[American Library of Dental Science.] 
TREATISE 
ON THE 
DISEASES OF THE MOUTH; 
COMPRISING 
THE STRUCTURE AND FUNCTIONS OF THE MOUTH, 
THE HISTORY OF ITS DISEASES, 
THE MEANS OF PRESERVING IT IN BEAUTY AND HEALTH, 
AND OPERATIONS 
APPERTAINING TO THE DENTAL ART. 
BY J. B. GARIOT, 
DENTIST TO THE KING OF SPAIN J MEMBER OF THE ROYAL COLLEGE OF SURGERY AT MADRID J 
ASSOCIATE MEMBER OF THE SOCIETY OF MEDICINE, AT PARIS, ETC. 
TRANSLATED FROM THE FRENCH, 
BY J. B. SAVIER, D. D. S. 
For the American Library of Dental Science, with Notes by the Editors. 
BALTIMORE: 
PUBLISHED BY THE AMERICAN SOCIETY OF DENTAL SURGEONS. 
WOODS AND CRANE, PRINTERS. 
1843. TO THE 
AMERICAN SOCIETY OF DENTAL SURGEONS, 
FOR THE 
NOBLE AND PHILANTHROPIC WORK IN WHICH ITS MEMBERS ARE 
ENGAGED FOR THE ELEVATION OF THEIR PROFESSION, 
AND THE 
PROTECTION OF THE PUBLIC AGAINST DENTAL EMPIRICISM, 
THIS WORK IS RESPECTFULLY DEDICATED, 
BY THE 
TRANSLATOR. [American Library of Dental Science.] 
TREATISE 
ON THE 
DISEASES OF THE MOUTH; 
COMPRISING 
THE STRUCTURE AND FUNCTIONS OF THE MOUTH, 
THE HISTORY OF ITS DISEASES, 
THE MEANS OF PRESERVING IT IN BEAUTY AND HEALTH, 
AND OPERATIONS 
APPERTAINING TO THE DENTAL ART. 
BY J. B. GARIOT, 
DENI 1ST TO THE KING OF SPAIN J MEMBER OF THE ROYAL COLLEGE OF SURGERY AT MADRID J 
ASSOCIATE MEMBER OF THE SOCIETY OF MEDICINE, AT PARIS, ETC. 
TRANSLATED FROM THE FRENCH, 
BY J. B. S A V I E R, D.D.S. 
For the American Library of Dental Science, with Notes by the Editors. 
BALTIMORE: 
PUBLISHED BY THE AMERICAN SOCIETY OF DENTAL SURGEONS. 
WOODS AND CRANE, PRINTERS. 
1843. TO THE 
AMERICAN SOCIETY OF DENTAL SURGEONS, 
FOR THE 
NOBLE AND PHILANTHROPIC WORK IN WHICH ITS MEMBERS ARE 
ENGAGED FOR THE ELEVATION OF THEIR PROFESSION, 
AND THE 
PROTECTION OF THE PUBLIC AGAINST DENTAL EMPIRICISM, 
THIS WORK IS RESPECTFULLY DEDICATED, 
BY THE 
TRANSLATOR. TREATISE 
ON 
THE DISEASES OF THE MOUTH. 
PART FIRST. 
STRUCTURE OF THE MOUTH. 
The mouth is truly the most important part of the countenance, 
and the most remarkable in its structure; it is the mouth and eyes 
that give to the physiognomy nearly all its expression. It is from 
the structure and form of the lips especially, that the famous 
Lavater infers the disposition of his characters ; by long observa- 
tion he acquired the art of divining the moral sentiments not 
merely from the features of the various parts of the human face, 
but also from the attitudes of the whole body under the various 
circumstances of life. This art would at first appear merely 
imaginary, yet we can perceive reality in it, for our physical 
faculties develope themselves in consonance with our moral affec- 
tions; this is a necessary result, and a coincidence more or less 
remarkable may ever be looked for. It is indeed curious to ob- 
serve to what a degree violent passions may change the aspect of 
the most beautiful countenance; while soft and kind feelings and 
manners modify the most repugnant features, and impart to them 
an amiable and winning expression. 
Of the various parts of the face there are none that have occa- 
sion to move so frequently as the lips: these do not merely move 
with the other features of the face to express the various passions 
and emotions, but they are exercised in speaking, singing and in 
mastication, and it is also known what part they take in the 
pleasures of caressing. The habit of moving with facility is 
acquired from these causes, and the lips become of the whole 
countenance that part mostly under the control of the will. Per- 
sons who have handsome teeth therefore, soon acquire the art of 
exhibiting them, while those whose teeth are bad with the same 
facility conceal them. 6 
STRUCTURE OF THE MOUTH. 
To understand well the several diseases to which the various 
parts of the mouth are liable, and to appreciate the influence of 
hygienic and medicinal agents proper to prevent or to remedy 
such diseases, and the operations that may be necessary, we 
should become acquainted with the structure of the organs that 
enter into the formation of the mouth. The apparatus of masti- 
cation is composed of bones, vessels, nerves and glands : interiorly 
the mouth is lined also with a mucous membrane which is con- 
tinuous with the skin upon the lips. 
SECTION I. 
Osseous Apparatus. 
The bones that enter into the formation of the superior part of 
the mouth are the two maxillary bones and the two palate bones; 
inferiorly is the inferior maxillary bone or the inferior jaw. 
The maxillse contain thirty-two teeth, to wit. eight incisores, 
four cuspidati, eight bicuspides and twelve molares. 
In the general formation of the mouth the prominence of the 
maxillary bones is remarkable. In mammiferous animals it is 
observed that the elongation of the jaws correspond to the flat- 
ness of the forehead, and is in an inverse proportion to the size of 
the cranium: thus it appears that when the face is elongated by 
the maxillary bones it is at the expense of the cranium, which is 
then narrow, flat, and can only contain a small quantity of cere- 
bral substance. 
If we remember that the capacity of the brain and the minute- 
ness of the nervous expansion are indicative of the degree of 
intelligence, it will be understood why we may judge of the 
intellectual faculties also from the extent of the maxilla. It is 
probably from this consideration that in vulgar parlance an igno- 
rant silk man is said to have "too much jaw." 
IT m the foregoing remarks it will be perceived that the 
degree of intelligence may in some manner be measured by the 
facial angle. To ascertain this angle Camper draws a line 
above the plane of the base of the cranium, which he supposes to 
pass over the auditory foramini and over the floor of the nostrils, 
and which inclines upon the most prominent part of the forehead. 
Hence it will be perceived that this angle is from 80 to 85 de- 
grees on the head of an European, from 75 to 80 on the head ot 
the Mongolite, from 70 to 75 on the head of the negro, and from 
60 to 65 on the head of the monkey. 
This angle diminishes in a very remarkable manner on the 
head of the wild monkey, and on those of other carnivorous and 
herbivorous animals. It is observed that in the Greek statues the facial angle is al- 
ways larger than we behold it in nature, thus imparting grace 
and majesty to the personation: that of Pythian Apollo is more 
than 90 degrees. In the different classes of mammiferous animals 
the superior jaw, which occupies more space, relatively, than in 
man, is developed by four points of ossification; these points pro- 
duce four bones; one on each side receives the name of submax- 
illary; the reunion of the other two in the middle, forms the inter- 
maxillary bones, in which are implanted the incisores. 
This disposition is noticed in all animals up to the ourang- 
outang inclusively; but in man the superior jaw is developed by 
two points of ossification, which produce the submaxillary bones. 
Thus is found in the development and structure of the superior 
jaw, a peculiar characteristic of the human species, which estab- 
lishes, in comparative anatomy, an important fact upon which we 
cannot too minutely dwell. 
STRUCTURE OF THE MOUTH. 
7 
The Superior Maxillary Bone. 
In man the maxillary bones form the greater part of the 
superior jaw. Situated by the side of each other, they occupy 
the smallest and anterior part of the face; they have their apo- 
physes superiorly and anteriorly, and their alveolar arch inferiorly 
and anteriorly. 
To facilitate the description of these irregular bones, we divide 
their surface into two faces, internal and external. 
Upon the external face is seen, in front and near its middle, a 
large foramen, which, together with that on the opposite side, 
forms the anterior opening of the nasal fossa. Above this open- 
ing is the apophysis of the maxillary bone, flat upon its sides ; 
this apophysis, exteriorly, is rough, and gives attachment to the 
levator labii superioris alceque nasi, and within two crests situ- 
ated one above another: the superior articulates with the superior 
turbinated bone, and the inferior wdth the inferior turbinated bone. 
The anterior border of this apophysis presents inequalities which 
correspond to those of the posterior border of the bone of the 
nose with which it articulates. Its posterior border, which gives 
attachment, exteriorly, to the orbicularis muscle, presents a part 
of a gutter, which the os unguis completes, and to which it is 
attached. Its summit is rough to be united with the os planum 
of the ethmoid bone. 
Below the opening of the nasal fossae is a slight depression into 
which the lavator labii is inserted. At the side of this is another 
depression, somewhat deeper, called the canine fossa. In the 
middle of this fossa are some little inequalities indicating the 
attachment of the canine muscle; above this is the suborbital 
foramen, through which pass vessels and nerves of the same 8 
name; above this again are rough ridges in which is implanted 
the levator labii superioris. This fossa is limited in front by in- 
equalities which give attachment to the dilator of the nose, and 
posteriorly it terminates near the large foramen below where is 
found the malar eminence. This eminence is very prominent and 
presents a triangular and rough projection which is united to the 
zygoma. In prosecuting the examination of the external surface 
of the maxillary bone, we find posteriorly the maxillary tube- 
rosity. Near the middle of this tuberosity is observed some holes 
or foramina which give passage to vessels that nourish the maxil- 
lary bone, and the commencement of the superior and posterior 
conduits which give passage to vessels and nerves of the same 
name. This tuberosity inferiorly presents inequalities to which 
the buccinator is attached and posteriorly are facets upon which 
the palatine bone articulates. Behind the apophysis, and above 
the parts that we have described, the maxillary bone contains 
a large depression of a somewhat triangular form which corres- 
ponds to the base of the orbit. This orbitary floor presents pos- 
teriorly a little fissure which is the commencement of the sub- 
orbital canal: in front and on this floor are small ridges to which 
is attached the oblique muscle of the eye. Its internal border is 
irregular, and articulates anteriorly with the os unguis, a little 
farther back with the os ethmoides, and posteriorly with the palate 
bone. 
Upon the external face of the maxillary bone is seen the dental 
arch which reaches all along its inferior border. This alveolar 
border, which is convex throughout its whole extent, has projec- 
tions and depressions which correspond to the alveoli and their 
transverse parietes. These parietes are thicker at the posterior 
part of the maxillary bone, where the large molares are situ- 
ated, than at the anterior part which receives the small molares 
or bicuspides. 
The alveoli are of the form of the teeth that they contain. 
This form will be described in detail when we shall speak of the 
teeth. We would here remark however, that the first five of these 
alveoli are generally single, although the fourth and fifth present 
a bifurcation at the bottom ; the alveoli of the last three have from 
two to five cavities each. These cavities are sometimes very 
divergent, and in some subjects, after having diverged, approxi- 
mate; in this case the roots that they receive cause the teeth to 
be called barred teeth. 
The membrane that lines the interior of the alveoli adheres 
very strongly to the roots of the teeth. A fillet of nerves and 
vessels passes through a foramen at the bottom of each alveolus, 
and reaches the pulpous substance of the tooth. 
The internal face of the maxillary bone is irregularly con- 
cave. It presents from before backwards and along its middle a 
STRUCTURE OF THE MOUTH. STRUCTURE OF THE MOUTH. 
9 
prominence called the palatine apophysis because it forms a great 
part of the roof of this name. 
The superior face of this apophysis is concave; it forms the 
greater part of the floor of the nasal fossae, and is covered with 
the pituitary membrane. At its anterior and internal part is seen 
the superior orifice of the anterior palatine canal. This canal is 
directed downward and forward through the thickness of the 
palatine apophysis; in its course it unites with the foramen on the 
opposite side and forms a single conduit which opens upon the 
inferior face of this apophysis. This face is regularly concave 
and forms a great part of the palatine arch and depressions which 
receive the glands of this name. Upon its external side is a fur- 
row in which is lodged the posterior palatine vessels and nerves: 
of the four borders that surround this face, the anterior is the 
thickest, the posterior is the thinnest, and is furnished with a little 
eminence upon its superior surface to articulate with the palate 
bone; its internal border which has a thick and rough surface, is 
united to its fellow. But the reunion of the two maxillary 
bones, at this point, is not perfect, superiorly; there is at this part 
a furrow which receives anteriorly the cartilage of the septum of 
the nose, and posteriorly, the vomer. The external border unites 
the palatine apophysis to the remainder of the bone. 
Above this apophysis, the internal face presents nothing remark- 
able; very high up is seen a large opening, which is the maxillary 
sinus. This sinus is bounded above by the orbit, and below by 
the alveoli of the posterior teeth ; this is important to be known in 
performing operations upon the sinus. The maxillary sinus does 
not exist in the foetal subject, but commences to be developed in 
childhood, and continues to increase with age. Its opening viewed 
upon the maxillary bone alone, is large, dry and isolated; but 
in the natural state, it is formed partly by the os unguis anteriorly, 
the palatine bone posteriorly, the ethmoid bone superiorly, and 
the inferior turbinated bone inferiorly; the circumference of this 
opening is very much diminished by the membrane that lines the 
sinus. The lining membrane, at the entrance of the sinus is folded 
back, in such a manner, as to leave an opening only of a line or 
a line and a half in diameter. 
The Palate Bones. 
The palate bones are of an irregular figure, and situated by the 
side of each other, at the posterior part of the nasal fossae and of 
the palatine arch. They are formed of two flat pieces one hori- 
zontal, the other vertical, and joined to each other, forming a 
right angle. 
In order to find the respective position of one of these bones, its 
horizontal part must be placed below and within, and the thinnest 10 
part of its vertical portion directly in front. The description of 
the various parts of the palate bone will be facilitated by examining 
successively, its internal and external faces, and, its four borders, 
one of which is situated internally, one posteriorly, one superiorly 
and one inferiorly. 
The internal face of this bone is concave. Its horizontal por- 
tion enters into the formation of the floor of the nasal fossae, and 
its vertical part contributes to the formation of the external wall 
of the same fossae. Upon the superior and interior vertical part, 
is seen a horizontal crest which terminates opposite the spheno- 
palatine foramen, and articulates with the superior turbinated 
bone, below the crest is a little gutter, which constitutes the pos- 
terior part of the superior duct, and below this is a depression 
which terminates the lesser duct. Below the parts that we have 
just named is another horizontal crest, and is larger than the pre- 
ceding one, it articulates with the inferior turbinated bone, and 
presents inferiorly a considerable depression that forms the re- 
mote part of the inferior duct. 
The external face is slightly convexed and irregular. Its hori- 
zontal portion forms the palatine roof; it is rough posteriorly, 
where the palatine membrane is attached. It has exteriorly a 
crest for the attachment of the peristaphilius extenuus. 
The vertical portion of the external face of the palate bone, 
closes the maxillary sinus posteriorly which adheres to the poste- 
rior and interior part of this bone. 
The anterior border presents, upon its horizontal part, irregu- 
larities for its articulation with the palatine apophysis of the 
submaxillary bone; this border is very thin at its vertical part, 
and it is adapted to a fissure which is seen upon the inferior part 
of the maxillary sinus. 
The posterior border is slightly concave and sharp at its hori- 
zontal part, where it gives attachment to the soft palate. Exter- 
nally is seen a large eminence which is called the tuberosity or 
pyramidal portion of the palate bone. This tuberosity has, supe- 
riorly, three fissures; the middle fissure is smooth and terminates 
the pterygoid fossa; the two lateral wings receive the wings of 
the pterygoid apophysis; the internal one is deeper and more 
uneven. The tuberosity contains anteriorly, the orifice of the 
posterior palatine canal; posterior to this canal is the orifice of 
the accessory canals. The external part has a smooth surface 
which corresponds to the zygomatic fossa, and is rough anteriorly 
where it articulates with the posterior and inferior border of the 
maxillary tuberosity. 
The vertical portion of the posterior border articulates, at its 
superior part, with the pterygoid apophysis. 
The superior border has two very prominent eminences, sepa- 
rated by a fissure which forms a large portion of the spheno- 
STRUCTURE OF THE MOUTH. STRUCTURE OF THE MOUTH. 
11 
palatine foramen. The anterior eminence is larger and generally 
presents five facets, three of which are articular. The anterior 
or submaxillary facet articulates with the submaxillary bone; the 
posterior is irregular and called the sphenoidal facet, because it 
is connected to the sphenoid bone ; the internal is concave and 
called the ethmoidal, from its connection to the ethmoid bone. 
Two of these articular facets can be always distinguished from 
the others, inasmuch as they are smoother; one of these is called 
the orbitary, from its entering into the formation of the orbital 
cavity and the other the zygomatic, as it forms a part of the 
zygomatic fossa. 
The posterior eminence is smaller than the anterior and has 
three facets; the superior articulates wdth the sphenoid bone, and 
has a fissure which completes the pterygo-palatine fissure; the 
internal corresponds to the nasal, and the external to the zygo- 
matic fossa. 
The inferior border, which has an inward direction, is thick, 
rough, and articulates with its fellow on the opposite side; it has 
superiorly a crest which projects outwardly. There is a similar 
crest on the opposite side which constitutes the groove that 
receives the inferior border of the vomer. 
The palate bones articulate with the submaxillary, the sphenoid, 
the ethmoid, the inferior turbinated bones and the vomer. Their 
development is not yet well understood; some suppose that they 
are developed by one point of ossification, while others imagine 
that they commence in four points. 
The inferior jaw is formed of a single bone, called the maxilla. 
This singular bone forms the base of the face. In its natural 
position, its convex part is in front, and its alveolar border supe- 
riorly and upon a horizontal plane. 
The maxilla is flattened from before backwards, and forms a 
paraboloid arch in that direction. The extremities of this bone 
which are called its branches, are directed upward, forming an 
angle with the body of the bone. The general configuration of 
the maxilla admits of its being divided into an external and an 
internal face, a superior or alveolar border and an inferior border. 
The external face is convex, especially in front, and has at its 
lesser part a vertical line, which indicates the union of the two 
pieces of which this bone was primitively formed ; this line is 
called the symphysis of the chin and becomes obliterated with 
age. The inferior part forms an irregular triangular eminence, 
called the chin; this gives attachment to the muscles of the chin. 
On each side of this eminence is the external maxillary line that runs 
obliquely upward and backward, and is continuous with the external 
The Inferior Maxillary Bone. 12 
STRUCTURE OF THE MOUTH. 
edge of the anterior border of the coronoid apophysis; along this 
line the platysma myoides, the triangulares and the depressors are 
attached. Near the symphysis and above the maxillary line are 
two depressions in which the depressions of the lower lip are 
inserted. 
At these depressions there are two gutters that continue along 
the external maxillary lines, and present near the second bicuspis, 
the external orifice of the maxillary canal, or mental foramen, 
which gives exit to the maxillary nerves aud blood-vessels. 
Posterior to the mental foramen, is seen a quadrilateral surface 
which marks the situation of the masseter muscle. 
The internal face of the jaw is concave, and presents at its 
centre, the internal side of the symphysis of the chin. The supe- 
rior part of the symphysis adheres to the fraenum of the tongue, 
and the inferior part terminates in a slight eminence called geni, 
which gives attachment to the genio-glossus and genio-hoyoideus 
muscles. On each side of this commences the internal maxillary 
lines, called the myloideus lines, which have, like those on 
the external face, an oblique direction, extending as far as the 
edge of the coronoid apophysis. To the anterior parts of these 
lines are attached the mylo-hyoideus, and to the posterior, the 
mylo-pharyngeus. Below and upon the sides of these lines is 
observed a depression for the reception of the digastric muscle. 
Near this fossa is a gutter w'hich receives at its anterior, the sub- 
lingual gland, and, at its posterior part, the submaxillary in a 
kind of oblong depression. There is, at the posterior part of 
the maxilla, a rough and flat space for the insertion of the ptery- 
goideus internus. At the upper part of this roughness is seen the 
maxillary foramen, through which enters a nerve, artery and 
vein; these pass along the bone under the alveoli, giving off 
branches to each tooth. When this canal reaches the socket of 
the cuspidatus it divides as do also the nerve and vessels that pass 
through it; one division of these passes along the anterior part of 
the bone, and gives off rami to the cuspidati and incisores; the 
other retrogrades and then passes out of the mental foramen, and 
are then called the mental nerve, artery and vein. At the edge 
of the maxillary foramen is a spine of bone, into which is inserted 
the ligament of the jaw. 
The superior or alveolar border is narrower than the inferior, 
and presents, in front, the inferior dental arch which has a hori- 
zontal position; but posteriorly, the alveolar border becomes 
more reduced, and assumes a vertical direction as the subject ad- 
vances in age. The alveolar border contains sixteen sockets, 
eight upon each side of the jaw. They are distinguished by the 
names of the teeth that they contain, or by their numerical num- 
ber, commencing with the anterior one. The transverse processes STRUCTURE OF THE MOUTH. 
13 
of the sockets form interiorly, but more especially exteriorly, 
alternate depressions and prominences. The sockets of the infe- 
rior are smaller than those of the superior jaw, and each is of the 
form of the tooth which it contains; thus, those into which the 
incisores are implanted are single and somewhat flattened, while 
the rest are round, the sockets of the incisores and cuspidati are 
generally single ; those of the bicuspides are sometimes divided by 
a partition. Finally, the sockets of the molares are divided into 
two, three, four and five cavities each containing a foramen 
through which passes a branch of the demal nerve, artery and vein. 
