dentinal fiber); by means of lateral processes the cells 
communicate with those on either side of them, and, by means of 
their pulp processes, with cells lying more deeply. The membrana 
eboris covers the surface of the pulp like an epithelium. * * * No 
lymphatics are known to occur in the tooth-pulp. * * * The exact 
nature of the terminations of the nerve-fibers in the pulp is not 
with certainty known; the primitive fibrils often form meshes, but 
this does not appear to be their real termination.” 
Robert Baume (in “ Deutsche Vierteljahrsschrift fur Zahnheil- 
kunde.” 1874) describes new formations of dentine in human pulps, 
as well as in those of the ox, elephant, and hippopotamus, to which 
he applies the term “interstitial dentikels.” 
(I am sorry to state that I have not been able to obtain Dr. Baume’s 
“Lehrbuch der Zahnheilkunde” in time for this publication.) 
31. Schlcnker (in “ Deutsche Vierteljahrsschrift fur Zahnheilkunde.” 
1875) describes two of new formations of dentine and bony 
masses in human pulps, but little their minute structure. 
Adolph Witzel, in his work, “ Die Antiseptische Behandlung der 
Pulpakrankheiten;” Berlin, 1879, says, “The odontoblasts at their 
free extremities exhibit thick prolongations, which have been torn 
out of the dentine ; and in their finely-granular protoplasm contain 
one or two nuclei. * * * The new formations of dentine, considered 
histologically, are composed of a finely-granular or lamellated basis- 37 
substance, in which more or less dentinal canaliculi are present. 
The basis-substance, as will be observed in these new formations, 
everywhere is largely prevailing. The course of the dentinal cana- 
liculi is very different. In some of the small globular new forma- 
tions the dentinal canaliculi divide, and are distributed within the 
basis-substance in a radiatory arrangement. * * * The development 
of the free new formations of dentine is, as Heider and Wedl 
announce it, accomplished by an invasion of the odontoblast layer. 
T, according to my own observations, cannot conform with this view, 
but have to support the assertions of Hohl, who, with right, claims 
that if the loose new formations of dentine arise by an invasion of 
the odontoblasts, they ought to be traceable, which Ilohl, as well as 
myself, has never been able to do. * * * The development of the 
free dentikels, according to my researches, is accomplished in the 
way, that, first, the connective-tissue corpuscles in the midst of the 
pulp-tissue are sprouting fine offshoots; or they proliferate and form 
anastomoses ; the connective tissue then begins to calcify, and, as cal- 
cification (dentinification) advances, the connective-tissue corpuscle 
itself becomes constricted, and gradually is transformed into a den- 
tinal canaliculus.” 
III.—Therapeutics. 
In the September number of the Dental Cosmos for 1876 there 
was published a paper, by Junius E. Cravens, D.D.S., of Indianap- 
olis, Indiana, entitled •• Lacto-Phosphate of Lime, Pathology and 
Treatment of Exposed Dental Pulps and Sensitive Dentine,” in 
which attention was called to the injurious effects of pure carbolic 
acid and creasote in the treatment of exposed pulps. This article 
seems to have awakened the interest of several thinking minds. 
At the meeting of the New York State Dental Society, a few 
months later, Dr. W. C. Barrett, of Buffalo, read a paper on “ The 
Use of Creasote in Treating Simple Exposures of the Dental Pulp. 
Is it Correct Practice?” This again directed my attention to the 
subject. Before that time I had usually capped exposed pulps with 
either a solution of gutta-percha in chloroform, or with zinc oxide 
mixed with creasote, filling the rest of the cavity with oxychloride 
of zinc, from which I had had to record quite a number of failures. 
I tided to save every pulp as long as there appeared to be life. 
Arsenious acid, which, before I became acquainted with Dr. Wm. 
H. Atkinson, I had used freely, I had. like him, laid aside altogether. 
In July, 1879,1 read the work of A. Witzel, and felt sure that every 
tooth treated with arsenious acid in the manner described in that 
work would, sooner or later, cause trouble. At the meeting of the 
American Dental Association held at Niagara Falls in August. 1879, 38 
I. ns well as Dr. Atkinson, severely criticised Witzel’s work and his 
advised use of arsenious acid. To-day, however, I have to corrobo- 
rate some of the assertions of Witzel, and believe that without 
arsenious acid the dental materia medica is incomplete. 
