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GAXGRENOUS TOOTH-PULPS AS CENTERS OF IXFECTIOX. 285

which surgery is based. Xow, the fundamental principle of the
modern science of surgery is antisepsis, and the dentist ought
not and dare not practice without it."
Witzel also recommends the cleansing of the mouth before
operations, and the requisite after-treatment of the wound or the
abscess-cavity.
Xot only in tooth-extractions, however, but also in other less
serious operations in the oral cavity, removal of tartar, tilling of
teeth, etc., must the greatest care be taken to keep the instru-
ments clean and aseptic. Tears ago I observed a case of the
transmission of syphilis by means of dental instruments used in
the cleaning of the teeth, and only a few weeks since a severe
case of phlegmonous inflammation of the gums, following a
careless removal of the tartar. Lanceraux reports on two cases
of syphilis, one of which was caused by an infected instrument
used in the catheterization of the left tuba Eustachii, the other
by dental forceps used in extracting a number of decayed teeth.
In this connection I may say that to me it is always a source of
wonder that infections do not oftener occur through the repeated
use of the coffer-dam for diiierent persons, particularly as it is
not always as carefully cleansed as it might be.
2. GANGRENOUS TOOTH-PULPS AS CENTERS OF
INFECTION.

Infections through gangrenous tooth-pulps are to be ranked
among the most frequent pyogenic infections of the human
body ; they by no means always have the harmless character
commonly ascribed to them. The fact that the point of infec-
tion is so deep-seated, and is inclosed by hard, bony tissue, of
itself anticipates results of a serious mature. According to
Israel, the root-canal furnishes a point of entrance even for the
ray-fungus, x\ctinomyces, and in one case the microscopic exam-
ination revealed the elements of this organism in the canal of a
pulpless tooth.
It in any way or other (by tooth-decay, mechanical injuries,
attempted extraction, etc.) the tooth-pulp be deprived of its
natural covering, either totally or to such an extent that l)ut a
thin laver of softened dentine remains, a number of different