The sockets are lined with a membrane which adheres very 
strongly to them and also to the teeth they contain. In inflam- 
mation of these parts in the administration of mercury and in 
scorbutic affections, this membrane becomes so thick as to 
loosen the teeth and sometimes even cause them to drop out. 
The vertical portion of the superior dental border is formed by 
the coronoid apophysis. On each side of this border, is a promi- 
nent ridge and also a groove which descends along the alveolar 
border. 
The inferior border is thicker in the middle than at the sides. 
The part of this border that belongs to the body of the jaw presents 
a horizontal direction, while that which appertains to the branches 
assumes a vertical direction, and is situated posteriorly. The first 
gives attachment to some of the fibres of the platysma myoides ; 
to the outer portion of the second, the masseter, to the inner por- 
tion the pterygoideus, and in the middle or upon the crest of this 
border the stylo-maxillary ligaments are attached. 
It should be borne in mind, that the angle formed by the border 
at this point becomes more acute, as the subjects advance in 
years; this arrangement causes luxation of the jaws of old persons 
to be very easy; whereas this accident is almost impossible in 
children. The rest of this border is enlarged superiorly, and pre- 
sents a depression that receives the parotid gland. 
The extremities of the maxilla are directed upward and back- 
ward, and have two apophyses, one anteriorly called the coronoid, 
and one posteriorly called the condoloid. 
The coronoid apophysis is flat, large at its base, and terminates 
in a point which is embraced by the temporal muscle. Its posterior 
part is adapted to the sigmoid groove which contains the masseter 
nerve. The condoloid apophysis is supported by a short neck ; is 
flatter from before backward, and contains at its anterior portion 
a slight depression for the insertion of the pterygoideus internus. 
The summit of the condyle is round, smooth, and covered with a 
cartilage. It articulates with the glenoid cavity of the temporal 
bone and its transverse apophysis, both of which are likewise fur- 
nished with a cartilaginous covering. 14 
STRUCTURE OF THE MOUTH. 
In the articular cavity is an intermediate cartilage, concave 
upon both surfaces, consequently much thinner in the middle than 
at its circumference. This cartilage rests upon the maxilla and 
follows the motion of this bone. 
The fibrous membrane which forms a capsule around the articu- 
lation is attached, by its superior border, to the transverse tempo- 
ral apophysis anteriorly, and in front of the glenoid cavity poste- 
riorly ; its inferior border adheres to the neck of the condyle 
which it surrounds. This membrane descends lower at its poste- 
rior than at its anterior part, or at its sides; its tissue is thin, 
flexible and thickest at its sides. It should be observed that it is 
attached around the inter-articular cartilage, so that there are two 
articular cavities, one above and the other below the cartilage. 
These cavities are lined with two synovial capsules, which adhere 
closer at the part that corresponds to the cartilages, than upon the 
fibrous membrane. The synovia which constantly lubricates the 
interior of these cavities is secreted by the synovial capsules. 
The articular capsules are not the sole means by which the 
jaw is retained in its position; there are two lateral ligaments 
and muscles that serve the same purpose. 
The internal lateral ligament is attached above to the spinous 
process of the sphenoid bone, and to the internal side of the gle- 
noid fissure; below it is inserted into the crust near the internal 
orifice of the maxillary foramen. 
Some anatomists mention a second internal lateral ligament; 
but it cannot be distinguished from the fibrous capsule, the fibres 
of which it is formed. 
The ligaments which we have just described are in a state of 
tension, when the condyles of the jaw are carried backward, and 
are relaxed when the condyles are brought forward. 
SECTION II. 
The history of the teeth should be studied with diligence and 
described with minuteness by dental writers, for we should regard 
with indifference nothing that appertains to the parts upon which 
we are in the daily habit of operating, in order to favor their 
development, to preserve them in a healthy condition, to arrest, 
or prevent disease and to be able to replace them when lost. 
Few authors have made the instruments of mastication their 
special study. We cannot obtain from dental works that infor- 
mation upon this subject which may be derived from any of the 
anatomical works. No person, however, is more concerned than 
those who devote themselves to this particular branch; it is there- 
Dental Apparatus. 15 
fore in treatises upon the teeth that we should be able to find all 
that is known relative to these organs. Before commencing the 
description of the human teeth, we shall rapidly review the con- 
formation of these organs in the various classes of vertebral ani- 
mals. This will necessarily throw great light upon the different 
phenomena that the teeth present, during the various periods of 
their growth. The influence that a knowledge of comparative, 
has upon the study of human anatomy, is at present, too generally 
admitted to require comment. 
Naturalists have examined the teeth with the greatest care, for 
they furnish essential characteristics in the classification of mam- 
miferous animals. 
To furnish a brief review of the conformation of the teeth of 
various animals provided with these organs, we think, -that we 
could not do better, than to levy upon such medical works in 
which a description of the apparata of the functions in man are 
preceded by the description of the same apparata in other animals, 
a course highly calculated to shed light and interest upon anatomy, 
by facilitating the study of this science and more especially by 
showing the relations and uses of the different parts that enter into 
the formation of organs. 
"Fishes, reptiles and mammiferous animals, are provided with 
teeth which are either implanted in the maxilla, or merely retained 
in their situations by the gums. 
"The jaws, the palate, the throat, the bones to which the longue 
and gills are attached and even the longue itself in fishes are pro- 
vided with teeth. Although this arrangement may be favourable 
for mastication, yet it is not so in regard to taste. Teeth of ani- 
mals that assume various forms, are supported by an osseous 
tubercle which is covered by a membrane; when this membrane 
is destroyed, the teeth and tubercles drop out and are replaced by 
others. 
"The teeth of mammiferous animals are divided info three classes. 
Those in front are called the incisores; this name has always been 
given by naturalists to those teeth which are implanted in the 
inter-maxillary bone. Those of the second class are cut upon 
several sides, are situated at the angles of the lips and are called 
angulares. Those of the third class are called molares ; these are 
large and situated posteriorly and upon the sides of the mouth. 
"The teeth of some animals are so long, and of such an un- 
seemly form, that they do not merit this appellation ; such are the 
tusks of the narwhale, the elephant, the hippopotamus, the wild- 
boar and the teeth of the barbyrouessa. 
"The molares exist in the jaws of all animals that have teeth ; 
but the incisores are absent in some; thus the edentes* are only 
STRUCTURE OF THE MOUTH. 
* A class of mammiferous animals which have only the molares. 16 
STRUCTURE OF THE MOUTH. 
provided with the molar teeth; the sloth are deprived of the in- 
cisores, the rongeurs* of the angulares. The ruminating animals 
have incisores only in the inferior jaw. The three classes of teeth 
that we have already named are observed in the solipede, several 
of the pachidermes,^ carnivorous animals, quadrumans, and in man. 
"Several animals have only a part of their jaws furnished with 
teeth ; this is the case with the polypede, and that part of the jaws of 
the horse where the bit is placed. 
"The incisores of the hare, the fox, and often those of children 
are indented. The indentations upon the incisores of the bat, are 
so deep that they resemble the teeth of a comb. The incisores of 
the rongeurs are long and curved. The angulares of the tartia 
are shorter than their other teeth. In man and monkeys they are 
all of equal height. The angulares of most monkeys are observed 
to be somewhat longer than their other teeth ; those of the large 
carnivorous animals are remarkably long. 
"The grinding surfaces of the molares are figured in various 
ways; those of carnivorous animals are furnished with one or 
more rows of tubercles; those of the pachidermes are tuberculous 
and those of herbivorous animals have prominent lines. These 
lines in ruminating animals form several crescents and in solipede, 
double festoons. 
"The teeth of carnivorous and quadruman animals, and of man, 
are formed of a bony substance; their crowns are covered with 
enamel. The teeth of ruminating animals are composed of an 
osseous substance enveloped in a membranous follicle which 
primitively contained the tooth ; their crowns are covered with a 
layer of enamel of a yellow color, the membranous follicle ossifies 
and forms a cortical envelope around the teeth. 
"The teeth of the young elephant and hippopotamus are com- 
posed of vertical lamas situated upon each other, and can, if the 
animal is young, be separated. The osseous lamse, unequal in 
length, are afterward united by means of an enamel fluid that 
overflows them, thus forming a consolidated body composed of 
enamel and osseous lamse. 
"The osseous surfaces, by mastication, are promptly worn 
away, and, at the expiration of some years, the surface of the 
tooth becomes covered with prominent, irregular, enamelled lines, 
which, like the rough surface of a mill stone, is well adapted to 
grind food. 
"That part of a tooth which is buried in the alveoli is called 
the root; the crown is that part which is seen above the gums, and 
the depression situated between the crown and root is the neck 
of the tooth. 
"The roots of teeth are single or multiple. Teeth having 
* Animals of the rabbit kind. 
tMammiferous animals characterized by their thick skin. STRUCTURE OF THE MOUTH. 
17 
single roots are at first very hollow; their cavity lined by a thin 
membrane upon which vessels and nerves ramify, is filled with a 
gelatinous substance, and becomes partly obstructed with age. 
"The body is the first part of a tooth that is developed, it pro- 
trudes through the gums and commences to be worn away before 
the root is completely developed. When the development of the 
root is completed, the capacity of the alveolus diminishes and 
gradually fills up; the root is destroyed in proportion to the filling 
up of the socket, and the tooth, wearing away at each extremity, 
becomes very short in advanced age. It afterwards becomes 
loose in its socket, and finally drops out. 
"The crowns of the teeth of solipede and ruminating animals 
are sometimes entirely worn down to the roots which separate 
when the tooth has more than one root. Denudation of the teeth 
of these animals pursues so regular and constant a course that 
the age of these animals can be accurately ascertained. 
"A number of the teeth, in many animals, drop out and are 
replaced by others. 
"Some fishes, as the shark, have their teeth enchased in the 
gums, and are shed four or five times; thesd teeth of replacement 
are concealed behind the others. Some reptiles present the same 
disposition, as is seen in the venomous dart of the viper. 
"A portion of the denture of mammiferous animals drop out at a 
regular period, and those teeth that succeed these have their germs 
situated behind them. The teeth of the crocodile, which are 
conical and hollow, receive in their cavities those that are to suc- 
ceed them. 
"The roots of the deciduous teeth are destroyed very promptly; 
they become loosened in their alveoli, and are pushed out by the 
teeth of replacement. Second dentition serves also to ascertain 
the age of animals." 
There are in each of the jaws of the human species, four inci- 
sores, two cuspidati, four bicuspides, and six molares. These 
organs are whiter and harder than other bones, and they differ 
from them in having their crowns covered with enamel. 
Description of the Teeth. 
Development of the Teeth. 
The alveolar border, in the foetus, is entirely closed; but we 
can, at this period, discover, in the interior of the jaws, partitions 
which separate the alveoli. Each alveolus contains a bundle of 
little membranous follicles which is nearly of the same form as 
the tooth of which it is the germ. These follicles are enveloped 
in a fine membrane which resembles a serous membrane; it forms 
a closed sac, and its double folds surround the germ of the tooth. 18 
STRUCTURE OF THE MOUTH. 
This membrane lines the interior of the sockets to which it ad- 
heres very strongly, and when it comes in contact with the ves- 
sels and nerves that penetrate it, it separates from the alveolus 
and forms a sheath for them. It secretes an albuminous serum 
which lubricates the parts which it surrounds. 
The pulps of the teeth commence to ossify upon the part near 
the alveolar border. As ossification progresses from the summit 
towards the root, we can gradually distinguish the form that each 
tooth will have when ossification is completed. 
Ossific matter is deposited upon the teeth by the vessels that 
penetrate the dental cavities, in concentric layers, which as the 
subject advances in age, tend to obstruct these cavities; while 
the development of other hollow bones is effected by eccentric 
layers, and the cavities of these enlarge by the destruction of the 
inner walls. 
The exact period of the formation of the membranous follicles 
has not yet been ascertained; but it is known that the first point 
of ossification is deposited between the fourth and fifth month of 
gestation. At birth the twenty teeth that constitute first dentition, 
are far advanced in their development, but are still concealed in 
the jaws. Their crowns, at this period, appear to be fully deve- 
loped, and a part of their roots contains a conduit, the walls of 
which are very thin; they finally reach the bottom of the sockets. 
As the teeth continue to increase in all directions they press 
against the alveoli which presents but slight resistance. From 
the seventh to the fourteenth month, seldom earlier than the first 
period or later than the second, the temporary teeth commence 
to appear above the gums. It sometimes happens that one or 
more teeth are cut before birth, which was the case with Louis XIV. 
At the usual period of dentition the dental cavities are very 
large, and the enamel at this time is of a cartilaginous consis- 
tency ; but is developed more speedily than the osseous substance. 
It has been pretended that the pressure of the gums upon the 
enamel of the teeth contracts its tissue, and gives it great solidity 
and a high polish. But generally the mechanical action of these 
parts upon each other modifies very little their development, 
which is occasioned by a vital action, and it is therefore not likely 
that the mechanical pressure of the gums can modify its structure. 
It has also been supposed that the teeth during their eruption 
meet with considerable resistance from the gums; hence various 
means such as corals and incision of the gums have been adopted 
to diminish and prevent this obstacle ; but all these are more or 
less useless. It is likely that scarcely any mechanical resistance 
exists. The eruption of the teeth is produced by the efforts of the 
economy, and in proportion to the health and vigorous constitu- 
tion of the subject, is the facility with which this process is accom- 19 
plished. When the child is weak and very nervous, dentition is 
laborious and occasions serious derangements; thus we witness 
symptoms of nervous affections characterised by vomiting, disease 
in the various parts of the gastric apparatus, such as an abundant 
salivation, loss of appetite, diarrhoea, &c. The diseases of denti- 
tion are so common among children who inhabit cities, that it is 
said that it destroys two in every hundred. 
The evils produced by teething are generally very rare among 
animals; they are, however, observed in horses, and this is not 
astonishing when we recollect the great changes that take place in 
their jaws at this period. 
The following is the order in which the teeth of first dentition 
appear; the two inferior central incisores are the first that are 
cut, about five days after these, the corresponding teeth of the 
superior jaw make their appearance, they however sometimes 
appear simultaneously. One or two months after the appearance 
of the centrals, the two inferior lateral incisores appear, and a 
short time after these the corresponding superior teeth. The eight 
temporary molares are the next which are cut, and finally, the four 
cuspidati the following year; so that in two years, seldom earlier, 
but often later, the child is provided with twenty teeth. The 
crowns of these teeth at first present slight reddish furrows, and 
the cutting edges of the incisores are frequently denticulated. 
About the sixth or seventh year of age the first molar appears 
through the gum. This tooth is not shed like those we have 
already named. 
If, after death, we open the alveoli of the jaws of an infant, a 
short time before the epoch of second dentition, we will discover 
in the sockets of the deciduous teeth a fungous substance enclosed 
in a membrane. This substance is a new dental follicle, the ves- 
sels of which are very large, and give to the follicle a reddish 
appearance. 
The follicles of second resemble those of first dentition. Their 
situation is generally behind the deciduous teeth; it is, however, 
not uncommon to see them above, or at the sides of these teeth. 
The germs of the second denture soon become a point where 
an energetic action of the economy is called into requisition; the 
vessels of this part become enlarged, nutrition is active and the 
increase is rapid. On the other hand vessels that nourished the 
deciduous teeth become gradually obstructed; the roots of these 
teeth, no longer receiving any nourishment, are destroyed and 
being gradually forced from their sockets, by the crowns of 
the permanent teeth, they become loosened and finally drop out. 
The teeth of second dentition commence to protrude through 
the gums about the sixth or seventh year, and follow the order of 
the deciduous teeth. 
STRUCTURE OF THE MOUTH. 20 
STRUCTURE OF THE MOUTH. 
About the eighth or ninth year the second molar is cut, and the 
third molar or wisdom tooth from the twentieth to the thirtieth 
year, sometimes this tooth does not show itself until old age. 
We have stated that the permanent teeth are never replaced by 
others when lost; there has been, however, some few examples to 
the contrary, thus Diemerboeck states, that in his fifty-sixth year he 
cut a cuspidatus, having a short time before lost one that occupied 
its place. 
The whole number of teeth of the second denture are not 
always cut; in consequence of some of the germs never having 
existed or because they had been arrested in their development. 
Several writers among whom are Pline, Valiere Maxime, 
Plutarch, Diemerboeck and others, have said that they have seen 
all the teeth of the jaw formed of a single piece, or united to one 
another. Sabatier and Desault have seen this disposition in the 
teeth of dead subjects ; but it was owing to thick layers of tartar, 
the polish and color of which resembled the enamel so closely 
that they would have been deceived by it, had they not examined 
the teeth near their roots when they discovered that they were 
separate. The observations of these two celebrated surgeons in- 
duces us to think that those who have reported similar cases of 
this kind of osseous union of the teeth, have been deceived by 
similar circumstances. It is not uncommon to see two and even 
three teeth united at their roots, which can only be discovered 
after extraction.* 
Sometimes part of the teeth of second dentition are naturally 
inclined backward, this arrangement is often influenced by the 
presence of the deciduous teeth. Persons whose teeth are thus 
arranged, are said to have two row's of teeth: the deciduous 
teeth in such cases are always in front and are called snag teeth. 
(sw dents.) 
Columbus relates a case of one of his children who had, in this 
way, three rows of teeth. Sometimes teeth present various aber- 
rations in their development: thus Sabatier informs us that he 
saw two teeth implanted in the palatine apophysis, at the point of 
union with the horizontal portion of the palate bone. The pro- 
minence that these teeth produced in the mouth occasioned an 
incommodious pressure upon the tongue. Albinus accidentally 
discovered a tooth similarly situated; but it was concealed in the 
substance of the bone. 
The last author relates a case of two very large teeth, situated 
in the mental apophysis; they were inverted and formed a promi- 
nence on the nose and upon the side of the cheek. Desault dis- 
covered a tooth buried crosswise in the substance of the alveoli. 
All of these irregularities caused little or no inconvenience. 
* The fact that the crowns of teeth, and sometimes the roots are united is 
now well established.-Eds. STRUCTURE OF THE MOUTH. 
21 
The three classes of teeth are called, incisores, cuspidati, bicus- 
pides and molares. 
The body of a tooth is that part of the organ which is above 
the alveoli, the root that which is implanted in the alveolar cavity, 
and the neck is the line that separates the root from the crown. 
The teeth of adults are harder than those of children and of 
very aged persons. The three classes of teeth possess peculiar 
characteristics upon their crowns and roots, by which they can 
readily be distinguished from one another. 
Thus, the incisores, which are eight in number, four in each 
jaw, are situated in the anterior part ot the jaws. The inferior 
are generally smaller and not as strong as the superior incisores. 
The two inferior laterals are larger than the centrals, while the 
contrary is the case with the superior incisores; so that all of the 
incisores possess differences that enables them to be distinguished 
from one another. 
The bodies of these teeth are flattened from before backward, 
and wedge-shaped, their external surface is smooth, convex and a 
little larger near its cutting edge; their internal surface, which is 
slightly concave, has a smaller transverse dimension than the 
external. Their sides are of a triangular form, are generally 
contiguous to the neighbouring teeth, and are not so highly polished 
as their anterior or posterior surfaces. These teeth terminate in a 
cutting edge, which, in children, is frequently denticulated; but 
becomes worn away by mastication. The edges of the inferior 
incisores are beveled obliquely backward, while the contrary is the 
case with the superiors; this is occasioned by the friction of the 
superior upon the inferior teeth. The inferior jaw of persons who 
have what is termed jimber-jaw, overlaps the superior and a con- 
trary wearing away of the teeth is the result. When the teeth 
close perpendicularly upon one another, denudation is horizontal. 
At the edges of the alveoli, the crowns of the teeth terminate in a 
slight depression which is the neck ; this circumscribes the tooth 
describing zigzag lines, and gives attachment to the mucus mem- 
brane of the mouth; it separates the crown from the root, as 
before stated. 
The length of the root of a tooth is generally in proportion to 
that of its crown. Thus the roots of the superior incisores are 
longer than those of the inferior, and those of the cuspidati are 
extremely long, these often nearly reach the base of the orbit, 
hence they are called eye-teeth. In those teeth upon which the 
gums are very high up, we find that the part implanted rn the 
alveoli is much longer as the part which is above the gum 
appears to be shorter. The incisores have single, long and 
Shape of the Teeth. 22 
conical roots, slightly flattened upon their lateral surfaces, where 
may be seen a small vertical groove. Their roots are surrounded 
by a membrane which adheres to them by one of its surfaces, and 
by the other to the walls of the alveolar cavity. The extremity 
of the roots contains a foramen through which a nerve, artery 
and vein pass. 
The cuspidati are situated posterior to the incisores; they are 
four in number, two in each jaw. Their crowns are of a conical 
fc\rm, and contain posteriorly a slight concavity ; the remaining 
parts are round. The extremity of the crown presents a kind of 
tubercle which terminates in a point; its neck is similar to that of 
the incisores. 
The roots of these teeth are single and very large; they have 
like the preceding teeth, a vertical direction, and a foramen at 
their extremities for the passage of a nerve, artery and vein. 
There are eight bicuspides ; four in each jaw, which are situ- 
ated immediately posterior to the cuspidati. The crowns of these 
are cylindrical, and are rounder and more polished in front than 
upon their sides which is contiguous to the neighbouring teeth. 
There are two tubercles upon their grinding surfaces, one exter- 
nal and one internal; the former is larger than the latter and is 
separated from it by a groove running from before backward. 
Their necks are more regularly round than the preceding teeth ; 
their roots are sometimes single at other times they are double; 
in this latter case they may be separated, or be partially or totally 
united; but they are seldom bifurcated near the neck. 
The apex of the root when single always contains a foramen, 
or two when the roots are double, which form a single cavity in 
the crown of the tooth. Their use are the same as those of the 
other teeth. 