I have been asked, “Is the knowledge of the minute anatomy 
and pathology of the dental pulp of an}- practical value?” My 
answer to this question is that I believe it is impossible, without 
this knowledge, to treat successfully all the difficulties that present 
tliemelves. To decide what the mode of treatment shall be,— 
whether a pulp, when exposed, can be capped, or had better be 
destroyed,—depends, in a great measure, upon a thorough scientific 
as well as practical understanding of the organ to he treated. If 
these querists, after due consideration of this paper, are led to cor- 
roborate this assertion. I shall feel more than gratified. 
In chapter II. of this paper I have described the microscopical 
appearances of the inflammatory process in the pulp, omitting its 
clinical features. These will, in connection with the therapeutical 
part of our subject, be of greater interest. 
In order to make the different stages of pulpitis comprehensible, 1 
will describe in few words some of its most characteristic symptoms: 
Inflammation of the pulp may occur in one portion or in several in- 
dependent portions at the same time, or may implicate the whole organ. 
It is of importance to be able, as far as possible, to distinguish 
the different stages of inflammation in the pulp. In a great measure 
successful treatment depends upon a correct diagnosis of the degree 
to which the disturbance has advanced; whether there is present a 
hyperemie condition, an inflammation involving a part or the whole 
of the pulp-tissue, or a dying pulp. 
A hyperemie condition of the pulp exists if the patient expe- 
riences pain only when the tooth affected comes in contact with 
anything hot, cold, salty, sweet, or sour, etc., the pain lasting but a 
few minutes, and ceasing as soon as the irritant is removed. 
When a tooth is attacked by caries, or suffers from any lesion 
which allows the approach of an irritant near to or into the pulp- 
chamber, a partial inflammation, in the majority of cases, is, sooner 
or later, the result. Slight pain, with long painless intermissions, 
first occurs, but the paroxysms of pain gradually increase in length 
until they sometimes last an hour, the intermissions being corre- 
spondingly shortened. Pressure applied in the vicinity of the ex- 
posed pulp produces intense pain, which does not subside with the 
removal of the pressure. Upon the application of heat or cold the 
tooth aches for an hour or more, but an application of pure carbolic 
acid or ereasote abates this. The tooth as yet is not at all sensitive 
upon percussion, and is as useful as before, except when, as in mas- 39 
tication, foreign matter is pressed upon the pulp. If the decayed 
portion of the dentine, which generally still covers the pulp, is very 
carefully removed with a sharp excavator, we observe the exposed 
portion of the pulp as a light-red dot, with a little blood escaping 
from the pulp-cavity. If such a pulp is left without therapeutical 
treatment, there occurs either an acute inflammation involving the 
whole of the organ, or, in ease the pulp-cavity is largely perforated, 
the process may become chronic. 
Inflammation of the whole pulp is characterized by very intense 
throbbing pain in the tooth, intermittent in the beginning, but soon 
becoming continuous, and which may last from one to three days. 
After the first or second day of the paroxysm a little sensitiveness 
becomes noticeable, from pressure or percussion upon the affected 
tooth, indicating the beginning of pericementitis. When the pulp 
can be brought to view at this stage, it will appear as a dark-red 
dot, bulging into the cavity and bleeding quite freely. 
If the exposure is large the pulp may protrude from its cavity, 
and, the pus which is formed escaping, the organ may retain its 
vitality for some time, and the inflammatory process assume a 
chronic form. If, on the contrary, the pulp-cavity is not perforated, 
or the exposure is small, preventing the swelling of the pulp-tissue 
out of its hard inclosure, then the vessels of the pulp, and especially 
the afferent vessels, become engorged with blood to such an extent 
that they are strangulated, resulting in gangrene of the pulp. The 
pain, shortly before the strangulation of the vessels, is excruciating, 
but only for a few minutes, when suddenly it ceases altogether. 
