The physiological action produced can be summed in a few words. Observation shows that the functions of the cerebrum are affected first; next, the anterior or motor centers soon fail to respond to mechanical irritation, yet the functions of the medulla-oblongata (the center of respiration) are performed. This is the proper stage to appreciate, for, if the inhalation be still further carried on, the sensory and finally the motor functions of the medulla-oblongata are involved, and death ensues from paralysis of the respiratory centers.
In conclusion, I must not fail to observe that ether has a peculiar and exciting effect on the genital organs, and a prudent operator will not fail to have a third party present throughout all the period of anæsthesia, otherwise his honor and reputation might be forever blasted by the emphatic assertions of some female laboring under the unhappy delusion of having been injured beyond reparation.
DISCUSSION OF DR. STODDARD'S PAPER: PORCELAIN FILLINGS. [4]
President Briggs:—Gentlemen, I think we all are paying more attention to porcelain fillings than we formerly did. Since 1883 I have referred to them in my lectures as one of the methods of preserving the teeth, and have used them in my practice. One point particularly interesting to me is the method Dr. Stoddard uses, of packing the clay into the plaster impression, biscuiting it, then removing the surrounding plaster and finishing the fusing. I presume it is because the carver I have employed does not do this that he fails to give me good results from irregular impressions. I imagine he tries to take them out while they are in the clay, and of course, cannot, if the shapes are peculiar.
Dr. Smith:—My method of using porcelains is so similar to what Dr. Stoddard has just presented that my remarks will be largely an endorsement of his paper. I do only the operative part; the laboratory part is done by my assistant, so I have only that part requiring the shaping of the cavity and taking the impression. I have a number of questions I want to ask Dr. Stoddard on working his furnace, but that hardly comes in to what you would call discussion. I like the method I have used, that is, taking an impression of the cavity, baking the enamel and setting in cement or gutta-percha. I have also ground them in, and, as Dr. Stoddard says, it is a very difficult thing to grind them in entirely. Even a very large cavity will seem very small when you get the porcelain between your fingers and attempt to grind it into place. I think it is a much better way to take the impression and bake the body and enamel it, as Dr. Stoddard has suggested. I would further say, Mr. President, that I am using the porcelains where we find large cavities in molars: for instance, dead teeth, where we have a compound cavity, either the mesial or distal surfaces in connection with the crown, and where amalgam is prohibited and the teeth too weak for gold. I find that when an impression is taken of the cavity, and the filling made as Dr. Stoddard says in his paper, and set in cement, that it makes a very nice-looking filling, and one that wears exceedingly well. I use the porcelain in that way a great deal and obtain from it success and satisfaction.
Dr. Taft:—There is but little I can say on the subject before us, from the fact that I have had no experience whatever in making porcelain fillings; although so frequently do cases present themselves in my practice, where porcelain tips and inlays would no doubt make not only as durable but more artistic fillings, by far, than gold or any of the plastics, that I feel encouraged to adopt this method after listening to the interesting paper of the evening, and upon examination of the specimens before us. In looking over the specimens I notice quite an appreciable difference in color between the inlay and the tooth itself, more so in some than in others. This may, of course, be due to the fact that possibly the inlays were placed in some of them previous to extraction. I do not yet quite understand how the doctor mixes his material so as to get the color of the inlay as nearly like that of the tooth as is possible, and should like to have him explain the point a little more thoroughly.
Dr. Stoddard:—I neglected to say that it was impossible to match the color of these dry, dead teeth out of the mouth, but there is no difficulty at all in the mouth. You have a baked sample of your body, which you keep, and from which you select your color.
Dr. Bigelow:—Mr. President and gentlemen: I have never used any of the porcelain fillings myself, but several cases have come under my observation, and the greatest objection that occurred to me, at least in those cases, was the well-defined line of demarkation between the filling and the tooth itself; not but what the porcelain was good color, but it was the material it was set in. A gentleman once opened his mouth and showed me his teeth, and spoke of the great pleasure and comfort that he had taken since his teeth were filled in that way. The porcelain fillings were made for him by a dentist in New York City. To me they were very much more unsightly than gold, possibly because the material used in setting them was not a good match in color for the natural teeth. I think I may have seen one of the cases that Dr. Stoddard has spoken of in his paper. So far as the porcelain itself was concerned, it was a very good match for the tooth, but the line of demarkation was very distinct, almost as much so as if gold was used, though perhaps the strength would be greater. I don't know, perhaps Dr. Stoddard manufactures his own cements and gets his shades just right, thereby overcoming this objection.
Dr. Taft:—There is one other place, Mr. President, where it seems to me these porcelain tips or fillings may not be always practicable that may be illustrated by a case in hand: namely, that of a patient whose upper incisors upon examination were found to be filled with fine fractures, extending along the surface of enamel from the biting edge well up towards the margin of the gums. In the left superior central I found what seemed at first to be a very small proximal cavity, and started very carefully to excavate it from the palatal side, when the corner of the tooth soon afterwards chipped off, and in still further excavating,—hoping to fill with gold,—it continued, in a most aggravating manner, to chip away more and more. To get the smallest possible undercut or groove to retain the gold seemed an utter impossibility, and the longer and more carefully I worked, the more discouraging it became, until finally I was obliged to give up altogether the attempt to fill the tooth with gold and to replace the broken corner with oxyphosphate cement.