The molares are twelve in number, six on each side of the jaws; 
the last of these in each jaw is called the wisdom-tooth, and is the 
smallest. The crown of the molares is somewhat of a quadri- 
lateral figure; the anterior face is more polished and more round 
than their sides. The grinding surface has four tubercles, two of 
which are external and are the largest. These tubercles are 
separated by a crucial groove; they are very hard and generally 
have unequal surfaces, but are subject to great variations. 
They have from two to five roots which at first rise from a 
common trunk then diverge. After branching out, these roots 
sometimes approach one another and embrace a part of the 
alveoli, it is then impossible to extract them without removing 
with them a portion of the jaw. The apex of each root contains 
a foramen which gives passage to a nerve, artery and vein. 
These foramina unite in a common cavity in the crown of the 
tooth. 
STRUCTURE OF THE MOUTH. STRUCTURE OF THE MOUTH. 
23 
Mastication wears away the teeth, and gradually produces 
upon their cutting edges remarkable alterations. 
The incisores of children of seven years of age generally have 
three points, which at the age of three years become effaced. 
From twenty to thirty years of age the cutting edges of these 
teeth become materially worn away; from forty to forty-five they 
are very much worn down upon their edges which contains in 
their centre a little yellow spot. This is the osseous part of the 
tooth exposed by the loss of the enamel. At a more advanced 
period, denudation continuing to increase, the yellow7 spot enlarges, 
and the height of the tooth diminishes more and more. 
The cuspidati are provided with a point of a diamond shape, 
upon which denudation manifests itself about the twentieth year of 
age. About the thirty-fifth year the yellow spot commences to 
show itself upon each of these teeth; at the fiftieth year, it is very 
large and the tooth at this period has very sensibly diminished in 
height. The bicuspides and molares also have a peculiar mode' 
of denudation. The summit of the external tubercle of the bicus- 
pides commences to wear away about the twentieth year of age, 
and that of the internal tubercle at a later period. At about the 
thirty-eighth year denudation has so far increased as to exhibit 
yellow spots upon each of these tubercles. About the fortieth 
year the tubercles are almost entirely effaced : the two yellow 
spots then uniting form a single one which gradually extends. 
The molares are affected by the denuding process in the same 
manner as the bicuspides. We are enabled from the changes that 
the teeth undergo, to judge of the age of the animals. The ages 
of solipede and ruminating animals cannot be so correctly deter- 
mined, because they live upon one kind of food and their teeth 
undergo very little change. 
We have pointed out the order in which teeth are denuded in 
individuals who have a complete and well arranged denture; but 
there are many circumstances that may produce a variation in 
this order for instance, when the teeth are badly arranged, and 
when they assume an oblique direction. A tooth is never denu- 
ded when its antagonist is lost. Teeth of persons who constantly 
masticate on one side are much sooner worn down than the teeth 
of those who masticate on both sides of the jaws. 
The teeth are adapted to their sockets, and are therein retain- 
ed by a species of immoveable articulation called gomphosis. 
Each class of teeth contributes in a separate manner to masti- 
cation. The incisores serve to cut aliment, the cuspidati to tear 
it, and the molares to bruise and grind it. The teeth also serve 
to retain the saliva, contribute to the articulation of sounds, and 
serve as an ornament to the countenance. 
Denudation of the Teeth. 24 
STRUCTURE OF THE MOUTH. 
In advanced age, when the teeth are shortened by friction ; and 
have diminished very much in height, it is observed that their 
roots are destroyed in the same proportion. As the extremity of 
the roots diminishes, the alveolar cavity becomes obstructed; the 
teeth, being gradually forced from their sockets, become loose 
and finally drop out. 
Although in cities the teeth are lost at an early period, their 
wearing and their premature loss should nevertheless be regarded 
as a species of disease; for it is not uncommon to see persons of 
extreme old age possessing a complete and sound set of teeth. 
After all the teeth have been lost, the inferior jaw, when clo- 
sed, occupies a position higher and farther forward, than it did 
previous to the absence of the teeth; so that the face becomes 
shorter and the chin more prominent. 
When the alveolar border is deprived of teeth, it undergoes 
remarkable alterations ; the bottom of the sockets become ob- 
structed, their parietes approach one another, the alveoli disappear 
entirely, and the surface once occupied by the teeth, now presents 
a cutting edge. In consequence of mastication, the gums acquire 
a degree of hardness, and supply in part the office of the teeth, 
though in a dull and less energetic manner. 
Structure of the Teeth. 
Having described the teeth, and pointed out the changes they 
undergo from their development until their loss, it now remains 
for us to describe their organic structure, and to relate the results 
of physical observations and chemical experiments upon their 
substance. 
The teeth are small bones which generally present the contex- 
ture of other bones; but their crowns are covered with an enamel 
substance of a white color, which is extremely hard, and is only 
met with upon that part of the organ. 
The osseous portion of the teeth is composed of a dense and 
serous tissue; the fibres of which it is formed assume various 
directions, but are generally in the direction of the length of the 
tooth. When analysed it produces the same results as other 
bones; one half of its weight is composed of a vascular and pa- 
renchymatous tissue, which constitutes the truly organised and 
living part of the bone. This vascular tissue by its reticular 
structure forms areolae, in which is deposited the saline matter that 
composes the other half of the weight of bone, and imparts to the 
organ its solidity. 
The enamel substance is of a much more serous tissue than the 
bone, and it contains a very fine vascular tissue, which also ren- 
ders the enamel organised, and gives it the properties of living 
principle. It is indeed known that the enamel is disagreeably 25 
affected by acids, which cause the teeth to be, as it is commonly 
denominated, set on edge, and that it experiences in other respects 
the various diseases peculiar to bone.* 
If we wish to separate the vascular tissue of a tooth from its 
earthy matter, we immerse it in mineral acid slightly attenuated 
with water: the acid dissolves the saline substance, the tooth be- 
comes entirely soft, still preserving it? size, but it loses one-half 
of its weight. 
We can separate the earthy from the soft part of a tooth, by 
placing it in a solution of caustic alkali; the alkali dissolves all of 
the parenchymatous tissue, and unites with it to form a kind of 
animal soap, the tooth becomes light, porous, and loses one-half 
of its weight. 
By separating the two substances of a tooth in the above man- 
ner, we discover that the soft part is a parenchymatous substance, 
which by analysis furnishes the product of the animal matter of 
the teeth. The hard substance is the phosphate and carbonate of 
lime; this last salt forms only a tenth part of the osseous sub- 
stance of the bone and enamel. 
It was for a long time supposed that the enamel of the teeth, 
so different in appearance from the rest of the organ, was com- 
posed of distinct substances. Some persons have advanced the 
opinion that the earthy salt of which the enamel is composed, 
contained a peculiar acid, and others have said that its peculiar 
appearance is owing to a crystallisation of the pure calcareous 
phosphate; but minute investigations have overthrown these as- 
sertions. In analysing the enamel of the teeth, it is discovered 
that one-half of its weight is owing to the vascular and paren- 
chymatous tissue that constitutes its true organised and living 
part; while the other half is composed of the phosphate and car- 
bonate of lime, in nearly the same proportion as in other bones. 
STRUCTURE OF THE MOUTH. 
SECTION III. 
The Muscular Apparatus. 
The muscles which are attached to the inferior jaw are design- 
ed to move it in various directions, they elevate and depress it, 
bring it forward and carry it backward, and enable it to perform 
rotary motions. 
* The only disease to which the enamel is subject, is chemical decompo- 
sition. The author, therefore, is mistaken in supposing that this substance 
is subject to the same diseases that attack other bone. The degree of vital- 
ity with which it is endowed, if indeed it has any at all, is too low to furnish 
it with attributes such as are possessed by other osseous structures of the 
body.-Eds. 26 
STRUCTURE OF THE MOUTH. 
The elevators are the strongest muscles of the jaw; they, with 
other parts that we have already named, contribute to adjust its 
articular surfaces and maintain them in their proper places. 
Temporalis. 
This muscle is of the form of a triangle, the base of which is 
round, and attached to the semi-circular ridge upon the temporal 
bone, and its summit is inserted into the coronoid apophysis. Its 
numerous fibres converge from all directions of the temporal fos- 
sa, and form a strong tendon, which, after having passed under 
the zygoma, is attached to the coronoid process, so as to surround 
it on every side. The direction of its anterior fibres descends 
vertically; and the posterior ones, which are more numerous, 
come from above downward, and from behind forward. When 
the mouth is opened very wide, which occasions the coronoid 
apophysis to be depressed and brought forward, the fibres of the 
temporalis, from their arrangement, are more or less oblique, and 
in contracting carry the condyle of the jaw upward and back- 
ward, until being arrested by the posterior border of the glenoid 
cavity, it is carried directly upward against the maxillary bone. 
That bone may also be slightly depressed by the action of this 
muscle. 
Masseter. 
The masseter is a very strong muscle and is of an oblong 
shape; it extends from the zygoma to the external face of the 
branches of the inferior jaw as low down as its angle. It consists 
of three portions which take different directions ; the first descends 
obliquely from the inferior border of the malar bone, as far as the 
angle of the maxilla ; the second comes obliquely from behind for- 
ward, from the posterior half of the zygomatic arch to the middle 
of the external face of the branch of the inferior jaw; the third 
portion is shorter and more deeply situated than the others, and 
extends from the whole of the internal face of the zygomatic arch 
to the upper part of the external face of the branch of the maxilla. 
This muscle is composed of a great number of muscular and 
aponeurotic fibres which, by their simultaneous action, elevate 
the inferior jaw, having a tendency to depress the superior. 
Pterygoideus Internus. 
This muscle is situated upon the internal face of the branches 
of the inferior jaw ; it is of an oblong form and is very thick. It 
extends from the pterygoid fossa and from the superior face of 
tuberosity of the palate, to the inferior and internal part of the 
branch of the jaw near its angle. Its direction is from above STRUCTURE OF THE MOUTH. 
27 
downward, from behind forward, and from within outward. Its 
aponeurotic fibres are irregular in length and occupy the extremi- 
ties of the muscle. Its principal use is to elevate the jaw, at the 
same time carrying it backward. 
Pterygoideus Externus. 
This muscle is smaller and situated below the preceding one. 
It is long and attached to the external side of the pterygoid apo- 
physis and the greater wings of the sphenoid bone. It passes 
outward and backward, and is inserted into the depression upon 
the anterior and inner side of the neck of the condyle and of 
the capsule that surround it. This muscle when it acts with its 
fellow on the opposite side, draws the jaw forwards; but if it acts 
alone, it draws the jaw to one side. 
The muscles already described are very strong, especially the 
two first which serve essentially to elevate the jaw in the perfor- 
mance of mastication. It now remains for us to speak of those 
that are attached to the base of the jaw and serve to depress it. 
Digastricus. 
This muscle receives its name from its being divided, in the 
middle by means of a tendon, into two fleshy bellies. It is situ- 
ated upon the lateral and superior part of the neck, and is inserted 
posteriorly into the mastoid groove, whence it descends obliquely 
forward for about three inches; its middle portion is converted 
into a tendon, which passes through the stylohyoideus muscle and 
is attached by an aponeurotic loop to the hyoide bone. 
The anterior belly passes upward, and is attached by very short 
aponeurotic fibres to the facet of the inferior maxilla, near its 
symphysis. The posterior muscular portion is larger than the 
anterior. These two parts should have distinct uses, since they 
have different directions and attachments. Indeed, the anterior 
portion depresses the maxilla and brings it into its natural posi- 
tion, when it has been carried forward. The posterior portion 
fixes the hyoide bone. 
When both parts of this muscle contract, the hyoide bone is 
carried upward and forward, and in this manner facilitates deglu- 
tition. From the points of attachment, it does not appear that 
this muscle can serve to elevate the inferior jaw, as has been sup- 
posed by some authors. 
Mylo Hyoideus. 
This muscle is flat and of a triangular form; it extends from 
the oblique line upon the internal face of the maxilla, to the ante- 
rior and lateral part of the body of the hyoide bone. Its fibres 28 
STRUCTURE OF THE MOUTH. 
are directed obliquely inward, backward and downward. When 
the hyoide bone is fixed, this muscle depresses and carries the 
jaw backward. 
Genio Hyoideus. 
This is a thin and long muscle extending from the symphysis 
of the maxilla to the median line of the body of the hyoide bone. 
Its use is the same as the preceding muscle. 
Genio Glossus. 
The genio glossus is concealed by the preceding muscle and 
bears a great resemblance to it. It is attached by short aponeu- 
rotic fibres to the symphysis of the maxilla, and upon the lateral 
parts of the internal maxillary line, thence to the tongue. A great 
part of its fibres are blended with those of the tongue, running in 
different directions. The remainder of this muscle is attached to 
the lesser horn of the hyoide bone and is connected with the 
muscles of the pharynx. Its action varies according to the direc- 
tion of its muscular fibres. It assists in depressing and carrying 
the jaw backward, it shortens the tongue by approximating its 
two extremities, and it tends to carry the tongue outward or 
inward, according as its anterior or posterior fibres contract. 
Platysma Myoides. 
This muscle is thin, and situated beneath the skin upon the an- 
terior and lateral parts of the neck, it extends anteriorly, from 
the superior part of the thorax and shoulder to the base of the 
face. It arises inferiorly, from the integumentary structure by a 
few short fibres; at this point it covers a portion of the pectoral 
and deltoid muscles. The most of the fibres of this muscle are 
implanted upon the anterior and lateral part of the maxillary 
bone; the rest of its fibres are blended with the muscles of the 
cheek. 
This muscle may assist in depressing the lower jaw, and cause 
the integuments of the face and neck to wrinkle. It is frequently 
so very thin that its action is scarcely perceptible. In the lower 
classes of animals this muscle forms a very thick, fleshy covering 
over the muscles of the face. 
Levator labii superioris, et alee nasi. 
This is a long, flat muscle. It arises at the nasal apophysis 
and internal angle of the eye; it is covered at the point by the 
orbicularis palpebrarum. It then descends along the wing of the 
nose, and enlarges, running outwardly under the skin, to be 
inserted into the superior lip. The name of this muscle indicates 
its use. STRUCTURE OF THE MOUTH. 
29 
This muscle exceeds the preceding muscle in size but is shorter 
than it. It extends from the inferior and external border of the 
orbit to the superior lip. It is covered superiorly, by the orbicu- 
laris palpabrarum, and is situated inferiorly under the levator labii 
et alse nasi to which it adheres. The direction of its fibres is 
obliquely inward, hence, in contracting, it carries the lip upward 
and outward. 
Levator labii Superioris. 
The levator anguli oris is smaller than the two preceding mus- 
cles, which are concealed partially by this muscle and partly by 
the orbicularis palpabrarum and the zygomaticus major. The 
levator anguli oris arises from the canine fossa; its direction is 
obliquely outward, and is inserted into the commissure of the 
lips. It elevates the angle of the mouth. 
Levator Anguli Oris. 
Zygomaticus Major. 
This muscle arises from the anterior and inferior part of the 
malar bone and extends to the commissure of the lips, where it 
divides to be inserted into each lip. 
It draws the corner of the mouth obliquely upward and outward. 
This muscle is sometimes absent; when present, it is situated 
on the internal side of the preceding muscle and has the same 
attachment; it however, sometimes arises from the inferior part of 
the orbicularis palpabrarum. Its use is the same as that of the 
zygomaticus major. 
Zygomaticus Minor. 
Depressor Anguli Oris. 
This muscle is of a triangular form. It is attached by its base 
to the external maxillary line, and its apex is inserted into the 
commissure of the lips. It depresses the corner of the mouth. 
Depressor Labii Inferior is. 
This muscle arises from the side of the chin and upon a level, 
and to the internal side of the preceding muscle. It runs obliquely 
upward, is inserted into the orbicularis oris and partly into the 
skin to which it strongly adheres. Some of its fibres and those 
of its fellow on the opposite side cross one another. Its use is to 
depress the inferior lip. 
Buccinator. 
This muscle forms the greater part of the cheeks. It arises 
posteriorly, from the external side of the dental arches near the 30 
STRUCTURE OF THE MOUTH. 
molar teeth; it is also attached to a ligament which extends from 
the internal wing of the pterygoid apophysis to the internal face 
of the superior maxillary bone. It is inserted anteriorly into the 
commissure of the lips where it divides and sends off a muscular 
slip to each lip. The duct of Steno passes through this muscle 
opposite the first molar tooth. 
The superior fibres descending and the inferior ascending de- 
cusate each other near the corner of the mouth; while the lesser 
fibres take a horizontal direction. The lips, w-hen this muscle 
contracts, are carried backward and against the teeth as in 
laughing. It is this muscle that forces the wind from the mouth 
when blowing the trumpet; hence its name buccinator. 
Orbicularis Oris. 
The Orbicularis Oris is almost entirely formed of the different 
muscles that are connected to it. It forms the lips and its muscular 
fibres are so arranged as to cross one another at the corners of 
the mouth. This muscle lies immediately beneath the skin to 
w'hich it strongly adheres; its action is varied. It contracts and 
rounds the opening of the mouth by forcing the lips forward, 
and, with the assistance of other muscles of these parts, it con- 
tributes to the execution of movements necessary in the perfor- 
mance of mastication, pronunciation, singing, &c. 
The Structure of the Lips and the interior of the Mouth. 
The lips are composed of muscular fibres, of cellular tissue 
that unites these, of vessels, nerves, glandular follicles and of a 
cutaneous or mucus envelope which covers the whole of these 
parts. The arrangement of their muscular fibres renders the lips 
capable of numerous and various motions necessary in the per- 
formance of their different functions. 
The smallness of the transverse opening of the mouth which 
constitutes the lips, is regarded as a characteristic of beauty; in 
fact, it is only in man that the lips form an opening sufficiently 
narrow' to prevent the saliva from flowing from the mouth. A 
large mouth is generally displeasing, as it recalls a disposition 
analogous to inferior animals. The external opening of the mouth 
is comparatively larger in the foetus than at a later period. 
The skin which forms the lips exteriorly is of a serous tissue, 
and adheres strongly to the subjacent parts, and is covered in 
man with beard, and in women and children with fine down. 
When the skin reaches the edges of the lips it becomes finer. 
It is constantly humid and of a vermillion color, which readily 
disappears in syncope, fright, &c. At this point it is blended 
with the lining membrane of the mouth. 
Notwithstanding the analogy that has been supposed to exist between the structure of the mucous membrane that lines the 
natural cavities of the body, and that of the skin which covers 
the exterior of the body, they are essentially different. Indeed, 
the cutaneous organ is composed of derma properly so called, or 
of skin of mucous tissue which imparts color to the skin, of little 
glandular follicles, and of epidermis which covers the whole. On 
the contrary, the mucous membrane of the mouth like that which 
lines the alimentary canal and bronchial cell, covers nearly al- 
ways fibrous surfaces more or less apparent, from which it is sepa- 
rated by a layer of dense cellular tissue. At other times it is 
composed of a thick, fungous, vascular layer which is strewed 
with glandular follicles of various forms and sizes; but the largest 
of which are but very small, and give to the surface of this layer 
the appearance of velvet. There are, however, numerous con- 
nections and great sympathy between the mucous membranes 
and the skin, as we shall have occasion hereafter to point out. 
The mucous membrane which lines the interior of the mouth, 
contains the orifices of the salivary glands, and the excretory 
conduits of the mucous follicles, from whence flows a viscous 
fluid which mixes with the saliva. It also contains little grains 
or glandular bodies which produce a constant moisture in the 
mouth. The surface of this membrane presents also a great 
quantity of absorbent vessels, arterial and venous branches, and 
the terminations of nerves. It will be apparent from the struc- 
ture of this membrane, that it possesses extreme sensibility, and 
is subjected to various affections. The lips are divided into 
superior and inferior; the term commissure has been given to 
their lateral union. The lips are flattened backward and con- 
vexed exterior. The lips of negroes are generally more convexed 
than those of white persons; this depends partly upon the greater 
prominence of the jaws in the latter, and partly upon the greater 
thickness of their lips. The superior lip contains in its middle 
portion a gutter which is bounded on each side by a slight eleva- 
tion. The internal face of the lips has attached to their centre a 
duplicature of the lining membrane of the mouth ; this duplicature 
is more apparent upon the superior than upon the inferior lip, and 
is called the fraenum. 
The walls of the mouth present, superiorly, a prominence occa- 
sioned by the malar eminence; below this, the face of fat and 
chubby persons is convexed, and depressed in those who are lean, 
especially if the molares have been lost. 
The internal face of the cheeks correspond to the gums and 
teeth; and in the space opposite the first molar teeth is seen the 
duct of Steno. 
STRUCTURE OF THE MOUTH. 
31 32 
STRUCTURE OF THE MOUTH. 
The Posterior wall of the Mouth or Palate. 
The posterior wall of the mouth is a fleshy, moveable partition ; 
it is attached superiorly to the palatine arch, laterally to the walls 
of the pharynx, and inferiorly to the base of the tongue. The 
opening at this part which communicates with the pharynx con- 
stitutes the fauces. 
The palate presents, at its superior and middle portion, an ap- 
pendix called the uvula, which is of a conical form and directed 
downward. In the various affections of the throat it is susceptible 
of augmenting in size, or of becoming so elongated as to impede 
deglutition and occasion serious inconveniences. The lateral 
parts of the muscles of the palate enlarge, descend, and form two 
pillars; the anterior pillar terminates at the side of the base of 
the tongue, and the posterior at the lateral and anterior parts of 
the pharynx. The space between these two pillars is occupied 
by an assemblage of glandular follicles, which furnish an abundant 
secretion that lubricates the surrounding parts. The muscles 
which are attached to the palate are the glosso-staphylius, the 
internal and external peristaphylius. These muscles are called 
staphyli from their insertion into the palate, which in Greek is 
called staphile. 
Glosso-S taphilus. 