The conservative treatment of the pulp is of great importance in 
the teeth of young persons, especially those under the age of sixteen 
years, where the roots are not quite fully developed. The death of 
the pulp in these instances frequently terminates, sooner or later, with 
the loss of the tooth. It is different with the teeth of adults and old 
persons, in which cases I do not regard the loss of the pulp as a very 
great injury. Though I do not want to be understood to say that 
a pulpless tooth is as good as one that contains a healthy pulp, still 
I consider it safer (when filled properly) than a tooth with a pulp 
which is composed mainly of fibrous connective tissue, or contains 
large eburnifications and spicula of bone. 
I have now come to the consideration of the question, Ought every 
exposed pulp to he saved ? I should say, Certainly not. As soon as the 
inflammation has invaded the whole of the pulp-tissue, or the forma- 
tion of pus has commenced, such a pulp ought not to be treated and 
afterward capped, but should be directly devitalized. In a hyper- 
emic or partial inflammatory condition of the pulp, and when the 
latter stage has not proceeded further than the liquefaction of the 40 
gluey basis-substance in a small territory of the pulp, the organ can 
be saved, provided the pulp in being exposed has not been wounded 
deeply, or for any length of time left in contact with the fluids of 
the mouth or the air. Such pulps, in skillful hands, and with the 
proper treatment, will be saved every time, and are the only ones 
that promise satisfactory results after capping. 
Regarding the use of pure carbolic acid or creasote in capping, I 
agree with Drs. Cravens, Barrett, A. Witzel, etc., that neither a 
hyperemic nor a partially inflamed pulp, when its preservation is 
desired, should be treated with anything stronger than a five-per- 
cent. aqueous solution of carbolic acid. Pure carbolic acid is an 
irritant, and as such, when applied to tissues, excites inflammation 
just beneath the layer which it has destroyed,—a process which, in 
the conservative treatment of the pulp, should be prevented. In 
the capping of this class of pulps we require no other action of car- 
bolic acid than that of a disinfectant, for which the five-per-cent, 
solution is ample. Some operators use this agent to destroy pulps, 
and in some instances I have done so myself. Therefore, pure car- 
bolic acid or creasote ought not to be used in connection with any- 
thing that is designed to cover an exposed healthy or hyperemic 
pulp. In shallow cavities, however, which do not reach the vicinity 
of the pulp-chamber, I always apply pure carbolic acid for a few 
minutes before the filling-material is introduced. When used in 
this way, I regard its action as beneficial. It is a powerful disin- 
fectant, and at the same time coagulates and mummifies the ends of 
the dentinal fibers. Thus the irritation of a metallic filling-material 
is greatly reduced. Whenever a cavity is large enough to admit of 
the interposition of cement and gutta-percha between the metallic 
filling and dentine toward the pulp-cavity, this protection should 
always be afforded. Since 1877 I have used directly upon the pulp 
no stronger aqueous solution of carbolic acid than the ten-per-cent., 
and lately only a solution of five per cent. So far as I know, all 
the pulps 1 have capped since 1880 are living,—that is, those teeth 
which 1 have seen since have given no trouble, and their appearance 
is perfectly normal. Their treatment has been as follows: When 
a cavity is deep, and the symptoms indicate that the pulp-cavity is 
very nearly or slightly perforated, 1 at once apply the rubber dam, 
if possible, and saturate the cavity with the five-per-cent, solution 
of carbolic acid. 1 then excavate and clean the side walls of the 
cavity perfectly before touching the vicinity of the pulp-chamber. 
If pain is produced by slight pressure with a piece of cotton upon 
the softened dentine covering the pulp (indicating a perforation of 
the pulp-chamber), I very carefully remove, with a sharp and large 
excavator, as much of the disintegrated dentine as possible, but 41 
without quite exposing the pulp, and apply the cap. If upon slight 
pressure into the cavity the patient experiences but little or no 
pain, I remove all the decay from the cavity. The best material to 
be placed upon the dentine, either soft or hard, covering the pulp, 
as well as upon an entirely bare organ, I have found to be zinc- 
oxide mixed to the consistence of thick cream with an aqueous 
five-per-cent, solution of carbolic acid. Over this, before it com- 
mences to dry, I very carefully place a thin wafer of gutta-percha, 
which, previous to its introduction into the cavity, I moisten with 
the carbolic acid solution. After three to live minutes, I cover the 
cap with either oxychloride of zinc or carbolic acid cement (Witzel*). 