This muscle is thin and situated in the anterior pillar of the 
palate. Its inferior extremity adheres to the sides of the base of 
the tongue ; its superior inclines inward along the palate as far as 
the uvula. When this muscle contracts it draws the palate from 
the base of the tongue and consequently contracts the fauces. 
Peristaphilius Internus. 
The peristaphilus internus is much stronger than the preceding 
muscle. It arises from the inferior face of the petrous bone 
between the two openings of the carotid canal, near the Eustachian 
tube; thence it descends obliquely forward, downward and in- 
ward as far as the middle of the palate, where it increases in 
size, gives off some fibres to the pharynx, and unites itself with 
its fellow on the opposite side by a very fine aponeurotic expan- 
sion. When these two muscles contract, they elevate and expand 
the palate by pressing it against the posterior openings of the 
nares. They prevent aliment from getting into the nasal fossa 
during deglutition. 
This muscle is attached, superiorly, to the depression situated 
behind the base of the internal wing of the pterygoid apophysis, 
and to the anterior and external part of the Eustachian tube; it 
Peristaphilius Externus STRUCTURE OF THE MOUTH. 
33 
then descends along the pterygoid apophysis, winding upon the 
hook of its internal wing, and becomes lost upon the lateral parts 
of the palate, and renders its application against the opening of 
posterior nares perfect. 
Pharyngo- Staph ilius. 
It arises from the posterior border of the palatine arch, and 
contracting as it descends in the substance of the posterior pillar 
of the palate; it then becomes larger and spreads itself upon the 
lateral parts of the pharynx. When this muscle Contracts, it de- 
presses the palate and assists the action of the glosso-staphilius; 
it may also slightly elevate the pharynx. 
Palato-Staphilius. 
The palato-staphilius may be regarded as an odd muscle. It 
is attached, superiorly, to the spinous process formed by the union 
of the two palate bones, and descends along the uvula, which it, 
in a great measure, forms. It shortens and elevates the uvula. 
The Superior and Inferior Walls of the Mouth. 
The superior and inferior wails of the mouth are covered by 
the mucous membrane that lines the whole of this cavity. At 
their anterior parts we observe the gums, which are formed of a 
thick serous tissue of reddish colour; these cover the alveolar 
arches and insinuate themselves between the teeth, the necks of 
which they surround, and to which they are strongly attached. 
The gums contain a great quantity of vessels and nerves, and 
unite with the periosteum. Their internal structure is but little 
understood. 
The membranous part that covers the palate is of a smooth, 
serous and whitish tissue; it contains, however, mucous follicles, 
which may be seen at the anterior part, where is observed in 
the middle, a longitudinal line analogous to those in other parts 
of the body. Between the incisores, where this line commences, 
is the anterior palatine foramen. It is commonly supposed that 
the palate is an essential part of the organ of taste; hence we 
hear of men having very fine palates, meaning that they have 
good taste; it is certain, however, that the palate does not enjoy 
this faculty. This fact can be demonstrated by placing any 
sapid body upon the palate, when a sapid taste will not be expe- 
rienced unless the substance touches the tongue, which is the sole 
organ of taste. The inferior wall of the mouth forms a cavity 
that enlarges as it progresses backward; the mucous membrane 
which covers it, folds under the tongue and forms the anterior 
ligament of this organ. In front of this ligament there are two 
tubercles, to which the canals of the maxillary glands communi- 34 
STRUCTURE OF THE MOUTH. 
cate, and upon their sides there are two prominences which cor- 
respond to the sublingual glands. 
The Tongue and its Muscles. 
The tongue is of soft and reddish texture; the muscular fibres 
of which it is composed form an inextricable tissue. If after 
macerating the organ for a time in acetous acid, we cut it longi- 
tudinally and crosswise, we will discover longitudinal and trans- 
verse fibres, and fibres that extend from the upper to the under 
surface. The tongue is attached to the base of the os hyoides 
where it is retailed by fasciculi of muscles which enter into its 
formation. 
The muscular apparatus of the tongue is composed of the 
stylo-glossus, hyo-glossus, genio-glossus and lingual. We de- 
scribed the genio-glossus when treating of the muscles that de- 
press the maxillary bone. 
The Stylo-glossus 
Is a slim, long muscle; it arises tendinous from the styloid 
apophysis; its fleshy portion descends by enlarging from behind 
forward, and from without inward. It terminates upon the sides 
of the tongue near its base. This muscle elevates the base of 
the tongue, carrying it backward; it also assists, when it acts 
with its fellow, in enlarging this part. 
The Hyo-glossus 
Is attached in front of the body of the os hyoides, along its lar- 
ger horn. It becomes narrower as it mounts upward, and is lost 
upon the lateral parts of the tongue. This muscle in contracting 
forces the tongue lengthwise, and causes it to form a longitudinal 
gutter at its superior part. When the os hyoides is fixed, it de- 
presses the base of the tongue. 
The Lingual. 
This muscle, which constitutes the greatest part of the tongue, 
extends from the base to the point of that organ. It is situated 
between the genio-glossus and the hyo-glossus. When it con- 
tracts it folds the point of the tongue under and draws it near the 
base of the organ. The arrangement of the muscles which com- 
pose the tongue, together with the peculiar form and structure of 
this organ, explains the cause of the numerous and various 
movements that this organ executes during mastication, degluti- 
tion, speaking and singing. 
The tongue is covered by a very thick membrane, which is 
continuous with the common envelopment of the walls of the 
mouth. This membrane, by being reflected over the neigh- STRUCTURE OF THE MOUTH. 
35 
bouring parts, forms three folds or ligaments which appear to 
limit the movements of the tongue. The one in front constitutes 
the fraenum or fillet of the two posterior ones; one of these may 
be called the glosso-staphilus, and the other the epiglottis. 
The superior part of the mucous membrane which covers the 
tongue is of a peculiar structure, and is essentially the organ of 
taste. This membrane contains papillae of various forms and 
sizes. The papillae appear to be formed of the termination of 
nerves, blood-vessels, glandular follicles, &c., and are divided 
into three classes. The first of these is of an inverted conical 
form; their number varies from seven to fourteen or fifteen; 
they are situated near the base of the tongue, and form two lines 
resembling the letter V, the apex of the lines point posteriorly 
and the base anteriorly. When these papillae are pressed, a 
viscous liquid is emitted. The second class of papillae are called 
fungiform, from their resemblance to a mushroom; they are at- 
tached to the tongue by a pedicle, and occupy the smallest and 
posterior part of that organ; they are more numerous than the 
preceding ones. The third class, called pyramidal, adhere to the 
tongue by their base, and are situated upon the lateral part of this 
organ near its point; some of these, however, are found inter- 
spersed among the two first species. 
The pyramidal papillae seem to be formed of a great many 
nervous buds. These papillae, from hunger or the presence of 
savory food, become erect and are then more observable. 
SECTION IV. 
Salivary Glands. 
The salivary glands are not the least important of those organs 
that enter into the formation of the apparatus of mastication. 
The secretion of these glands mixes with the food, and is an in- 
dispensable agent for it to undergo the preliminary stage neces- 
sary for digestion. 
These glands are six in number; three upon each side. They 
are remarkable for their size, but more especially on account of 
the great quantity of fluid that they secrete. 
The parotid is the largest of all the salivary glands. It is situ- 
ated below the external auditory foramen, and extends from the 
mastoid apophysis to the masseter muscle; it is covered by a fine 
aponeurotic expansion of the platysma myoides and by the skin. 
It is formed of an assemblage of little glandular bodies, united by 
cellular tissue. In other respects, it is of a serous tissue of a 
Parotid Gland. 36 
STRUCTURE OF THE MOUTH. 
pale red colour, and contains a great number of blood-vessels 
and nerves. 
Each of the little glands of which this organ is composed gives 
off as many little tubes, which unite and form the superior sali- 
vary canal, (the duct of Steno). This excretory conduit arises 
anteriorly, near the summit of the parotid gland, thence it passes 
forward to the anterior border of the masseter muscle, about an 
inch below the zygomatic arch. At this point it penetrates the 
cheeks, through the buccinator muscle, and opens into the mouth 
opposite the second superior molar tooth. 
The parotid, like all conglomerate glands, is surrounded by a 
great many vessels and lymphatic glands. It secretes during 
mastication a great quantity of saliva. The secretion of this 
organ is increased by sour food, hunger, and the various sub- 
stances that have a specific action upon it, and by pressure during 
the motion of the jaw in mastication. 
Maxillary Gland. 
This gland receives its name from its position, which is upon 
the internal side of the maxillary bone, neai' its angle. It is situ- 
ated behind the posterior border of the mylo-hyoideus muscle, 
and united, posteriorly, to the parotid by cellular tissue. In colour 
and consistence it resembles the preceding gland, and it appears 
to have the same internal structure. 
Its excretory duct is called the duct of Wharton, though it was 
described one hundred and thirty years before him by Berenger 
of Carpi. This duct is formed by the union of little canals 
which arise from the different glandular bodies. It arises from 
the anterior part of this gland, passes beneath the mylo-hyoideus 
muscle along the sublingual gland, from which it occasionally 
receives some of its conduits, and also those of other little glands 
in the midst of which it passes. It opens into the mouth under 
the tongue and upon the side of its anterior ligament. 
Sublingual Gland. 
This gland is of an oblong shape slightly flattened, and smaller 
than the two preceding glands. It is often united to the maxil- 
lary gland. It has about twenty excretory ducts, which are so 
small as to be scarcely visible; the orifices of these open in front 
and underneath the tongue. Of the three glands of which we 
have spoken, the parotid is the largest, and consequently fur- 
nishes the greatest quantity of saliva. Sabatier relates a case of 
a soldier who would wet three napkins during a short repast, 
with the saliva that escaped externally from the duct of Steno, 
which had been accidentally wounded. Gavard says that he 
saw, at the Hotel Dieu in Paris, a man similarly affected, and STRUCTURE OF THE MOUTH. 
37 
who lost at least two ounces of this fluid during a repast of ten 
minutes. The abundant secretion furnished by these three sali- 
vary glands is of a serous kind, and its chemical composition ap- 
pears to be but little understood. It mixes in the mouth with a 
viscid fluid furnished by mucous follicles which are situated upon 
the sides of the mouth, the tongue, or lips; the combination of 
these two fluids constitutes the saliva. The food during mastica- 
tion becomes saturated with the saliva, and is thus prepared for 
digestion. To terminate the anatomy of the mouth, it only re- 
mains for us to describe the origin and distribution of the nerves 
and arteries that ramify to the various parts of the mouth, the 
formation of veins which return the blood, and lastly, the dispo- 
sition of vessels and lymphatic glands which convey the residue 
of the various secretions necessary for the apparatus of mastica- 
tion. 
SECTION V. 
Nervous and Vascular Apparatus. 
The nerves which are distributed to the different parts of the 
mouth that have been already described, are branches of the fifth, 
seventh, eighth and ninth pairs. 
The fifth pair of nerves, also called the trigeminus, from its 
dividing into three branches before it escapes from the cranium, 
arises from the pons varolii and the crura ceribri, by a great 
number of separate fillets. 
Of the three branches of which this nerve is composed, there 
are only the second and third branches, called the superior and 
inferior maxillary branches, that supply some of the parts of the 
mouth. 
The superior maxillary branch gives off the anterior and poste- 
rior dental fillets; it also enters into the formation of the spheno- 
palatine ganglion, which sends off the palatine and spheno-pala- 
tine nerves. 
The inferior maxillary branch is larger than the preceding; it 
furnishes the masseter, deep temporals, the pterygoid, the superfi- 
cial temporal, the lingual which imparts to the tongue the faculty 
of receiving the impressions of acids, and finally the inferior den- 
tal nerve. 
The seventh pair, or auditory nerves, arises from the lateral and 
posterior parts of the anular eminence by two cords, called the 
portio dura and portio mollis. The portio dura gives off some 
nervous twigs to the parts of which we have been treating: viz. 
the vidian, the temporal, malar and buccal branches. 
The eighth pair of nerves, or the parvagum, derives its origin 38 
STRUCTURE OF THE MOUTH. 
from the lateral and superior parts, medulla oblongata, by nume- 
rous fillets which pass out of the cranium, through the posterior 
foramen lacerum. The glosso-pharyngius is derived from this 
nerve. 
The ninth pair is called the gustatory or lingual nerves; it 
arises from between the corpora pyramidalia and olivaria by seve- 
ral fillets, which unite and pass out of the cranium through the 
anterior condyloid foramen. This nerve distributes branches to 
the tongue, by which it imparts to this organ the faculty of motion. 
Arteries. 
The aorta furnishes at its origin a large trunk, (the primitive 
carotid,) which divides at the summit of the larynx. One of 
those divisions supplies the interior of the cranium, and is called 
the internal carotid; the other is distributed upon the exterior of 
the head, and is the external carotid. It is from the external 
carotid, that the arterial branches which supply the different 
parts of the mouth are derived. The external carotid is more 
deeply seated than the internal, its direction is upward and out- 
ward, as far as the body of the condyle of the maxillary bone; 
before it reaches this point it gives off eight principal branches, 
one half of which furnishes arteries to the parts that demand our 
special attention. 
The lingual artery gives off the sublingual branch. The labial 
furnishes the musculo-palatine; the sub-maxillary, the tonsilaris; 
the inferior labial, the two coronaries. 
The external carotid, arriving at the posterior part of the con- 
dyle of the maxilla, gives off two posterior branches. One of 
these is the temporal, which furnishes the anterior auricular and 
the transnesalis facii; the other is the internal maxillary, from 
which is derived the inferior dental, the zygomatic-maxillary, the 
masseter, the buccal, the palatine and the spheno-palatine. All 
of these branches, in their distribution to the parts that are indi- 
cated by their names, divide and subdivide into an infinite number 
of branches, and present frequent anastomoses with one another. 
Veins. 
The arterial blood, after having furnished the various parts 
with materials for nutrition and secretion, returns through nume- 
rous veins that follow the course of the arteries, the names of 
which they receive. The venous branches empty into the inter- 
nal jugulars. 
Lymphatic Vessels and Glands. 
Serous liquids, the residue of all the secretions, return from 
the various parts of the mouth, by lymphatic vessels. These vessels originate from extremely fine roots. These last re-unite 
and form branches which empty into the great lymphatics. 
The lymphatics situated in the skin covering the lateral parts 
of the head and cheeks, empty into the little glands situated about 
the parotid gland. Those that are situated upon the wings of the 
nose, the lips, the cheeks, and the lateral parts of the face, empty 
into the sub-maxillary glands, situated upon the internal sides of 
the jaw. Lastly, those which are derived from the tongue, pal- 
ate, posterior nares, and some more distant parts, join the sub- 
lingual glands, the name of which indicates their position. The 
lymph, after being elaborated in these different glands by means 
of an order of vessels which accompany the divisions of the veins, 
proceed to unite to those at the anterior part of the neck. 
PHYSIOLOGY OF THE MOUTH. 
39 
PHYSIOLOGY OF THE MOUTH. 
SECTION I. 
Mastication is performed by the motion of the inferior jaw, 
and by means of the teeth. To understand this phenomenon, we 
must examine; 1st, the relation of the superior maxilla, against 
which all the force during mastication is applied; 2d, that of the 
inferior jaw which executes the movements by means of the 
muscles that are attached to it. 
Mechanical Function of the Apparatus of Mastication. 
The Adaptation of the Superior Maxilla for Mastication. 
The superior maxilla is thick and solidly retained in its position 
by several neighbouring bones. Thus, the nasal apophysis is 
united to the coronal by a denticulated and bevelled border. 
That apophysis is slightly inclined inward, and articulates with 
its fellow near the most solid part of the frontal bone, forming at 
this point a kind of roof; this arrangement renders these bones 
very firmly fixed in their positions, and diminishes a little the 
movements transmitted along this apophysis. On the other hand 
we discover the malar eminence of the maxillary bone united to 
the anterior border of the zygoma by a broad surface, which is 
turned partly posterior and partly anterior. It should also be 
noticed that the malar bone is also joined to the frontal, so that 
it is by this last bone that all the motions that are transmitted 
upon the alveolar border are sustained. The maxillary receives 
a great support posteriorly, from the palatine bones, which are 40 
PHYSIOLOGY OF THE MOUTH. 
themselves sustained by the sphenoid bone which is situated in the 
middle of the base of the cranium, and articulates with nearly 
all the bones of the head. 
From this general view, we discover that the maxilla is very 
solidly sustained by the neighbouring bones, and especially by 
the frontal bone. In front it is supported by the nasal apophysis 
of the frontal bone, and posteriorly by the zygoma; so that the 
part of the alveolar border of this bone, against which the great- 
est force in mastication is exercised, is the most secure and well 
adapted to sustain a shock. 
It necessarily results from the arrangement of the superior jaw 
that the motion communicated to the alveolar border by the infe- 
rior jaw, should pass to the sides of the orbits to be transmitted 
obliquely to the frontal bone, whence it passes along the bones of 
the cranium. In fact, in all violent motions upon the superior 
teeth, a very remarkable shock is experienced near the top of 
the head; it is also known that the pain that is experienced when 
a handkerchief has been forcibly withdrawn from between the 
teeth, in case of injury of the cranium, has been, for a long time, 
regarded as a sign of fracture: but this is simply a consequence 
of the motion communicated to the forehead, thence to the organs, 
which a shock more or less violent has rendered very sensible. 
That part of the superior maxillary bone in which the incisores 
are implanted, is situated under the opening of the nasal fossae, 
and is but slightly sustained; but the force is not great that it has 
to resist, it being the most distant part from the fulcrum; it is, 
nevertheless, firmly adjusted by the mode of connection of the 
maxilla to each other by means of their thick and denticulated 
crests. That portion of the jaw which receives the last molares 
•is likewise found not to be strongly supported; but great force is 
never exercised at this part, from the difficulty of placing verv far 
back into the mouth, substances that we wish to grind. 
The maxilla is not only well adapted to sustain the motions of 
the inferior jaw, but also all shocks that it may receive from falls 
without being displaced. It is retained interiorly by the zygoma, 
which is connected to the temporal arch. It should be remarked 
that, in its connection with the neighbouring bones, the articular 
surfaces are bevelled alternately in different directions: so that it 
is likewise retained on all sides similar to nearly all the bones of 
the head.* 
* See the Memoir of Hunaud, upon the connection of the bones of the 
cranium|; and that of Borden upon the connection of the bones of the face ; 
recorded in the Memoires de l'Academie des Sciences. 41 
PHYSIOLOGY OF THE MOUTH. 
The Inferior Jaw, and the Action of the Muscles that are attach- 
ed to it. 
The inferior jaw contains an articular condyle, the formation 
of which is well adapted to the great and easy motions of the 
jaw. The jaw can be depressed and elevated, carried slightly 
forward and backward and perform a rotary motion. 
The jaw is depressed by the action of all the muscles that are 
attached to it and the hyoide bone, and by the digastricus which 
is attached to the mastoid apophysis. All of these muscles are 
very thin, and proportioned to the slight force that they have 
habitually to perform ; but if their action is exercised with vio- 
lence, as in yawning, it may produce luxation of the jaw. This 
accident is more apt to occur in persons of a certain age, the 
branches of whose jaws form nearly a right angle with the body 
of this bone, because the condyle can, in such case, be easily 
brought forward in opening the mouth very wide; while displace- 
ment cannot take place in young subjects, the condyles of whose 
jaws are almost upon a line with the body of the bone. 
The elevation of the jaw is effected by the action of the tempo- 
ral, masseter, and the two pterygoid muscles.' The two first of 
these are the strongest; the temporal muscle firmly adheres to 
the temporal bone, and progressing downward, surrounds the 
coronoid apophysis. This muscle in very ravenous animals, as 
the hyena, is very large and strong. Jt extends upon the whole 
side of the cranium and is attached to a longitudinal crest upon 
the top of the head. 
The masseter is attached by one extremity under the zygomatic 
arch to the zygoma, and to the part of the maxilla which is united 
to it, and by the other extremity to the external side of the branch 
of the inferior jaw. It is short, very thick and properly situated 
to act most advantageously in elevating the jaw. 
The internal pterygoid muscle tends to carry the jaw backward 
and upward, and the external to direct it forward. 
When the jaws are open to break a substance placed between 
the teeth, the motion is performed by a very unfavorable.leverage. 
The muscular action which is the power, is situated at the fulcrum 
which the condyle of the jaw assumes in its articulation; and the 
resistance which is the power it possesses near the bod), placed 
between the teeth, has the disadvantage of being situated too 
near the fulcrum, and consequently the lever is too short. It is 
in this kind of articulation, as in nearly all those of animal 
mechanism, that the muscular power is adapted to the unfavorable 
position of the levers. 
Mastication is performed most advantageously upon the sides 
of the jaws between the bicuspides and first molares, near the 42 
PHYSIOLOGY OF THE MOUTH. 
muscular power; it is at this point that hard bodies that we may 
wish to break are placed. When we merely wish to cut food 
with the incisores, or to tear it with the cuspidati, a great force 
is not required. 
The motions which are exercised anteriorly, posteriorly, and 
upon the sides of the jaw, may by their combination produce a 
rotary motion necessary in grinding alimentary substances. This 
rotary motion is owing to successive or simultaneous action of 
the different muscular powers; the muscles on the right and left 
side act alternately. All muscles which are attached to the inferior 
jaw, even those that contribute to depress it, assist in the produc- 
tion of this movement of mastication, which can be better ima- 
gined than described. 
The inferior jaw, which in its constant motions presents a lever 
of the third species, may, under some circumstances, offer ex- 
amples of the two other species of levers. Thus, when a sub- 
stance is placed between the last molar teeth, and consequently as 
near the point of support of the jaw as possible, the direction of 
the muscular action changes in relation to the anterior fibres of 
the masseter, and the resistance may then be between the point 
of support and a part of the power. 
In cases of luxation, it may happen that the jaw being greatly 
depressed, and the condyle carried far forward against the trans- 
verse apophysis of the temporal bone, a part of the action of the 
temporal and masseter muscle and particularly the pterygoid, 
is exercised behind the condyle. This then has its fulcrum in 
the middle and forms a lever of the first species; the muscular 
action, in this case, tends to favor luxation, instead of carrying 
the jaw into its proper position. 
Although we have said that in mastication, the motions of the 
jaws, are referable to the inferior maxilla; we must, however, 
observe that the superior maxilla contributes in part to this 
motion. It is said that when the mouth is opened, the inferior 
maxilla is depressed four-fifths while the superior is elevated one 
fifth. To ascertain the truth of this, an individual has stood 
before a mirror, placed between his teeth the blade of a knife, 
which was held tight, and in opening the mouth the distance above 
and below the blade was estimated ; but it will be readily per- 
ceived that this elevation of the superior jaw is owing to the 
motion of the head which is slightly inclined backward, by a 
movement upon its articulation. PHYSIOLOGY OF THE MOUTH, 
43 
SECTION II. 
Organic Function of the Apparatus of Mastication. 
The functions of the mouth are as important as they are nume- 
rous. The muscles which form its lateral walls or the cheeks, 
and those that surround the lips, contribute in a great measure to 
the expression of the physiognomy. Sound produced at the open- 
ing of the larynx is modified by all parts of the mouth. This 
combination of organs is essential to mastication. 
In the dissection of the muscles of the face, it is observed that 
all these parts are united to one another by adipose cellular tissue, 
looser and finer than in other parts. This arrangement explains 
in a measure the extreme mobility of which the muscles of the 
cheeks are susceptible. 
Short and flat jaws, great mobility of the muscles of the face, 
a small mouth, well formed and animated eyes, are the principal 
characteristics by which the countenance of man is elevated 
above that of other mammiferous animals. It is observed that 
the more marked these characteristics are, the more noble and 
expressive is the physiognomy; at least when they have not been 
degraded by heinous passions or habitual debauchery. 
When the countenance deviates from these characteristic traits 
of beauty, it resembles that of brutes in so striking a manner that 
we naturally discover in them a resemblance to several animals, 
as may be seen in the celebrated work of Lavater. If the physi- 
ognomy remains unmoved and without expression, as in nearly 
all animals, the muscles of whose face are only fleshy membranes, 
which are only exercised in howling or masticating; if the eyes 
are round, large or very small, and move but slightly; if the 
mouth is large as in large carnivorous animals, we find that all 
these characters present an aspect more or less repulsive.- This 
resemblance, however, to the inferior class of animals may be 
partly effaced or entirely obliterated by soft and kind feelings, 
and by constantly endeavouring to express by the countenance 
the sentiments resulting from the intellectual faculties. 
The mouth contributes essentially to the formation of voice 
and speech. The air escaping from the lungs traverses its cells, 
enters the trachea and makes its escape with more or less force. 
This air meets in the trachea with the cartilage that covers the 
glottis (epiglottis) and causes it to vibrate like the reed of a haut- 
boy; the shaking of the cartilage gives motion to the air which 
surrounds it and sound is produced. The sound afterward 
traversing the different parts of the mouth and nose becomes 
modified by these organs. The vocal organs of man, and those 
of the various mammiferous animals, differ very much from those 44 
PHYSIOLOGY OF THE MOUTH. 
of birds. Sound in birds is produced at the base of the trachea, 
by the motion of two membranous folds, which form, in part, the 
opening of the two branches. Sound produced at this inferior 
larynx becomes modified as it progresses, along the trachea, at 
the superior larynx, and in the beak, by the various forms of 
which these parts are susceptible. In man, sound produced by 
the motion of the epiglottis is strong or weak, grave or acute, 
according as the larynx is shortened and dilated, or lengthened 
and its calibre increased by the different movements of the neck, 
in consequence of the force with which the air is expelled by the 
lungs and according as the glottis is more or less opened. Sound 
thus produced is afterwards modulated by the various parts of 
the mouth and nose in order to form the voice and speech. It 
may be modified in the mouth by the different positions of tongue, 
cheeks, teeth and lips. The loss of the front teeth is a great ob- 
stacle to a correct pronunciation; which is very perceptible in 
persons, thus affected, who speak or sing in public. It should be 
observed that the kind of apparatus of the vocal organ of man 
produces a quality of sound exceedingly disagreeable, as may be 
noticed in the cries of an infant; and it cannot be conceived 
how man can attain the art of drawing from such an instrument, 
sounds as harmonious as some produced. This is a proof of the 
great flexibility of these organs, and of their aptitude to overcome 
the greatest difficulties by long practice. 
The function of the mouth is at the very commencement of life 
called into requisition, and that which is very necessary to life is 
mastication. This preparatory function of digestion is much 
more important than is commonly supposed. 
Food should be well masticated, in order to be properly digest- 
ed. It is generally remarked that persons who masticate their 
food well, have an easy digestion and enjoy good health. 
The conversion of all kinds of food into a homogeneous pulp, 
and which contains a chyle always of the same nature, is one of 
the most beautiful and astonishing phenomena of the organization. 
It can readily be conceived that it requires nothing less than the 
action of an apparatus as extensive as that of digestion, to per- 
form this operation perfectly. Hence it is not astonishing that a 
slight derangement or a defect of action of one part of this appa- 
ratus should ultimately affect the performance of this function. 
Mastication being indispensable for good digestion, it will be 
discovered that those who have bad teeth can only exercise this 
function in an imperfect manner. The stomach, suffered to re- 
ceive aliment that has not undergone this preparatory process, 
gradually becomes weak ; hence, persons who have bad teeth 
arc said to have weak stomachs. There is, however, another 
cause that may produce the same effect: it is the connection and PHYSIOLOGY OF THE MOUTH. 
45 
intimate union that generally exist in all the parts of the same 
apparatus; in such a manner, that when an apparatus is weak or 
diseased we also find symptoms of that derangement in all its 
parts. Hence, in a bad condition of the digestive apparatus, the 
teeth will soon become carious and give rise to frequent pain, 
the mouth will often be the seat of aphthous affections, the breath 
will be disagreeable, there will be heaviness in the stomach, flatu- 
lency, and alternately diarrhoea and constipation. 
It is in feeble children, particularly during dentition, that we 
can discover the sympathy which exists in the different parts of 
the digestive apparatus; for it is known that the painful affection 
of the gums nearly always occasions, at this period, a derange- 
ment in the alimentary canal, which is indicated by a more or 
less obstinate diarrhoea. 
The incisores serve to cut, the cuspidati to tear, and the bicus- 
pides and molares to grind aliment: these different processes of 
mastication are important in many respects. It is well known 
that organs which are properly used acquire more strength and 
are preserved in a better state of health than those that remain 
inactive; hence the teeth require the performance of their functions. 
The act of mastication preserves the teeth in a state of cleanli- 
ness, and prevents the accumulation of tartar upon them. Lastly 
it is necessary that the food be properly masticated, to enable it 
to undergo the preliminary and indispensable process of digestion. 
It is interesting to examine in detail this important function of 
the various parts of the mouth. When food has been put into 
the mouth, and has commenced to be masticated, its savoury 
quality is soon felt by the nerves of the tongue and by the walls 
of the mouth. 
It has not been ascertained what is the precise nature and 
common properties that the substances which affect the organs 
of taste enjoy; but it is observed that all very sapid bodies are 
very soluble in saliva, or in waters which compose it, as acids, 
alkalis, alcohol, many of the salts, &c. It appears that the great 
solubility of these substances favours the savoury action which 
they exercise upon the organs of taste. It is observed that the 
parts that enjoy the greatest degree of the faculty of taste is par- 
ticularly the tip of the tongue, together with its surface and the 
lips; and that the palate is not susceptible of this property, as has 
been commonly supposed. 
When the organs of taste are put in action by food, it is re- 
marked that nervous papillae swell, become erect, and are very 
apparent: this takes place more particularly among epicures. 
Aliment stimulates the organs of taste, and also increases the 
action of the salivary glands; the secretion of saliva, being estab- 
lished, is afterwards kept up by the taste of the food which the 
person continues to take, and by the act of mastication. 46 
PHYSIOLOGY OF THE MOUTH. 
As the flow of saliva is always a concomitant act of digestion, 
the secretion often commences from the mere association of 
ideas; thus, every thing that calls to the mind of an epicure who 
is impatiently waiting for his dinner, the delicious food that he is 
to enjoy, commences to put in action the salivary organs. This 
has given rise to the common phrase, "your mouth waters." 
As the aliment is ground by the teeth, it becomes, when pro- 
perly masticated, completely saturated with saliva. It should be 
observed that during mastication the food is necessarily mixed with 
a certain quantity of atmospheric air, which surrounds the vis- 
cidity of the saliva, and which contains its albumen. 
Aliment properly masticated is reduced to a pulpous mass 
which becomes tasteless and requires to be swallowed; it is col- 
lected together in a bolus, and by the action of the tongue and 
walls of the mouth is carried to the posterior part of the mouth, 
pressed against the palate and pushes the uvula against the poste- 
rior opening of the nares. The bolus passes into the pharynx, 
down which it descends pressing the epiglottis upon the glottis. 
The neck now elongates, and by a simultaneous action of these 
parts, the aliment traverses the oesophagus, and is carried into 
the stomach. The food does not, as some anatomists contend, 
fall into the stomach by its own weight. 
When mastication is properly performed, in a young and 
healthy person, the lips are of a vermillion colour, the teeth white, 
and all parts of the mouth exhibit that state of freshness which 
characterizes health. But under various circumstances of disease, 
these parts show phenomena of numerous derangements, which 
shall be the subject of the second part of this treatise. PART SECOND. 
DISEASES OF THE MOUTH. 
The various anatomical apparata of organs which enter into 
the formation of the mouth, and of which we have already spoken, 
are subjected to a variety of diseases. These diseases may be 
peculiar to the mouth, or they may depend upon a general affec- 
tion of the system of organs to which they appertain. 
We shall present, in the following order, the history of the dis- 
eases of the mouth: 1st, those which originate in the mucous 
membrane that lines the mouth and forms the gums; 2d, the nu- 
merous and various affections which have their seat in the sub- 
stance of the various parts of the mouth; 3d, those that are 
peculiar to the salivary and lymphatic glands; 4th, nervous or 
rheumatic affections; 5th, diseases of the maxillary and palate 
bones; 6th, those peculiar to the teeth, and which constitute the 
principal object of this work. 
SECTION I. 
Diseases of the Mucous Membrane of the Mouth. 
The mucous membrane, which lines the mouth, covers the 
tongue, forms the gums and spreads itself as far as the edges of 
the lips, is subject to a variety of diseases. 
Chaped Lips. 
The lips of some persons become chaped from the effects of 
cold, and more particularly from cold winds. The lips sometimes 
become excoriated, and the epidermis detaches itself in flakes, at 
other times there will be very numerous and very deep clefts in 
them. 
This affection has occasioned the manufacture of a variety of 
lip salves; nearly all of these are composed of oleo-mucilaginous 
substances, or of cerate coloured red. These salves, when spread 48 
DISEASES OF THE MOUTH. 
upon the lips, protect them from the air and impart a handsome 
red colour. 
Aphthce of the Mouth. 
Under various circumstances, the mouth becomes the seat of 
little ulcerations, that have been called aphthae. This disease 
rarely occurs alone; but generally accompanies catarrhal affec- 
tions, simple mucous fever, and some fevers of a malignant cha- 
racter. 
Aphthae manifest themselves by little flat pustules of an ash or 
whitish colour. We at first discover a little, inflamed point; 
afterward a little cuticle is formed, which detaches itself, and the 
part thus excoriated becomes extremely sensitive. 
Sometimes these pustules are separate and scattered over the 
different parts of the mouth, pharynx and oesophagus, so as to 
impede mastication, deglutition and even respiration. 
In some cases aphthae are very numerous and confluent; they 
then produce extensive ulceration, covered by a whitish and tena- 
cious cuticle; when the disease is on the decline, a great quantity 
of mucous and membranous shreds are discharged from the mouth. 
Some persons are affected with aphthae during cold and wet 
weather. Indigent persons, such as are of a bad constitution, 
and such as reside in low and humid districts, are often subjected 
to this complaint. 
1 have frequently had occasion to observe that persons who 
have often taken mercury, and who were of a lymphatic consti- 
tution, were very much disposed to attacks of this disease, which 
would appear from time to time, and continue for a long period. 
In such cases, the repeated action of mercury upon the mouth 
induces a degree of sensibility or weakness, which renders it sub- 
ject to that affection. It then often happens that these aphthous 
eruptions are mistaken for chancres, as in cases where the vene- 
real disease has not been perfectly cured ; under this hypothesis, 
mercury is again had recourse to, which only makes the patient 
more susceptible to the affection. 
Vagler has often seen mucous fevers terminate in numerous aph- 
thous eruptions, and in an abundant salivation. Children are parti- 
cularly subject to the different species of aphthae which have re- 
ceived various names. This affection sometimes occurs epidemi- 
cally in hospitals for children, and would appear to assume a 
contagious character among the children who were in the neigh- 
bourhood. 
It often happens, with persons of a catarrhal constitution, and 
who have decayed teeth, that their gums, in cold and wet weather, 
become turgid, swollen and very painful; the teeth which are 
then loosened, sometimes threaten to drop out. This affection DISEASES OF THE MOUTH. 
49 
generally occurs where there are decayed teeth; sometimes it 
extends over the whole of one or both sides of the jaws. 
Some practitioners regard this disposition as a scorbutic disease, 
for which they generally prescribe anti-scorbutic remedies; were 
we to assent to what most practitioners assert, we would be led 
to believe that scurvy is a very common disease among all classes 
of society. 
This opinion is carried to such an extent, that a dentist of 
Paris, in a modern work, has said, "that three-fifths of the inhabi- 
tants of large cities are of a scorbutic constitution.* 
Aphthous affections originate generally from a catarrhal dispo- 
sition, which particularly manifests itself upon the mucous mem- 
brane of the mouth; it is also very often kept up by the presence 
of tartar or decayed teeth. Catarrhal constitutions are overcome 
by cleanliness, exercise, healthy locations, good nourishment and 
the use of tonics, and all means capable of imparting force and 
energy to the whole organism. Aphthous predispositions of the 
mouth may be removed, if the teeth are kept clean and such as 
are decayed be extracted. We should also use a gargle con- 
taining some stimulating substance, as spirituous liqours; great 
benefit is often derived from chewing scurvy-grass or other plants 
of the class of cruciferae. 
We have said that, in scorbutic affections, the gums become 
turgid, fungous, of a livid red colour, and present fleshy excres- 
cences, often very large. As the foregoing symptoms are also 
often observed in other affections, and as it is important not to 
confound them, we shall give a history of scurvy, in which can 
be seen the nature of the phenomena which this disease produces 
upon the mouth. 
S curvy. 
Scurvy has a greater tendency to make its appearance among 
persons who are collected together in great numbers, those who 
live on the banks of rivers and in marshy districts, when confined 
to narrow, humid and gloomy localities, when their nourishment 
is not good, and restricted in quantity, than it does in persons dif- 
ferently situated; thus it will be readily perceived why mariners 
are so frequently affected with this disease, particularly during 
long voyages. 
To the foregoing causes of this disease may be added a feeble 
constitution, protracted disease, excessive fatigue and depression 
of spirits. 
This disease generally commences with a feeling of wreighti- 
ness, general lassitude accompanied by a pale and swollen coun- 
* Theorie et pratique de Part du dentiste; par Laforque, p. 65. 50 
tenance. The patient soon experiences an itching and pricking 
sensation in his gums, which afterward become very sensitive, 
soft, spongy, of a livid red colour, and bleed upon the slightest 
touch; he is also troubled with pain in all his limbs, along the 
back, and often in his breast. 
After a lapse of time, the patient feels great lassitude in his 
legs, and pains in the knee-joints; the ankle-bone soon becomes 
swollen; and this swelling gradually extends along the limb; 
nodes then make their appearance, and sometimes the calf of the 
leg assumes considerable hardness. Sometimes, instead of swell- 
ing, the legs waste away and become extremely dry: the patient 
finally discovers his inability to walk, because his limbs bend 
under him and continue in that state. Very often, at this period, 
there will be hemorrhage of the nose, dysentery and discharge of 
blood from the gums. As the disease progresses, the gums aug- 
ment in size, they become soft, very fetid, ulcerated and finally 
gangrenous: then the teeth which are blackened become loose 
and drop out, and the patient is often troubled with an abundant 
salivation. In some cases we observe that the face very soon 
becomes oedematous, the serum poured out settles in the most 
depending part; the oedema frequently disappears and again ap- 
pears a short time after. Notwithstanding all these evils, there 
will be little or no fever; the appetite is good, and the intellectual 
faculties remain in all their integrity. When the disease has 
continued for a long time, the pulse becomes small and frequent, 
and the patient is troubled with great heat and thirst. We gene- 
rally observe that, so long as they remain quiet in bed, they ap- 
pear to enjoy a sufficient degree of strength; but if they become 
restless, if they rise, they become very weak, experience acute 
pains, and sometimes die very suddenly when moved too forcibly, 
and when exposed to a current of air. 
At the close of the disease, the skin upon the legs burst where- 
ever nodes have formed ; the ulcers resulting from them become 
malignant, and they are often covered by clots of blood; if these 
clots are removed, a hemorrhage difficult to arrest may ensue, or 
we will discover, on the succeeding day, the formation of new 
clots. These ulcers are very much disposed to become gan- 
grenous. 
Scurvy generally lasts several months, during which time the 
the patient is predisposed to contract prevalent diseases, especially 
malignant fevers, under which he unavoidably will sink. 
In dissecting persons who have died with this disease, we dis- 
cover serous and bloody infiltrations in all the tissues, and the 
soft parts undergo a peculiar alteration, which causes them to 
lose their ordinary adhesion, so that they can be readily torn. 
Sometimes we find traces of phlegmasia in some of the viscera, 
DISEASES OF THE MOUTH. 51 
and an alteration of the synovia in the articular capsules, and 
finally decay of several of the bones. 
The surest method of arresting the progress of this disease, is 
to remove the causes that may have produced it; the patient 
should be conveyed to a dry and well ventilated situation, he 
should have healthy aliment, vegetables, fresh meats, good wine, 
&c. these, together with good air and exercise, will enable the 
patients to recover the natural colour of their face, the gums will 
become more firm, they will lose their wan colour; generally a 
slight perspiration will supervene, after which all the symptoms 
of the disease will entirely disappear. 
When, however, persons of a feeble constitution are a long 
time affected with this disease, they generally become subject to 
rheumatism. When the disease has lasted for a very long time, 
there will be chronic diseases of the viscera, dropsy, &c., and the 
patient perishes in a kind of consumption. 
Scurvy is essentially owing, as we have before stated, to a 
long continued influence of dampness upon the body. The action 
of this cause may be afterward favoured by all such means as 
are capable of diminishing the vital energies. Thus, scurvy 
oftener attacks weak, indolent and lazy mariners, than those who 
are active, robust and laborious. It is uncommon for this disease 
to attack officers, who are well provided with the comforts of life. 
Since humidity is the principal cause of scurvy, it is not at all 
astonishing that this disease occurs more frequently upon sea 
than upon land. Under some circumstances it is known to occur 
upon sea very violently, while, under similar circumstances, and 
where there is a great deal of moisture, it may be seen to produce 
the same effects upon land; so that there is no essential difference 
between land and sea scurvy. 
Hence, scurvy has been known to assume an epidemic charac- 
ter in all places habitually covered with water and thick fogs, 
where the numerous and half civilized population were ignorant 
of the means of avoiding the causes of the disease. 
Scurvy was endemic for a long time in Holland, and when the 
surface of that country only presented meadows covered with 
water, and its numerous inhabitants, badly sheltered and nourished, 
lived in low, small and gloomy cottages. The disease disappeared 
as the inhabitants, by industrious habits, removed all these causes 
of the unhealthiness of the country. Thus the numerous canals 
of this country have given easy and free circulation to the stag- 
nant waters, the houses are more elevated, better ventilated, and 
kept remarkably clean. Commercial enterprise has enabled the 
inhabitants to be better nourished and sheltered. Scurvy has now 
entirely ceased to appear among the inhabitants of this country. 
The causes that we have mentioned as producing the disease 
DISEASES OF THE MOUTH. 52 
DISEASES OF THE MOUTH. 
under consideration is so manifest, that it has been known to 
appear several times, in the same country, during the time of 
war, when the inhabitants, for their security, were obliged to 
inundate their country, especially when, by a long siege they 
were deprived of the necessaries of life. 
What we have said of Holland, has been noticed in several 
countries of the north, as in some parts of Russia, Scotland and 
Ireland. 
This disease is also seen in large cities, particularly among the 
lower classes, and among those who inhabit confined, gloomy, 
damp and filthy streets, and who are badly nourished, and con- 
fined to hard labour. It is likewise known to occur among other 
classes of society. It attacks such as have been very much 
weakened by long sickness and grief. Many chronic diseases 
terminate in a kind of scorbutic affection. 
Scurvy is not contagious, as has been for a long time supposed; 
but it will be perceived that it may exhibit itself at the same time 
in a great number of individuals, under the influence of the causes 
capable of producing the disease: so that it is from its epidemic 
character that it has been supposed to be contagious. 
From what we have said, it is easy to discover the true charac- 
ter of the disease. When a dentist discovers the gums of his 
patient to be thick, fungous and of a livid red colour, the teeth to 
be loosened, the breath fetid, he can soon discover if these symp- 
toms appertain to a scorbutic or catarrhal affection. Thus, when 
the patient has a pale countenance, the skin of a dull white, a little 
cedematous and covered with blotches of a brownish red colour; 
if he experiences pain in his limbs, and a general weakness, if he 
has been exposed for a time to the influences of damp air, and if, 
with these, he has had long sufferings, no matter of what kind 
they may have been, the disease is evidently of a scorbutic 
nature. When, on the contrary, we do not witness these phe- 
nomena in so marked a manner, when the disease of the mouth 
is, in a measure, merely local, it evidences the disease to be of a 
catarrhal nature. 