When sufficiently hard, I use oxyphosphate or amalgam to till up 
the rest of the cavity. The latter filling I always expect to remain 
for at least one or two years before I would consider it safe to fill 
such a cavity with gold. 
In a former chapter 1 stated that, when myxomatous connective 
tissue is attacked by an inflammatory process, this, as all other tis- 
sues, returns to its medullary condition, from which, as long as the 
single medullary elements are connected with one another, a fibrous 
cicatricial tissue, bone, or dentine may arise. This tissue can never 
again return into the myxomatous condition, and consequently, in 
some instances, when spieula of bone or dentine are developed in 
the pulp-tissue, severe disturbances may occur. For this reason I 
advocate the devitalization of pulps the whole tissue of which lias, 
by inflammation, either wholly or to a great extent retrograded into 
its medullary condition. 
No doubt every dental practitioner of experience has met with 
patients who have suffered from neuralgic pain, which, after devi- 
talization of a pulp or the extraction of a tooth, suddenly ceased. 
I have on my record quite a number of such cases, of which I will 
describe a few: 
I. For Miss S., aged fourteen years, I filled, on the 25th of Novem- 
ber, 1872, the second lower molar with amalgam. The cavity was 
* The formula for Witzel’s carbolic acid cement is as follows: 
R Acid, carbol., 5-0; 
Alcohol, absol., 2-0; 
Aq. dest., 40 0; 
Grlycerinae, 20’0. 
Mix, and add an equal volume of the zinc chloride used in preparing oxy- 
chloride fillings. To a sufficient quantity of this mixture add oxide of zinc to 
give it the necessary consistence for filling. 
This author also mentions a varnish composed of collodion, gutta-percha, and 
a little carbolic acid, which he applies upon an exposed pulp previous to the 
adaptation of the cap. This I have found very serviceable. 42 
situated on the buccal, near the mesial surface, and rather exten- 
sive. The tooth, after the filling had been inserted, remained sensitive 
to thermal changes for a long time, but otherwise gave no trouble. 
In December, 1879, the tooth was decayed on its mesial surface, but 
in trying to prepare this cavity I found the dentine so extremely 
sensitive that the patient, being at the time in bad health, would not 
let me fill the tooth. June 3, 1880, I saw the tooth again, when 
the decay had reached the pulp-cavity. It had never given very 
much trouble, except when food, during mastication, was pressed 
into the cavity. I found the dentine sensitive as before, and con- 
cluded. therefore, to devitalize the coronal portion of the pulp, and 
made an application of arsenious acid. The next day, when the 
patient entered my office, she told me she felt better that day than 
she had for many months. When I removed the dressings and 
examined the state of the pulp, I found a large so-called “pulp- 
stone” lying in the direction toward the amalgam filling. The 
patient, since that time, has had no more neuralgia, has got quite 
strong and vigorous, and the molar, Avith the coronal portion of the 
pulp amputated, does good service, and has not given any further 
trouble. 
II. On September 3, 1881. Mrs. R., aged twenty-two, came to 
me Avith excruciating pain in the left upper lateral, containing a 
large gold filling in its mesial surface Avhich had been inserted se\T- 
eral years previously. About a year before the patient first noticed 
lameness of the left upper arm, Avhich. after some Aveeks, terminated 
in more or less constant neuralgia, affecting, at times, the Avhole left 
side of the body; but no pain avrs observed in this lateral previous 
to the 1st of September, two days before the patient applied to me 
for relief. I opened the pulp-chamber from the lingual surface of the 
tooth, and found the pulp in a high state of inflammation, Avhich had 
extended someAvhat into the pericementum. An application of car- 
bolic acid, tannin, and morphia Avas made, Avhich greatly relieved 
the patient. About one hour later I reneAved the application, and 
after a feAv minutes introduced the arsenious acid paste, and then 
dismissed the patient, avIio felt greatly relieAmd. The next day I 
extracted the pulp by means of a broach, and immediately immersed 
it in a very Aveak solution of chromic acid. A section of this is 
exhibited in Fig. 6. The patient, Avho at that time lived in the 
country, came back tAvo days afterAvard to thank me for the cure of 
her neuralgia, which, up to this time, has not recurred. 