Fungous excrescences that appear upon the gums in scorbutic 
affections, often grow to a very great size. Sometimes these 
excrescences are livid red, at other times they are of a sandy 
grey colour, and they vary in form. They may be either fungous, 
having a broad or narrow base, or they may be scales, having the 
appearance of being torn. They differ also in consistency; some- 
times they are firm, and require to be cut; but generally they are 
soft, and may then be generally destroyed by touching them with 
muriatic acid. In some hospitals where scorbutic patients are 
treated, this operation, which is called batonnage, is performed 
with a little piece of stick, furnished at one end with a piece of 
of linen dipped in acid, and with this the gums are rubbed. DISEASES OF THE MOUTH. 
53 
Angina. 
The membrane that lines the posterior mouth, the pharynx, the 
trachea and the larynx, becomes inflamed and presents diseases 
which vary in their nature and intensity, according to the part 
affected and the character of the disease. 
Angina has been termed, according to the part affected, angina 
tonsillaris, angina pharyngius, angina trachealis, angina laryngitis. 
When the patient experiences great difficulty in swallowing; 
when pain is felt, during mastication, in the ear along the Eusta- 
chian tube, with a kind of crepitation; if, on looking into the 
throat, the tonsils and palate are discovered to be very much 
inflamed; lastly, if there be an abundant secretion of mucus, the 
disease is seated principally in the tonsils. 
When the pharynx is affected with angina, deglutition will be- 
come laborious, and the person's food, taken into the mouth, 
will pass into the nose; respiration is generally easy. In this 
species of angina, the inflammation is also visible in the posterior 
part of the mouth. 
When deglutition is but slightly impaired and no redness is ob- 
servable in the throat, and the patient experiences great difficulty 
in breathing, suffocation, an acute pain in moving the pharynx, 
has a sharp, whistling voice, the angina, in such cases, is seated 
in the larynx, or superior part of the trachea. 
An affection of this kind generally attacks children under twelve 
years of age, and proves fatal in a very short time. This disease 
has been very accurately described by Michaelis.* 
Sometimes the symptoms of the disease are moderate and in 
some measure purely phlegmatic; at other times it is accompanied 
with such violent inflammation that the parts affected become 
gangrenous. 
Angina is not always a local affection; it frequently accompa- 
nies other diseases. It is sometimes accompanied with derange- 
ment in the digestive apparatus. The most serious disease of this 
kind is attended with fever of a malignant character; the disease 
in such cases is generally epidemic, and produces great ravages. 
When the tonsils have been affected with angina, they very 
often remain ulcerated, hard or scirrhous, and require removal. 
The extirpation of the tonsils may be effected with the hook and 
bistoury ; these are the most certain means; sometimes the opera- 
tion is performed with the kiotome : if the patient should, through 
fear, be unwilling to undergo this operation, the tonsils can be 
removed by means of a metallic or silken ligature well waxed. 
The most convenient manner of applying the ligature around the 
* Michaelis, de angina polyposa, sive membranacea. 54 
DISEASES OF THE MOUTH. 
tonsils, is to use the ligature-carrier, invented by M. Desault. 
When the ligature has been applied, it should be tightened every 
day, until it has cut entirely through the tonsils. 
In cases of inflammatory sore throat, the uvula becomes so elon- 
gated and tumefied as to assume sometimes a considerable size: 
strong acidulated gargles are, in such cases, very proper. But 
sometimes the uvula preserves its increased size, and becomes 
scirrhous; excision then becomes indispensable. This operation 
is performed in the same manner as that for the removal of the 
tonsils. 
SECTION II. 
Diseases that have their seat in the substance of the various parts 
of the Mouth. 
The mouth is often observed to be affected with phlegmasia 
which has its seat principally in the cellular tissue. This inflam- 
mation appears to have a tendency to affect parts in the imme- 
diate neighbourhood of decayed teeth. It sometimes is limited to 
a portion of the gums, but generally it involves the whole side of 
the jaw. 
The patient, at first, feels a constrained and painful tension in 
the affected part, which gradually swells and becomes red; great 
heat soon manifests itself, and the part becomes extremely pain- 
ful, which is increased by the motions of the jaw. 
When the phlegmasia is very extensive, or when it developes 
itself with great violence, it soon occasions general derangement. 
Headache, sleeplessness, acceleration of the pulse and other 
symptoms characteristic of the febrile state, are the result. When 
the inflammatory symptoms have lasted for some days, the 
phlegmonous symptoms may gradually decline and the parts return 
to their natural state. The remedies that tend to favour this ter- 
mination, are emollient topical applications upon the affected part, 
and an antiphlogistic regimen. But if the inflammatory symptoms 
continue to increase, we soon discover, upon the part affected,an 
augmentation of size and sensibility, accompanied by lancinating 
pains. A collection of pus will next be formed, which may be 
detected by feeling the most prominent part of the tumour; this 
part becoming thin finally bursts to give vent to the matter. 
The spontaneous opening of abscesses is generally effected in 
the interior of the mouth, which occurs between the fourth and 
seventh day, and sometimes at a much later period. 
Such is the general course of phlegmons; but their progress 
may be caused, by a thousand different circumstances, to vary. 
Sometimes the disease consists of a pustule upon the gums in DISEASES OF THE MOUTH. 
55 
the neighbourhood of a decayed tooth, and developes itself in 
twenty-four h urs; at other times, it consists of a large deposi- 
tion which disfigures the whole side of the cheek, and suppurates 
about the expiration of a fortnight. This deposition may occur 
upon any part of the mouth and throat, as upon the palate, and 
as far as the inferior parts surrounding the amygdalae, upon the 
posterior part of the pharynx, &c. 
When phlegmons have acquired a certain size, they impede 
respiration and deglutition so that it is always proper to open 
them prematurely. Those that are situated upon the inferior 
part of the posterior mouth are often very difficult to open. To 
effect this, a large bistoury with the blade enveloped, as far as the 
point, with a piece of linen should be used. In this manner the 
neighboring parts are secured from injury. After the abscess has 
been opened the head of the patient should be inclined forward, 
to prevent the matter from getting into the throat. The opening 
should be large, otherwise it will close, or the contents of the 
abscess will not be perfectly evacuated and hence the cure will 
be greatly retarded. 
If the abscess be very deep, if it be situated upon the lateral 
parts or near the base of the larynx, it will be expedient to open 
it with the pharyngatom. 
When phlegmons of the mouth have suppurated they generally 
cicatrize in a few days; but it sometimes happens, in persons of a 
feeble constitution, that they produce indurations or ulcerations of 
a more or less serious character. These indurations or ulcera- 
tions being surrounded by the moisture and heat of the mouth, do 
not fail to produce excrescences of various kinds and often very 
difficult to cure. 
Epules. 
Among the excrescences of the mouth the result of ulcerations 
or other causes, there are none more remarkable than those that 
affect the gums and which are called epules, or epulides. Those 
tumours of the gums designated by the same appellation, differ, 
however, very much in character. 
Some are soft, whitish, indolent and of a polypus nature, they 
vary in size, their base is of different dimensions and in all cases 
may be removed without injury. They are merely local affec- 
tions and produce no constitutional impairment. 
At other times these tumours are, at first, hard, red, indolent, 
and of a scirrhous nature. We may then apprehend a change 
in the nature of disease; in fact they may inflame, become very 
painful and ulcerate. A cancerous termination of this kind is 
more to be looked for when the patient is naturally of a bad con- 
stitution. The disease is often provoked by the use of various 56 
DISEASES OF THE MOUTH. 
caustics upon the part when in a scirrhous condition. If these 
tumours be neglected they will continue to grow, occasion acute 
suffering and may produce caries of the maxillary bones, the loss 
of the teeth, &c. 
These excrescences should, when in a scirrhous state, be extir- 
pated in the same manner as those which are of a polypus nature. 
This is effected by seizing the tumour with a pair of forceps and 
excising it as low down upon its pedicle as possible with a bistoury. 
The hemorrhage that follows this operation is suppressed by pres- 
sure judiciously applied. The operation generally succeeds and the 
tumour will not return. Should any fungi make their appearance 
after the operation, they should be destroyed with caustic and in 
this manner a complete cure will be effected.* But the like suc- 
cess will not attend such tumours as are painful and have taken 
on a cancerous nature and are of long standing. Our hopes to 
affect a cure will in such cases be very limited. We should not 
however, hesitate to remove them as soon as possible, with a 
cutting instrument, and endeavour by the resources of medicine 
to subdue this serious disease. We should be particular to destroy 
with mild escharotics the first little tumours that may appear. It 
is only by such remedies and long continued care that we can 
hope to obtain a complete cure of the affection which is more 
difficult to remedy in proportion to the age of the subject and the 
feebleness of his constitution. 
Ozena of the Maxillary Sinusf 
There is also another species of morbid growth that appertains 
to the diseases of the mouth, it has its seat in the maxillary sinuses, 
and is called ozena from the fetid odor it emits. 
This disease, from its serious nature, from the obscurity of its 
symptoms in the early stage of the affection, and from the opera- 
tion it demands, requires to be treated of in detail. 
The disease may be produced by a blow upon the malar 
apophysis. Sometimes it occurs after acute disease, at other 
times it appears without any appreciable cause.J It manifests 
itself by an acute and deep-seated pain in the substance of 
the maxillary bone, and sometimes along the alveolar border. 
In the latter case the disease has been attributed to a decayed 
molar tooth, which an unscientific dentist will extract, without 
affording any relief. The intensity of the pain, which continues 
to increase for some days, soon occasions a febrile condition, but 
* The application of the actual cautery is generally more effectual than 
caustics.-Eds. 
jThis affection is usually designated by the name of muco-purulent secre- 
tion.-Eds. 
| The most frequent cause is dental and alveolar irritation.-Eds. DISEASES OF THE MOUTH. 
57 
in a short time the pain and fever gradually subside. If the 
phlegmasia terminates in resolution, a cure will have been effected, 
but if it suppurates, the sinus will be filled with pus. 
The matter contained in the sinus generally discharges itself 
into the nasal fossse, through the natural opening, or by the de- 
struction of the osseous and membranous walls which separate 
these two cavities. The matter having got into the nasal fossae, 
may make its way out of the anterioi' nares, or pass down the 
throat according to the position of the patient. 
The matter is generally very fetid, which probably arises from 
its constant contact with the air that passes through the nares, 
and its retention in a warm and humid cavity; circumstances 
very favourable for the prompt decomposition of this humour. 
This acrid and corrosive pus has been frequently known to 
decay different parts of the walls of the sinus, and in this manner 
to effect an opening through which it discharges itself. Some- 
times the superior walls are destroyed by the pus, which pene- 
trates the cavity of the orbit, becomes infiltrated into the cellular 
tissue which lines the orbital cavity, and forms a tumour and a 
fistule between the inferior eyelid and the cheek. At other times 
the pus affects the anterior part of the sinus, and forms a fistu- 
lous tumour upon the cheek. The tumour and fistule, in some 
cases, are seated upon the gums, and the discharge of pus is often 
observed to be between the gums and teeth. 
These fistulous ulcers are nearly always surrounded by callous 
flesh; if a probe be introduced into them, it will be discovered 
that the fistulous canal runs in the direction of the maxillary 
sinus, and even communicates with this cavity. 
M. Jourdain has, in cases of this affection, advised the use of 
detersives, to be injected through the natural opening of the sinus ; 
but, in addition to the difficulty of injecting the sinus through this 
opening, we cannot thoroughly empty the contents of the cavity 
in this way, and the small quantity of pus that remains keeps up 
a constant irritation. 
The most simple and certain way of effecting a cure, is to 
make an opening into the sinus through the alveolus, or the infe- 
rior part of the canine fossa. 
When the disease is accompanied with caries of the molareson 
the affected side, if these teeth should be loosened, or if the pus 
be discharged between them and the gums, we should extract 
them, and with a trepan make an opening into the sinus, and cut 
away the alveoli, so that the opening may be sufficiently large 
as not to become obstructed in consequence of the swelling that 
occurs some days after the operation. Should the teeth be sound 
and firmly situated in their sockets, the opening should be made 
through the base of the canine fossa. 
To perform this operation properly, the patient should be 58 
DISEASES OF THE MOUTH. 
seated. The operator, standing in front of his patient, draws 
the commissure of the lips backward, at the same time raising it 
from the gums. The internal membrane of the mouth, and the 
parts which unite the cheeks to the maxillary bones, are now to 
be separated. With a pointed trepan a hole is to be made through 
the walls of the sinus at the inferior part of the canine fossa; 
this hole must then be enlarged by means of another trepan with 
a blunt extremity, which will prevent injury to the opposite 
walls of the sinus. The parts are then dressed with pledgets of 
lint placed between the gums and cheek. 
When the evils attendant upon the inflammation have subsided, 
and when suppuration is well established, detersive injections and 
gargles should be used, recommending to the patient, at the same 
time, to introduce his finger frequently into the artificial opening, 
to prevent a premature closing up. The disease will, by this mode 
of treatment, be generally cured in six weeks. 
Some dentists, who have written upon the diseases of the 
mouth, have described, under the terms, engorgement and dropsy 
of the maxillary sinus, two diseases which are merely modifica- 
tions of ozena of this cavity.* We shall now speak of those 
circumstances which have caused these modifications to be re- 
garded as separate affections. 
We remarked that in ozena of the sinus, the pus emitted a 
very fetid odor, and that it became so corrosive as to cause the 
destruction of the walls of this cavity. 
The extreme fetor of the pus appears to be owing to the free 
entrance of air into the sinus in its passage through the nares; 
as this fetor is the consequence of the decomposition of the pus, 
which could not have taken place in so prompt a manner without 
the presence of oxygen contained in the atmospheric air. This 
decomposition is also influenced by the health of the patient and 
the nature of the ulceration which constitutes the disease. 
It may occur, that the pus which is formed in the sinus instead 
of being continually exposed to the contact of air, may be entirely 
excluded, either by a cyst, or by the complete obstruction of the 
natural opening. The pus in such cases does not undergo any 
remarkable decomposition ; but as it is retained, it fills the whole 
interior of the sinus and from this last circumstance it has been 
called engorgement of the sinus. It may be readily seen that this 
difference is but of little importance. It only renders the disease 
in its early stage more obscure; but it nevertheless, produces 
decay of the bones and all the other evils of which we have 
spoken as attendant upon ozena, so that the curative means are 
in both cases the same. 
* See Jourdain- DISEASES OF THE MOUTH. 
59 
When the purulent matter which fills the sinus, instead of com- 
mencing to produce denudation and decay of the walls of the 
sinus, in order to make an outlet for itself, distends this cavity, as 
we have stated, sometimes happens. The term dropsy has been 
given to this disease. The matter may vary in consistency; but 
it is always of a purulent nature. The walls of the sinus not 
being lined with a serous membrane, cannot occasion lymphatic 
effusion necessary to produce dropsy. 
The history of ozena of the maxillary sinus is closely allied to 
that of polypus of this cavity, which we now propose to examine 
in detail. 
Polypi or fungi of the Maxillary Sinus. 
This disease is sometimes the result of blows upon the cheek, 
but generally its cause is unknown. In its early stage a dull pain 
is felt in the sinus, and very frequently a tumour at this time 
makes its appearance upon the gums. The disease has been 
attributed to decayed teeth situated beneath the sinus, and they 
have been by unscientific dentists, extracted without affording 
any relief. 
When polypus of the sinus has attained a large size, it distends 
the walls of this cavity in every direction. The cheek becomes 
elevated, the nostril of the affected side closed, the palatine arch 
sometimes depressed, the mouth distorted, the teeth on the affected 
side loosened and may, by the slightest force, be removed. As 
the disease progresses, the polypus sometimes becomes visible in 
the nasal fossae, or in the sockets of such teeth as have been ex- 
tracted: the malar apophysis becomes considerably elevated, and 
the maxillary bone disarticulated. The fungus elevates the floor 
of the orbit and forces the eye out of its socket; it cornpresses 
the nasal canal, and produces fistula lacrymalis. When the bones 
become carious, pustules and abscesses, discharging ichorous 
matter, are formed in the mouth and upon the cheeks. This dis- 
ease, as can be readily imagined, is of a very serious character, 
and our hopes to effect a cure is very slight indeed. If, however, 
the patient be not nervous, and if he has a good constitution, and 
should the disease not have made great progress, it may be cured 
when under the care of a skilful surgeon. There are several 
cases on record to corroborate my assertion. 
To obtain a perfect cure of this disease, it is necessary to make 
a large opening into the sinus at its most depending part, and 
through it to destroy the fungus with the actual cautery. 
The operation is performed by detaching the cheeks from the 
maxillary bone, this is done by cutting the lining membrane of 
the mouth; then, after having denuded the bone of the soft parts 
which cover it, the inferior part of the sinus is removed with an 60 
DISEASES OF THE MOUTH. 
instrument of the shape of a pruning knife; the parts which offer 
great resistance are cut away with a chisel and mallet. It is 
useless to extract the teeth previous to the operation, for they will 
be brought away with the portion of the sinus that is excised, 
'rhe opening thus made will be as large as the base of the sinus. 
The operation is often followed by profuse hemorrhage; but the 
cautery, which is used to destroy the fungi, will generally suffice 
to arrest it. 
The cauterizing iron should be heated to a white heat, and 
having placed the patient in a proper position and protected the 
neighbouring parts from injury, it should be applied to the fungi 
and not allowed to remain longer than a second, so as not to 
produce much pain, and for fear of lighting up great inflammatory 
action in the surrounding parts. 
It will be found necessary to repeat the application of the 
cautery every five days until the fungus be entirely destroyed, as 
it possesses a tendency to be reproduced whenever any portions 
of it are permitted to remain. A gargle of barley water and 
honey should be used after every application of the cautery. 
When the polypus is entirely destroyed, fleshy and red granu- 
lations will form at the bottom of sinus; the walls of this cavity 
will approximate, and the parts will cicatrize, leaving no other 
deformity than that which arises from the loss of the teeth. 
If the polypus be small, it will only be necessary to open the 
sinus with a perforating trepan, as recommended in cases of 
ozena of this cavity. It should be borne in mind that success 
greatly depends upon the size of the artificial opening. 
Wounds, Ulcers, Tumours and other Diseases of the structure of 
the different parts of the Mouth. 
THE LIPS. 
Imperforation of the Mouth.-Sometimes children are born with 
their mouths imperforated. It will readily be perceived that this 
freak of nature will in a few days produce death, if it be not 
remedied. 
To remedy this evil an incision should be made in the place 
where the opening of the mouth should have been. As the lips, 
in cases of this kind, generally adhere to the gums, these should 
be separated with a suitable cutting instrument. 
In order to prevent the reunion of the parts, it will be found 
necessary to place a compress between the lips and the gums, 
also one between the lips, and a bandage applied to sustain 
them in position. As the infant will be unable, for a time, to re- 
ceive the breast, it should be artificially nourished. DISEASES OF THE MOUTH. 
61 
Contraction of the Mouth. 
The cicatrization of the eruptions of small-pox, or of an ulcer, 
may produce contraction of the mouth by glueing together a part 
of the borders of the lips, particularly near their commissure. 
This may be prevented by placing a compress between the lips; 
but when this union has taken place, the operation, as recommended 
in case of imperforation of the mouth, becomes necessary. 
Hare-lip. 
Hare-lip consists of a division of the lip. It may be congenital 
or accidental. 
Congenital hare-lip generally occurs in the superior lip; the 
division may be in the middle or lateral parts of the lip. 
When the division of the lip is accidental and has recently oc- 
curred a reunion may be attempted, especially if it has been 
produced by a sharp instrument, or even by a blunt one, if it has 
not occasioned very great inflammation. Should the inflamma- 
tion be very great, it will be proper to use such means as will 
tend to subdue it, and to favour the suppurative process, and 
when granulations have formed, we can then unite the divided 
parts. 
If we neglect to unite the edges of an accidental division of 
the lip, the result will be a hare-lip resembling a congenital mal- 
formation. 
Congenital hare-lip may be single or double; when double it 
presents two slits separated by a fleshy partition: in order that 
this partition may be preserved in the operation, it must be at 
least four or five lines in width near its base, for we are obliged 
to remove at least a line from each side Bf it. 
The fleshy partition is sometimes too short, we must, in such 
cases, ascertain if we can make it reach the level of the lip, either 
by putting it upon the stretch, or by detaching it from the freenum 
of the lip or jaw; but should it be too short or too narrow, it 
should be removed, making the incision in the shape of a triangle 
with the apex upward and the base downward. 
Hare-lip is sometimes attended with the prominence of a tooth, 
or a portion of the alveolus. As this would interfere with the 
reunion of the lip, or would at least leave a deformity after the 
operation, it would be advisable first to extract the tooth, or to 
remove the prominent portion of the alveolar border. 
It may also be accompanied by a fissure extending along the 
palatine arch as far as the soft palate. When the hare-lip is 
double, there will sometimes be two fissures in the palatine arch. 
In cases of this kind, the success of an operation is very much 
diminished, because there is not sufficient hold to sustain the bor- 62 
DISEASES OF THE MOUTH. 
ders of the divided parts. We can, however, with great care, 
effect a union of the lip, and we may even hope that the fissure 
upon the palatine roof will become completely closed up, espe- 
cially if the child is but a few years old. 
The affection under consideration is finally attended with loss 
of substance from the palatine arch; this disposition is more serious 
than the preceding. When this loss of substance is not very 
great, it will still be possible to unite the borders of the opening 
after the operation; but, in such cases, the superior dental arch, by 
contracting, no longer preserves its natural relation with the infe- 
rior, and the inferior teeth becoming more prominent, close in 
front of the superior. 
Persons having hare-lip are subjected to too great inconvenien- 
ces not to desire to have the deformity removed ; yet we see many 
persons neglect to have their lip operated on. The deformity 
creates an unpleasant appearance; it occasions, in children, a 
difficulty in sucking, and it opposes prehension and mastication 
of food, in adults, who, while speaking, are constantly spitting 
and forcing the saliva from their mouths. 
This deformity is remedied by uniting the edges of the fissure 
in the lip. The various means proposed to effect this, merely 
consist in excoriating or paring off the edges of the fissure. 
Some practiciens recommend the edges of the fissure to be 
pared off with the bistoury, others with a pair of scissors. 
The latter method is, perhaps, preferable, because the incision 
is made more smooth, and can be effected more expeditiously. 
The objection that has been made to performing the operation with 
the scissors is, that they bruise the borders of the wound; this will 
not be the case if the ^cissors be properly constructed, which 
should be slightly curved, and have sharp cutting edges. 
The operation for hare-lip, in all cases, is performed in the 
following manner. The patient should be seated, an assistant, 
standing behind him, supports his head and approximates the 
commissures of the lips with his hands placed upon the cheeks. 
The surgeon, having raised the lips from the gums, and having 
separated them with the bistoury if they adhered, holds, with the 
thumb and index finger of his left hand, the portion of the left 
border which he is about to remove, and, with one cut of the 
scissors, he makes an incision beyond the angle of the hare-lip; 
he next holds, in like manner, the right portion of the lip and the 
external side of the place where he will make his incision, and 
with his scissors makes the second incision, forming an acute 
angle at the extremity of the first. The hemorrhage, which fol- 
lows this operation, is generally arrested by the approximation 
of the edges of the wound, which are kept together by adhesive 
plaster, or by the united suture, with a proper bandage. The 
first method of sustaining the edges of the fissure in contact with DISEASES OF THE MOUTH. 
63 
each other will not always suffice; the second, though, more 
painful, is more certain. When, however, either method is had 
recourse to, a proper bandage will be found very useful; the 
bandage suggested by AI. Louis is generally used. . Some prac- 
ticiens advise only the employment of a bandage; but it is to be 
feared that, in many cases, this would be insufficient.* 
Swelling of the Lips. 
There are persons who have naturally large lips; this occa- 
sions no other inconvenience than a difficulty of distinct pronun- 
ciation. Sometimes lips assume suddenly a very large size; this 
swelling, which is not generally painful, yields, in a short time, to 
the use of tonics. 
Affection of the Fraenum of the Tongue. 
The fraenum is sometimes too hard, or is inserted into the tip 
of the tongue; the tongue then, being restrained, cannot reach 
the palatine roof, and is constrained in some other of its move- 
ments. This slight defect of conformation prevents the child 
from receiving the breast and from swallowing; it impedes pro- 
nunciation and prevents the articulation of certain words, par- 
ticularly those which contain the letter t. 
The shortness of the fraenum does not, as many suppose, occa- 
sion stammering or lisping. This affection of the fraenum is much 
more uncommon than is generally supposed by nurses, and in 
ten cases which are said to require a division of the fraenum, 
there will scarcely be one which actually demands the operation. 
Division of the fraenum may be easily effected with a pair of 
blunt-pointed scissors. It is very common for this operation to 
be performed while the mouth of the child is opened when crying. 
Small encysted tumours, or carcinomatous and scirrhus ulcers, 
which impede mastication, deglutition and pronunciation, are 
sometimes formed in the substance of the fraenum. The only 
remedy for these is excision. 
To effect this an assistant holds open the mouth of the patient 
by means of a piece of wood introduced between the last molare 
teeth. The surgeon then seizes the tumour with a pair of forceps 
or a hook, he then carefully detaches it with a blunt-pointed 
bistoury. 
Affections of the Tongue. 
The tongue is not an organ so essentially necessary as to be 
indispensable to life. Children have been born without tongues, 
and persons have accidentally lost this organ, and have been, 
nevertheless, able to swallow with facility, and to pronounce 
words distinctly. 
* The twisted suture is the one now most commonly employed in the 
treatment of hare-lip.-Eds. 64 
DISEASES OF THE MOUTH. 
The tongue is not essential for speech, as many persons sup- 
pose. Sound produced by the escape of air expelled from the 
lungs through the narrow opening of the larynx, supplied with 
moveable cartilage of the epiglottis, is modified by the various 
parts of the mouth and nose to constitute words and harmonious 
sounds. Although the tongue assists, in a great measure, in mo- 
dulating and accenting sound, its presence, however, is not indis- 
pensable to the performance of these phenomena. 
The tongue may be amputated without producing any very 
serious evil. It is known that in Turkey this operation is per- 
formed usually as a corporal punishment, and, although ampu- 
tation is carelessly performed, the hemorrhage and inflammation 
which follow are not usually attended with serious consequences. 
It is seldom that this cruel punishment causes death. Persons 
who have undergone this punishment are frequently known to 
recover, at the expiration of a longer or shorter time, the use of 
speech sufficiently to be understood. 
The tongue may be cut in a spasmodic motion of the jaw's. 
A person during an epileptic paroxysm pressed his tongue be- 
tween his teeth so hard that he cut three-fourths of its length and 
nearly entirely through its thickness; he would have divided it 
completely had he possessed all his teeth. No means were used 
to unite the edges of the wounds, yet a reunion was effected in a 
short time, without leaving any deformity, by the position, and 
the repose that the patient was induced to take on account of his 
pain. If we have strong reasons to fear that a reunion will not 
be spontaneously produced, we should endeavour to facilitate it 
either by a suture, or by means of the bladder of Pidrac. This 
last mode is preferred because the suture is painful, and it may 
augment inflammatory symptoms, and may tear the parts. 
All simple wounds of the mouth will, in time, heal of them- 
selves, without any assistance of art. 
Swelling or the morbid elongation of the tongue is a very rare 
disease. It has been witnessed at birth, and in very young in- 
fants, but is rarely seen in advanced age.* 
Generally this disease at its commencement scarcely demands 
notice. The tongue, at that time, merely presents itself upon the 
borders of the lips; this does not interfere with the functions of 
the mouth. Should this bad habit be not corrected by forcing 
the tongue to remain within the cavity of the mouth, it will gra- 
dually acquire a larger size; it will afterward hang partly out of 
the mouth, and occasion a very repulsive appearance. The in- 
Intumescence of the Tongue. 
* See an excellent dissertation of Professor Lassus on this subject, pub- 
lished in the first vol. Des Memoires de I'Jnstitut National. DISEASES OE THE MOUTH. 
65 
fant, in this condition, is unable to receive the breast, and will 
perish if other means be not used to nourish it. Those children 
who are advanced in age when thus affected, are only able to 
chew and speak with great difficulty, and the saliva continually 
flows from their mouths. 
When the disease has so far advanced that the tongue fills the 
interior, and hangs out several finger-breadths from the mouth, 
its surface will be constantly rough, covered with a thick coat of 
mucus, and ulcerated in several places. The inferior lip will be 
depressed anteriorly, and sometimes much increased in size. 
If a child be the subject of this stage of the affection, the teeth 
being continually pressed against by the tongue, are pushed for- 
ward, and from their constant exposure to the air do not fail to 
become injured; so that if the disease of the tongue last for a 
few years, the teeth will nearly always decay. 
'We can readily imagine the inconveniences that must result 
from a considerable enlargement of the tongue. That organ, 
which descends as low as the base of the chin, causes a continual 
stream of saliva to flow upon the breast. The patient is almost 
entirely unable to masticate and to speak. 
The subject of so hideous a deformity can only live upon li- 
quids, which he with difficulty swallows. 
It has been proposed for this affection to amputate the tumefied 
part of the tongue,* this operation has been practised, but modern 
surgery prescribes means of cure much more rational. 
When the disease commences to show itself in a suckling in- 
fant, that is, when the tongue only shows itself between the lips, 
where it constantly remains, we should soon cease giving it the 
breast, and feed it with a spoon; because the motions in sucking 
favours the progress of the disease, as the end of the tongue is 
pressed against the nipple, while in drinking, the child is obliged 
to make a contrary motion with its tongue. A bandage should 
also be adopted. The use of a bandage to keep the mouth 
closed, and only removed when the subject is to receive his food, 
will suffice to remedy this evil, whether the person be a child or 
adult. 
If the tongue has assumed a certain size it may be reduced by 
the application of leeches and emollients; it should be then forced 
into the mouth and there retained by means of a bandage applied 
over the mouth. 
Should the disease have arrived at its worst stage, it still will 
be susceptible of being cured. Emollient lotions and leeches, 
blood-letting from the ranine vein and deep scarifications should 
be resorted to, to effect the disgorgement of the tongue; a mode- 
* Julii Caesaris Claudini emperica nationalis-Bononice, 1613, lib. iii. ch 
6, page 603. 66 
DISEASES OF THE MOUTH. 
rate and constant pressure should be exercised upon it either with 
the bladder of Pidrac, or in any other manner, until it is reduced, 
and afterward it is to be prevented from hanging out of the 
mouth as before recommended. 
The teeth which have been forced from their proper positions 
may be regulated by adopting the means that we shall hereafter 
describe. The inferior lip may also be made to assume its proper 
form by the constant use of the bandage employed in cases of 
hare-lip. 
Doubling over of the Tongue. 
We have frequently heard of doubling over of the tongue, 
which produces suffocation, spoken of; such tales are told by 
negroes who have been badly treated, or who wished to avoid a 
cruel chastisement by stating that they can put an end to them- 
selves voluntarily by swallowing their tongue; but all such ac- 
counts are, to say the least, very doubtful. 
Gun-shot Wounds in the Mouth. 
It sometimes occurs that a person, wishing to commit suicide, 
discharges the load of a pistol in his mouth; this very often does 
not produce death, but it can easily he imagined what mischief 
must result from the discharge of a pistol in this cavity. 
Sometimes the inflammation and swelling of the throat are so 
great, a few days aftei' the wound has been inflicted, that the pas- 
sage of air may be completely obstructed, and the patient dies 
from suffocation. In cases of this nature surgical operations, that 
at first appeared inconceivable, have been attended with happy 
results. 
In case of injury of the trachea and oesophagus from gun-shot 
wounds, M. Desault, surgeon at the Hotel Dieu in Paris, has passed 
through the nostrils two large gum elastic tubes, one for the pas- 
sage of food into the stomach, and the other passes into the 
windpipe. The patient breathes through one and receives his 
nourishment through the other by injecting into the stomach with 
a syringe, soup, cream of rice, and all other nourishing food, in 
a sufficiently liquid state. The wound, by this method, being no 
longer irritated by the continual passage of air and of aliment, 
may be very easily cured. 
Compound Wounds. 
Wounds of the mouth which do not heal, are such as are ac- 
companied with causes that keep up a constant irritation. These 
causes are principally the opening of the salivary conduit, decay, 
constitutional affection, &c. 
When the duct of steno is involved in a wound of the mouth, 67 
the saliva which continually flows through it prevents the parts 
from cicatrizing; there will then remain fistulous ulcers, which 
can only be cured by first preventing the saliva from flowing 
through the wound. To accomplish this several compresses are 
to be applied over the parotid gland, and sustained by bandages, 
some passing underneath the chin, and others around the head. 
The gland, by this means, gradually sinks down; it ceases to 
secrete saliva, and the wound being no longer moistened with this 
fluid, heals. It often happens, however, that the ulcer which has 
existed for a long time presents thick and hard edges; these 
should be destroyed by touching them with some caustic applica- 
tion in order to effect a speedy cure. 
After a cure has been obtained there will remain a slight de- 
pression upon the part corresponding to the salivary gland. Mas- 
tication can be properly performed; digestion will not be found 
deranged, and the remaining salivary glands will easily supply 
the functions of the one the action of which has been suspended. 
All wounds, complicated with caries of the bone, cannot be 
cured until after the complete separation of the dead or diseased 
portion of bone. 
In syphilis, when accompanied by all the symptoms attendant 
upon disease, if it be not arrested in its course by proper treat- 
ment, it is not an uncommon circumstance to witness consecu- 
tive chancres in the mouth, even accompanied with decay of 
the palatine arch and the bones of the nose; these generally yield 
to a mercurial treatment, judiciously administered. It is some- 
times seen that the curative means dispel the signs of the disease 
from the genital organs, and the other symptoms of the affection, 
as the osteocope pains, &c., but the pain in the mouth will remain 
unshaken, and will even continue to progress. Under such cir- 
cumstances it often occurs that the patient is put under another 
course of mercurial treatment, and even increased by administer- 
ing large doses for the want of a knowledge of the causes that 
keep up these chancres in the mouth, when even the syphilitic 
affection itself has been cured. These symptoms of the disease 
may remain after the use of the most methodical treatment, either 
in consequence of the bad condition of the ulcer, or from caries 
of a portion of the subjacent bone, which is very long in healing. 
Finally, they may still continue to manifest themselves, and this is 
most commonly the cause, from the natural weakness of the con- 
stitution, which has been greatly increased by the disease and the 
treatment, and there being no longer sufficient vital energy to 
allow the economy to make the necessary effort to effect cicatriza- 
tion of an old ulcer. In cases of this kind the use of tonics, ex- 
ercise, a visit to the country, and all means which tend to improve 
the general state of the constitution, are the only remedies that 
should be resorted to. 
DISEASES OF THE MOUTH. 68 
DISEASES OF THE MOUTH. 
SECTION III. 
Diseases of the Salivary Glands and Conduits, and affections 
peculiar to the Lymphatic Glands. 
Children frequently have under and upon the sides of their 
tongues, little tumours of the form of a crest, these are nothing 
more than prominent sub-lingual glands. It is necessary to be 
acquainted with this fact in order not to interfere with these little 
glandular bodies. 
Salivary like other glands become inflamed from various 
causes. Inflammation of these glands may end in any of the 
modes of termination of inflammation that other parts do. When 
violent inflammatory action is set up in a salivary gland, when it 
suppurates, the phlegmon always has its seat in the cellular tissue, 
that surrounds the gland and unites its lobules; genuine pus is 
furnished from this tissue alone and not from the substance of the 
gland proper. 
Glandular inflammation terminates by resolution, induration, 
and even gangrene. Induration of these glands may insensibly 
diminish and finally disappear; but if it continues for a very long 
time, the gland will become scirrhous. This scirrhus may as in 
other parts of the body, remain stationary or it may take on a 
new action and become cancerous. 
Sometimes the salivary glands, in consequence of long con- 
tinued disease, become atrophied and disappear. 
In inflammation of the salivary glands, their secretion of saliva 
is always more or less suspended ; but sometimes the action of 
these organs is so much excited, that the saliva is continually 
flowing from the mouth. It is in such cases altered and it is not 
by chemical analysis, that we should endeavour to discover the 
nature of its composition. 
The secretion of saliva is increased by masticating various 
acrimonious plants, but there is no substance that increases flow 
of this fluid more energetically than mercury in the treatment 
of syphilis when given in very large doses, or when administered 
to very irritable persons. 
Various means, acting in different ways, have been extolled for 
arresting salivation; among them are camphor, opium, and the 
various preparations of sulphur; these have no more efficacy than 
mild purgatives and cooling gargles. Salivation sometimes con- 
tinues so long and is so violent that every part of the mouth 
becomes affected; the swollen and softened gums retain in a 
slight manner, the teeth that are implanted in their sockets, and 
which sometimes drop out; the walls of the mouth and the sur- 
face of the tongue are covered with ulcerations. When saliva- 69 
tion is suspended and the inflammation of the mouth ceases, the 
use of detergent gargles, and especially those which are acidula- 
ted, become very useful; they favor the cicatrization of the 
ulcers, strengthen the gums, and the teeth soon become firmly 
fixed in the alveoli. The reiterated use of mercury, however, 
when carried to the extent of salivation, always effects the teeth, 
which loose their whiteness and their firm attachment in their 
alveoli, and are not so capable of being preserved.* 
There are other diseases of the salivary organs, which apper- 
tain more especially to the excretory conduits through which the 
saliva is poured into the different parts of the mouth. When 
these conduits are involved in a wound of the cheek, the saliva 
that continually flows through them, prevents the wound from 
closing, causing it to become fistulous. It is not uncommon for 
dentists to be consulted in such cases, as the subject thinks that 
a wound of this kind is prevented by decayed teeth from healing, 
and it is important that the dentist should know' the causes of the 
disease. 
These fistules are generally occasioned by the duct of Steno. 
The wound contains fungi and callosities, in the middle of which 
is a narrow opening, often imperceptible, and through which 
saliva continually flows; but in greater abundance during mas- 
ticating and speaking. If the internal orifice of the fistule is 
higher up than the external the saliva runs freely; in contrary 
cases, this liquid accumulates and forms a tumour the contents of 
which may be emptied by proper pressure. The internal orifice 
of the fistule is very near the duct of Steno, or some of its 
branches, or communicates directly with the parotid gland. 
Salivary fistules are cured with caustics and escharotics, which 
destroy the callus and impart tone to the edges of the ulcer. These 
remedies should be assisted by a compress, and it is necessary, 
during the whole course of treatment, for the patient to abstain 
from chewing and speaking. 
Sometimes the saliva produces concretions, which have been 
known to be sufficiently large to form genuine salivary calculi. 
The formation of these calculi is often occasioned by the presence 
of little foreign bodies, introduced in the excretory canals, and 
around which molecules of calcareous substance are continually 
collecting. The presence of these calculi prevents the excretion 
of saliva and occasions foreign depositions. 
DISEASES OF THE MOUTH. 
Among the different diseases of the salivary conduits, there are 
none more remarkable than that which has been called ranula. 
Ranula. 
* The destruction of the alveoli, and loss of the teeth, frequently results 
from the protracted and excessive use of mercurial medicines.-Eds. 70 
DISEASES OF THE MOUTH. 
This disease consists of a tumour beneath the tongue, formed 
by a dilation of the excretory duct of the maxillary gland, (the 
duct of Wharton.) It seldom has its seat in the duct of Steno. 
When the tumour first makes its appearance, it is situated upon 
one of the sides of the fraenum of the tongue, the part is then 
found drier than usual; and as the tumour increases in size, it 
forces the tongue upward and backward and occasions a promi- 
nence below the chin; in this state, it occupies the whole of the 
base of the mouth, and it becomes difficult to ascertain to which 
side the diseased duct belongs. Mastication and pronunciation 
are impeded in consequence of the size of the tumour, which 
always contains purulent saliva and sometimes calculi; sometimes 
a crevice is formed in the encysted deposite, and the matter which 
is discharged from it is extremely fetid. 
As this deposition is encysted, to obtain a perfect cure, we must 
necessarily remove a part of the cyst, to give exit to the matter 
contained. 
The means for obtaining this result are setons, caustics, actual 
cautery, injections, incision and excision. The last is preferable 
to the others, which are subject to inconveniences more or less 
serious, and are not so certain in their effects. 
The operation consists in making a crucial incision into the 
tumour and removing the greatest part of its walls; to effect this, 
the cyst is held with a hook, and with a bistoury, as much of it 
as possible is dissected out. If there be much hemorrhage it 
should be arrested with agaric and with a proper compress. 
The suppuration that occurs some days after will destroy the re- 
mainder of the cyst. 
Sometimes very large tumours remain for several years, and 
entirely prevent the possibility of speaking; in this case, the first 
benefit derived from an operation is the restoration of speech, as 
that of the extraction of a cataract is the restoration of sight. 
Affections of the Lymphatic Glands which encompass the Jaws. 
The glands in the neighbourhood of the jaws, as the maxillary, 
parotid and other glands, are more subject to inflammation than 
are the salivary glands. Inflammation in them terminates in the 
same manner as that of the salivary glands. 
Among the numerous causes that may produce swelling of these 
alands, the most common one is dentition. This process produces 
upon the side of the heads of children a very remarkable action, 
from which arises a series of diseases of a more or less serious 
character, according to circumstances, and which have received 
the vague term of strangles: sometimes there will be occasioned 
peculiar cutaneous affections; at other times ophthalmia or deaf- 
ness, and often an engorgement of the lymphatic glands in the 
neighbourhood of the jaws. All these merely indicate great DISEASES OF THE MOUTH. 
71 
feebleness, or a great nervous susceptibility. The great degree 
of action in the jaws, which is necessary for the development of 
the teeth, is communicated to the neighbouring parts, and dis- 
turbs their customary functions. It is in this way, probably, that 
in the greater number of cases, engorgement which occurs in 
those glands just mentioned, is occasioned by the process of teeth- 
ing, and not dependent upon a peculiar humour as is generally 
supposed. It often happens, however, that swelling of the glands 
near the jaws, in children, is of a scrofulous affection, this is easily 
detected from the constitutional appearance. 
Those who are of a scrofulous diathesis have fine white skin, 
a ruddy complexion, are fleshy, their teeth are often dark and 
decayed, their lips large, also the wings of the nose and the eye- 
lids; their jaws are thick, large near their angles, and are subject 
to cutaneous affections of various kinds. Children of a scrofulous 
constitution are generally more or less fair or chestnut colour, 
with blue eyes; their cranium is of a large size, and they are 
generally remarkably intelligent. This disease usually developes 
itself at the period of second dentition, at puberty, or after some 
sickness. When we observe merely these symptoms of scrofulous 
affection, and it has not developed itself energetically, it may be 
prevented by the use of tonics, change of air, baths, exercise, a 
vegetable diet, &c. 
If these means are neglected, and even sometimes when they 
have been used, the disease will develope itself and progress with 
more or less rapidity, as circumstances may favour it. It first 
manifests itself by a swelling of the glands of the neck, especially 
those situated near the angles of the jaw. This swelling, at its 
commencement, is not attended with pain nor change of colour of 
the skin that covers it, and it often remains for a long time in this 
state. As the disease progresses, however, sensibility and pain 
in the glands are developed; the skin assumes a violet hue, it 
becomes thin, and a prominent point is formed, which suppurates. 