III. On the 1st of June, 1878,1 inserted for Dr. H. an oxychloride 
filling in the right upper first molar, which had previously been 
filled Avith amalgam. The cavity was large, involving the distal and 
grinding surfaces, Avith half of the lingual wall broken off. On the 43 
21st of August, 1880, I restored the last portion of the tooth with 
gold, but left much of the oxychloride cement over the pulp-cavity. 
The walls of the cavity were quite sensitive under the bur, so much 
so that my patient, who in all other operations 1 had previously 
performed for him never said a word of the pain produced by exca- 
vating, in this instance remarked that the drilling in some places 
was very painful. There had been no pain in the tooth whatever 
previous to the introduction of the gold, but about a week after the 
operation was completed the tooth became sensitive upon per- 
cussion and mastication, without signs of pulpitis. About two 
weeks later my patient was suffering from an alveolar abscess 
situated above the buccal roots of this molar tooth. I immediately 
tried to open the pulp-chamber, but could only go a little way into 
the dentine, when the patient informed me that the drilling caused 
him severe pain, which was analogous to the excavating of a sensi- 
tive tooth. 1 abstained from drilling any further, tilled the small 
hole with gutta-percha, and began the treatment of the abscess 
through the gum at the buccal surface, but with no success. The 
abscess was continually discharging until the beginning of Decem- 
ber, when I removed the gutta-percha, and, with a sharp drill, 
perforated the pulp-chamber, but, to my surprise, found the pulp 
alive and bleeding freely. I then, as quickly as possible, capped 
the pulp in the usual way, and filled the outer portion of the drill- 
hole, Avhich had been widened with a larger bur up to the cap, 
with oxyphosphate cement, concluding to wait a few weeks longer, 
and then, if the abscess did not heal, to devitalize the pulp. On the 
23d of January, 1881, I removed the filling, together with the cap, 
in order to destroy the pulp, but found that the pulp had died 
recently, as there was no smell of putrefaction present in the pulp- 
chamber. 1 took out a large filling in the mesial surface of the 
tooth, and from this situation thoroughly exposed the pulp-chamber, 
from which I extracted a very large so-called “ pulp-stone” of the size 
of a small pea, occupying the neighborhood of the buccal roots. This 
is the specimen which 1 have described in chapter II, Xo. 4, “ So- 
called pulp-stones’ composed of dentine with the features of primary 
dentine.” The canals of the tooth were then examined, and I found 
the two buccal canals in a very putrid condition, but the lingual 
canal contained its recently-dead portion of the pulp without large 
calcified or eburnified masses. After the disinfection and filling of 
the pulp-canals the abscess began to heal, and the tooth to-day is as 
serviceable and comfortable as any other tooth in the mouth. 
A few years ago I tried to save every pulp, even after an acute 
total inflammation had been present, treating them with every suit- 
able remedy, but cautiously avoiding arsenious acid. Many times 44 
I have rather let my patient suffer a great deal of pain than 
devitalize the pulp in the usual manner. Such practice to-day I re- 
gard just as one-sided as to try to fill every cavity with gold and 
adhere to the opinion that nothing but that material will he able to 
save teeth from decay, and vice versa of other filling-materials. 1 
have experimented with arsenious acid in quite a number of cases, 
but am not quite ready yet to say anything about them. This, how- 
ever, I can state, that so far as I know I have met with the same re- 
sults as described by Witzel, namely, that arsenious acid applied upon 
a healthy or a superficially inflamed pulp (for from twelve to twenty- 
four hours), which has previously been treated with a solution of 
tannin in carbolic acid, does not devitalize the whole of the pulp, 
and when after twenty-four hours the arsenious acid, together with 
the destroyed portion, is removed, the remainder of the pulp, which 
appears to be quite healthy, can be capped and preserved. As this 
subject is of very great interest, I will give a very brief abstract of 
the method as published by Witzel in “ Die Antiseptische Behandlung 
der Pulpakrankheiten des Zahns” ( Berlin, 1879): 
“Before excavating I insert a piece of spunk moistened with the 
carbolic acid and tannin solution into the carious cavity for a few 
minutes, clean the surrounding gum of the mucus-like saliva with 
a soft brush or a piece of spunk, and make the cavity accessible. 
And now I begin to clean the cavity either with broad spoon-shaped 
excavators or sharp oval burs. Before the introduction of the 
arsenious acid I make an application of the carbolic-acid-tannin 
solution,* until the pain in the tooth has entirely ceased, which is 
generally the case in five or ten minutes. The arsenious acid and 
morphine made into a thin paste is then laid directly upon the exposed 
pulp, and the cavity hermetically sealed. If the coronal portion of 
the pulp is to be amputated and the stumps preserved, this applica- 
tion should not remain longer in the tooth than from twelve to 
twenty-four hours, if. however, the whole pulp is to be extracted, 
the arsenious acid paste should remain in the tooth for forty-eight 
hours. Before the removal of the whole dressing the cavity must be 
moistened with a weak solution of carbolic acid. Then take a sharp, 
new bur, with the engine, now remove the last dressing, and with a 
few quick revolutions of the bur amputate the coronal portion of 
* li Acid, carbol., -150; 
Tinct. aconit rad., 
Aq. menth. pip., a a 050 ; 
Glycerina1, -020 ; 
Acid, tarmic., 030; 
01. menth. pip., 
01. caryophylli, aa gtt. xxv.—M. 45 
the pulp, and immediately fill the cavity with carbolic acid solution 
until the bleeding has ceased; then place a piece of spunk moistened 
with the carbolic-acid-tannin solution over the amputated stumps. 
The amputation of a portion of the pulp is to the patient somewhat 
uncomfortable—about as painful as exposing a pulp. With very 
sensitive patients I make an application of a solution of iodine with 
cai’bolic acid previous to the amputation for about a quarter of an 
hour, which makes the operation painless. The whole treatment 
must be done quickly, very cleanly, and without exposing the ampu- 
tated stumps much to the action of the air. The cavity is now to be 
syringed out well, dried, the stumps touched with carbolic acid, 
mastic, and pulp-varnish, and quickly capped with carbolic acid 
cement; then a layer of oxychloride and gutta-percha is placed 
over it, and, lastly, the rest of the cavity is filled either with amal- 
gam. oxyphosphate, or other material.” 
Since December last I have tried a new remedy (iodoform), which 
of late has been reported as doing great wonders in surgery. The 
very disagreeable smell of this drug had prevented me from using 
it before. In a German dental journal ( Vierteljahrsschrift fur Zahn- 
heilkunde) I noticed an article on iodoform by Dr. Julius Scheff, of 
Vienna, who has been very successful with it in capping slightly 
inflamed pulps, using it in the form of a paste, the formula of which 
was original with Dr. Paschkis, and is as follows: 
R Iodoform pulv. 
Kaolin pulv., aa 4-00; 
Acid, carbol. cryst., 0*50. 
Mix; add sufficient glycerin to form a paste; then add ol. menth. pip., gtt. x. 
I have tried this paste in a small number of exposures, and ap- 
parently with good results. I placed the iodoform paste over the 
exposed pulp, covering it with a wafer of gutta-percha and a layer 
of carbolic acid cement, and tilled the rest of the cavity with either 
gutta-percha or oxyphosphate of zinc. None of these teeth have 
given any trouble since then ; but in what state their pulps are I am 
unable to say at present. I have found another very valuable use 
for iodoform,—in chronic alveolar abscesses. For this purpose I use 
the saturated solution in sulphuric ether, which, when forced through 
the end of the alfected root into the old abscess, acts, I believe, as a 
very powerful disinfectant, and is therefore of great service as an 
application previous to filling the roots of pulpless teeth. I have 
also used the solution of iodoform in ether as an injection into the 
antrum, the mucous membrane of which was inflamed. In this case 
it did not quite stop the formation of pus. but prevented it longer 
than any of the other agents which, in this case, I had used pre- 
viously or intermittingly.