The granulous abscess generally opens in several places, which 
communicate with different little openings of the glands; a viscous 
serum, mixed with some purulent flakes, is discharged through 
these little orifices. The orifices remain a long time fistulous, 
and become covered with fleshy excrescences; sometimes they 
unite and form an unhealthy ulcer, the borders of which harden, 
turn over, and have the appearance of being torn. 
As suppuration goes on, the glands diminish in size and appear 
to be insensibly destroyed; when they entirely disappear, the 
wounds cicatrize, leaving wrinkles and an unseeming ridge 
which never becomes effaced. 
The disease may affect several glands at the same time or 
successively. Wounds that have cicatrized will again re-open. 
Scrofulous affection attacks successively the glands of the neck, 72 
DISEASES OF THE MOUTH. 
those situated below the clavicle, in the axilla, &c. It frequently 
shows itself near the different articulations, and especially at the 
elbow, knee, phalanges and toes; tumours that make their appear- 
ance in these various parts often occasion decay of the bone. 
This disease may be cured by a proper treatment, or it may 
spontaneously disappear by some peculiar change in the system, 
by acute disease, or at the period of puberty, &c.; but if it con- 
tinues progressing, the pulmonary glands and those of the abdo- 
men will become affected, and occasion consecutive evils which 
would render the disease altogether incurable. 
Of Scirrhus and Cancer in the Mouth. 
Inflammation of the salivary and lymphatic glands, and even 
the white fibrous parts that enter into the formation of the mouth, 
may terminate in induration. This condition sometimes gradu- 
ally disappears; but it often happens that the part insensibly in- 
creases, it becomes circumscribed, assumes a greater degree of 
firmness, not always accompanied by pain, and is then termed 
scirrhus. Scirrhous tumours may remain stationary for several 
years, without giving rise to any other inconvenience than that 
which is occasioned by the presence of a hard body; but it fre- 
quently happens after a contusion upon these tumours or from 
the use of irritating applications, caustics, &c., and sometimes 
without any appreciable cause, that they inflame and assume a 
cancerous form. In this case, the tumours at first produce a 
tickling sensation, which gradually changes into pain more or less 
acute. The tumour is then observed to be sensitive to the touch, 
augmented in size and becomes irregular or tuberculous. The 
subjacent skin takes on a red hue, which becomes gradually 
brown, and the circumference of the tumour presents varicose 
veins. 
As the disease progresses, the skin is elevated and becomes 
thin at some parts; it then bursts, and a serous and inodorous 
humour is transuded. Soon after an escar is detached that exposes 
a very malignant ulcer; the pus that is discharged from it is 
reddish, extremely fetid, and so irritating that it excoriates the 
neighbouring parts, which it touches. In time the edges of this 
ulcer are folded down, become hard, irregular, very painful, and 
often occasion alarming hemorrhage. This cancerous ulcer 
constantly enlarges by destroying the surrounding parts; the pain 
it produces becomes so acute, so insupportable that all the func- 
tions are deranged by it. Sleep and appetite are lost, fever su- 
pervenes, and the patient perishes slowly in a most painful manner. 
The glands of the breast and of the testicles are the parts most 
generally subjected to cancerous affection ; other parts, however, 
as the lips and different parts of the walls of the mouth are 
often affected with this disease. DISEASES OF THE MOUTH. 
73 
Cancerous Tumours of the Lip. 
Cancerous tumours sometimes make their appearance upon 
the inferior lip. It is at first difficult to distinguish the nature of 
these little tumours, they are seldom seated upon the superior 
lip. The disease generally consists of a little pustule covered 
by a crust, and remains for a long time in this state. The 
crust drops off and is renewed for a number of times, so that 
a continued irritation is kept up in the part. A little hard body 
about this period is observed to form in the substance of the lip. 
This tubercle at first is moveable, indolent, a little troublesome; 
but when it has increased in size it becomes painful and ulcerated. 
The ulcer discharges a reddish, ichorous and very acrid matter; 
its edges gradually become hard, callous, irregular and very pain- 
ful. The application of various ointments appears to produce no 
good effect, and those which contain stimulating substances cause 
great pain, and brings on a worse condition of the ulcer. Should 
the disease be left to itself it may destroy gradually a great por- 
tion of the lip, and continue to produce fearful ravages. 
When the disease is well characterized, the only means of 
arresting its progress is excision. It should be performed with a 
bistoury and in such a manner, so as to remove the whole of the 
diseased part. When the tumour extends very deep into the lip, 
there may remain a large and deep cavity after the operation; 
to unite the borders of this cavity the same means that are used 
to unite the fissure of hare-lip must be resorted to. 
If the cancerous tumour has been completely removed, if there 
be no other part affected with the disease, lastly if the patient be 
not of a cancerous predisposition it will be completely cured ; but 
if a cancerous diathesis be strongly developed in the patient, or if 
the cancerous button has not been entirely removed, the cicatri- 
zation will not go on, or will soon re-open, and the disease make 
new progress which will become nearly impossible to arrest. 
Cancer of the Cheek. 
In some rare instances a cancerous tumour makes its appear- 
ance upon the cheek ; heals up and a short time after again breaks 
out and remains for a long time in the same condition. If the 
part be irritated with the finger nail, or the application of stimu- 
lating substances, a little ulcer which will not cicatrize, will make 
its appearance. This ulcer, is of the same nature as the preced- 
ing, and is sometimes attributed to the presence of carious teeth. 
Its progress is slow and constant, its bottom is of a wan color, its 
edges are hard, turned over and irregular; and an ichorous, fetid, 
and very acrid humour is discharged from it. If it be commu- 
nicated from one part to another, the periosteum and the bones 
will swell, become carious, and all parts of the face become so 74 
DISEASES OF THE MOUTH. 
deformed, as to present a most hideous appearance. In this state, 
the disease is incurable, the person is subjected to long and most 
excruciating suffering; he insensibly grows weaker and weaker, 
fever supervenes, he looses his usual sleep and appetite, and dies 
a most miserable death. Cancerous ulcers may also appear upon 
the palatine arch, the palate, in the nares, &c. 
All these constitutional diseases, though they do not strictly 
come under the province of the surgeon-dentist, appertain never- 
theless to the history of the diseases of the mouth, since the diffe- 
rent parts of this cavity are liable to the disease. A person who 
has a correct knowledge of all these disorders may discover them 
when they first make their appearance in the mouth, and be able 
to give salutary and always very important advice, while the dis- 
ease is in its incipient stage and capable of being arrested. The 
dentist who has some knowledge of medicine, will be aware of 
the impropriety of performing a serious operation upon an indi- 
vidual, the state of whose health holds out no hope for success, 
and which would expose the life of the patient and the dignity 
of the science. 
SECTION IV. 
Some affections simply nervous, or of a Rheumatic Nature. 
Tooth-ache generally depends upon decay of those organs in 
which the pain is felt. The pain is then produced by the expo- 
sure of the dental nerve in consequence of disease, and which 
experiences an acute and painful sensation from the contact 
of acrid sanies that produces decay, from the impression of 
atmospheric air, heat, cold and other foreign bodies coming in 
contact with the nerves exposed and in a diseased state. In all 
these cases of tooth-ache,.it is simply an epiphenomena; decay is 
really the disease; we shall speak of this in another place. It 
often happens that a person experiences severe tooth-ache, while 
there is not disease in these organs; it is generally an affection 
of the white fibrous tissues which form the alveoli and is of a 
rheumatic nature, as may be discovered by the progress of the 
pain; in some cases, however, these pains appear to be purely 
nervous, and are allied to facial neuralgia. 
Tooth-ache more frequently attacks persons who have been, or 
who are still subject to rheumatic and catarrhal affections, those 
who are subject to diseases of the mouth which has become, in 
consequence of this, very irritable, than it does others not thus 
affected. 
Sometimes the pain appears to be seated in a single tooth 75 
which the patient points out as the organ affected; if an unlearn- 
ed dentist extracts it, the tooth is discovered to be sound, and 
often the pain does not disappear. If however the extraction of 
the tooth is painful and difficult to effect, the tooth-ache may be 
suspended for a longer or shorter time, as if by the application of 
a viscatory to the temples or at the angle of the jaw, or by all 
other counter irritants; but it would be paying dear to sacrifice 
a sound tooth to be relieved of pain that is liable to return at any 
moment. 
The pain very often affects the whole of one side of the jaw, 
and the patient cannot precisely point to the seat of it. It fre- 
quently appears to affect different parts ; the patient at one time 
suffers in the superior, at another time in the inferior jaw ; some- 
times the pain will be felt upon the right, at other times upon the 
left side of the jaw. 
If the pain is very acute, and if it continues very violent for 
several days, the affection, at first confined to the white fibrous 
parts of the alveoli, extends itself to the cellular tissue and the 
mucous membrane that envelopes them. The parts then become 
swollen and the teeth are loosened and painful to the touch. If 
these series of phenomena affect a single tooth, its sensibility and 
its becoming loosened may lead one to suppose that this organ is 
diseased, and should he not understand the nature of the affection, 
he will extract a sound tooth which would have regained its 
former solidity in its socket. In this case the gums may remain 
fungous and soft for a longer or shorter time, it may sometimes 
happen that even phlegmons appear upon the part and suppurate 
at that point. 
Tooth-ache of a rheumatic nature, generally attacks adults of 
strong constitution in cold and wet weather, and who have had 
frequent diseases of the mouth. 
When tooth-ache is subdued very easily, as do all rheumatic 
affections, it may yield to the most simple remedy. It will be 
relieved by charms performed with a mysterious air imposed 
upon the credulity of the patient. It is known that the presence 
of the dentist is often sufficient to relieve tooth-ache of nervous 
persons. 
It is especially for these species of pains that many dentists, 
and even the good women, have particular odontalgic elixirs. 
These liquids are nearly always made of alcoholic tinctures, the 
action of which often suffices to suspend the pain. Indeed, a 
drop of the tincture of opium applied to the part by means of a 
piece of cotton will dispel the pain, which will not fail to return; 
but often, however, not until after a long lapse of time. Hence, 
various elixirs, and other means more or less ridiculous, have 
been extolled for the cure of tooth-ache. 
DISEASES OF THE MOUTH. 76 
DISEASES OF THE MOUTH. 
7'ic-Douloureux. 
The history of odontalgia, which is essentially of the same nature 
of pain that produces chronic rheumatism, naturally follows that 
of tic-douloureux, both of which appear to be of the same nature 
and are termed Neuralgia. 
This disease appears to have its seat in the nerve of the affected 
part, or at least in the membranous sheath which envelopes the 
nervous pulp, for the pain seems to follow the course of the nerve. 
This convulsive affection may be remittent or intermittent. When 
intermittent the returns may be regular or irregular, and vary in 
duration and intensity. 
Tics of the face manifest themselves by a convulsive affection 
of some of the muscles. The involuntary motion which consti- 
tutes them is always very inconvenient, and sometimes very 
painful. It generally attacks the superior lip, thence it extends 
along the wings of the nose as far as the inferior eyelids. Some- 
times it appears upon one side of the mouth. It frequently affects 
the eyelids and the muscles of the eye. 
In some cases the affection appears to be confined to a single 
part of the face; but when it becomes very violent it may involve 
the whole side of the head and neck. This nervous affection, 
from its primitive seat, may be traced to the three principal trunks 
of the fifth pair of nerves (trifacial) and to their different rami- 
fications. 
Facial neuralgia is very rare; it generally attacks feeble and 
very nervous persons. It often appears to be occasioned by the 
effects of cold and dampness of a north wind. It often assumes 
the appearance of catarrhal affections, and accompanies nearly 
always some symptoms of rheumatism and gout. It is often sus- 
pended by paroxysms of those diseases. 
Neuralgia of the face has been known to appear after the 
suppression of hemorrhages or ulcers, eruptive diseases, fistulous 
ulcers of the gums, &c., and it has been supposed that the hu- 
mours of these affections were conveyed to the nerves of the 
face and produced the disease; under this hypothesis originated 
the following proverb: Post hoct ergo propter hoc. But it is much 
more reasonable to suppose that an attack of neuralgia has caused 
these various discharges to cease, and that their suppression is an 
effect and not a cause of the disease. In some cases, however, 
the disease appears to have been occasioned by a pricking, tear- 
ing or contusion of the nerve, or by the development of a tubercle 
which exercised a continual pressure upon it. 
Facial neuralgia varies very much in its progress; sometimes 
there will be a pain which lasts scarcely a few seconds, and which 
disappears and re-appears at a regular period; at other times the 77 
paroxysm lasts for several minutes and returns several times in 
the course of the day. 
The disease frequently returns periodically; thus, the parox- 
ysm which generally comes on about evening lasts for several 
hours, and returns daily at about the same time. When the pain 
has its seat in the superior and inferior maxillary nerves, the 
whole of the inferior part of the face of the affected side is drawn 
to one side; the secretion of the salivary glands and of the pitui- 
tary membrane is very much increased; the patient experiences 
pain and a return of the neuralgia whenever he attempts to speak 
or eat. 
Treatment.-These nervous affections of the face are so 
obstinate that it has been found necessary to employ all of the 
most active remedies to subdue them. 
The local disease, in its early stage, is generally accompanied 
with general indisposition; there will be fever and inability to 
sleep. The dim white-colored tongue portends a deranged con- 
dition of the gastric apparatus. In such cases, if we employ 
energetically the various means capable of overcoming these 
symptoms of general derangement, we will observe the subsidence 
of the nervous affection. Thus the application of leeches several 
times in the neighbourhood of the part affected, an emetic, the 
constant use of diluents, laxatives, pedeluvia and purgatives, 
skilfully employed, according to the strength and peculiar state of 
the patient, have been found to be of great importance. 
When the disease has passed through the first stage, and has 
resisted the first course of treatment, it then assumes a chronic 
character, and the above remedies oftener exasperate the disease 
than cure it. It would be proper in this case to use various stimu- 
lants, tonics, antispasmodics, &c. As each of these remedies 
have succeeded with some practiciens, they have been succes- 
sively recommended ; hence, in nervous pains, the return of which 
is periodical, bark given in large doses and in different ways has 
often been successful. In other cases these pains have yielded to 
the use of opium, camphor, ether, musk, &c. either given inter- 
nally, or, which is better, applied to the affected part. Ice has 
also been employed in this affection ; its application has sometimes 
relieved the pain for a longer or shorter time; at other times it 
has removed it entirely, and in some instances it has exasperated 
the nervous irritation. 
Pedeluvia are nearly always advisable as they procure relief; 
also, moderate exercise, light food, and such as is easily digested. 
When none of the above recommended remedies have suc- 
ceeded, and the disease continues for a long time, it has been 
advised to send the patient to the hot mineral watering places, and 
success is often obtained, which is attributable as much to the 
DISEASES OF THE MOUTH. 78 
DISEASES OF THE MOUTH. 
change of air, the voyage, and the great diversion of the mind, 
&c. as to the efficacy of the waters. 
Depositions sometimes have been known to appear in the neigh- 
borhood of the part affected with tic douloureux; and when these 
depositions remain open for any length of time they often effect 
a cure of the neuralgia. This fact has given rise to the employ- 
ment of vesicatories, setons, moxa, caustic, and the actual cau- 
tery ; these sometimes succeed, but they are often useless, and in 
such cases it is fortunate, indeed, if they do not aggravate the 
disease. 
When the disease is the result of a slight wound or contusion, 
a cure has sometimes been effected by making a deep incision 
upon the part primitively wounded, and by keeping up a suppura- 
tion. 
It would appear that in some of these instances the pain is oc- 
casioned by the lacerated or partly divided nerve, and that the 
pain is removed by completely dividing the nerve. 
These cases have induced several noted practiciens to divide 
the nervous branch, which is the principal seat of the disease, 
when practicable. The operation has been performed upon the 
suborbital nerve as it passes out of its canal, by making an in- 
cision under the inferior lip, which is detached for this purpose. 
Notwithstanding the precautions afterwards taken to keep up 
suppuration for a time by means of irritants, caustics, and even 
the actual cautery, it sometimes happens that the cure is but mo- 
mentary. The last class of certain energetic remedies that have 
been employed in these nervous affections, are the magnet, elec- 
tricity and galvanism; the use of these physical stimulants has 
sometimes succeeded, and they may be used with much less in- 
convenience than the various operations we have just spoken of. 
SECTION V. 
Diseases of the Jaw Bones. 
The hard, like the soft parts of the body, are subjected to 
various diseases, and they present in their progress analogous 
phenomena. 
This identity of phenomena will not astonish us when we reflect 
that the bones, as well as all the soft organs, present a same gene- 
ral structure. The bones are principally formed of a membranous 
and reticular tissue in the composition of which nerves and the 
various species of vessels enter. This vascular tissue, which is 
truly the living and organic part of the bone, exist in the embryo, 
and even in the foetus, whose bones are still soft. The depo- DISEASES OF THE MOUTH. 
79 
sition of the phosphate of lime, which is deposited in the cells 
of this tissue to impart to it its solidity, only modifies these phe- 
nomena of organization of which it is susceptible in the various 
circumstances of health and disease, but does not change its 
essential nature. 
We can be convinced of this fact from a rapid examination of 
the various affections of the bones, compared with those of the 
soft parts. 
The articular portions of the bones may be displaced in violent 
and sudden efforts. This displacement occasions in luxations 
diseases analogous to hernia. 
The bones may be broken by a blow, fall, &c., and the frac- 
ture, like wounds, presents a series of phenomena which tend to 
the reunion and consolidation of the divided parts. 
It sometimes happens, from a contusion, that the bone being 
denuded and exposed to the atmosphere becomes necrosed; the 
living part, contiguous to that which is deprived of life, takes on 
a new mode of action, which separates the dead portion from it. 
The exfoliation of bone presents a series of phenomena resem- 
bling the escar of the soft parts. 
When the whole of a bone is dead, another bone is formed 
around it, in the middle of which the old bone is sequestered and 
becomes a foreign body. The necrosis in this respect differs from 
grangrene. 
In consequence of blows, falls, and certain constitutional affec- 
tions, the bones, also the periosteum that covers them, may swell 
and produce tumours of various consistencies, and hence it can 
be seen that various bony tumours may correspond to the diffe- 
rent scirrhous tumours to which the soft parts are liable. 
In fine, these osseous tumours after remaining for a longer or 
shorter time in the same condition, may take on a new action 
and experience a peculiar affection which tends to the destruction 
of the substance proper of the bone; here we again see that de- 
cay may present phenomena resembling that of cancer. 
We shall speak of these different modes of alteration limiting 
ourselves to the phenomena which they present in the maxillary 
bones, and more especially in the teeth. 
Luxation. 
Luxation is applied to the displacement or the change of rela- 
tion which occurs to the articular surfaces of the bones. These 
displacements may be produced by blows, falls, and all violent 
motions. 
In order to understand well the mechanism of luxation of the 
maxillary bone, it will be proper to recall to mind the action of 
the muscles which serve to move this bone, the disposition of its 80 
DISEASES OF THE MOUTH. 
articular surfaces, and that of the bones which surround the arti- 
culation of the jaw. 
The maxilla can only be luxated in front; when the displace- 
ment occurs, the condyle glides over the transverse eminence 
into the zygomatic fossa. 
Luxation cannot occur posteriorly; not on account of the ob- 
stacle that the anterior wall of the auditory foramen presents, but 
because the chin cannot be sufficiently elevated to give rise to 
this displacement. 
The maxillary bone cannot be displaced inwardly; first, be- 
cause there is no muscular action which can act with sufficient 
power, in that direction, to produce lateral motions of the jaw 
capable of resulting in luxation; secondly, all exterior power, 
violently applied against the branches of the maxillary bone, 
would fracture sooner than displace them. 
The maxilla is only luxated in adults and old men; there are 
no examples of displacement of the jaw in children, though they 
frequently open their mouths very wide. We account for this 
from the difference that exists between the form of the branches of 
the jaws of infants when compared with those of adults. The 
neck of the condyles and of the branches of the jaws of infants 
form a great angle with the body of the bone; while in adults 
they form nearly a right angle; it can be conceived, from this, 
that, in order that luxation may take place in young subjects, 
it would be necessary for the jaw to be carried almost perpendi- 
cularly downward. In the ordinary motion of depressing the jaw, 
the displacement of the condyles is very slight in children, while 
it is very considerable in old men. 
Luxation of the jaw generally occurs in yawning; it may also 
be produced by the introduction of a very large body into the 
mouth, when carried very far back between the last molares, in 
such cases it is perceived that luxation is the effect of muscular 
action. It may also be produced by external violence, such as a 
blow upon the body of the bone and which tends strongly to de- 
press it; but generally, violent blows oftener fracture the 'bone 
than luxate it. 
Luxation of the jaw may be detected by the following signs: 
the mouth, after an excessive depression of the maxillary bone, 
remains open, which it is at first impossible to close, the person 
experiences a very great difficulty in pronouncing certain words, 
the saliva flows involuntarily from the mouth, an elevation is ob- 
served anterior to the ear and a depression near the temple, ac- 
companied by pain at this part in consequence of pressure upon 
the deep temporal and masseter nerves. We should also observe 
that when the luxation has occurred upon both sides at the same 
time, the prognosis is much more manifested; the chin, in such a DISEASES OF THE MOUTH. 
81 
case, is very prominent, and is not turned to one side, as when 
luxation has happened to one side only. 
Notwithstanding the numerous signs that characterize this ac- 
cident, it frequently happens that it is not discovered and that the 
luxation has not been reduced. The patient then becoming ac- 
customed to this condition of his jaw, and by continued and repeat- 
ed exertions he is able to close his mouth and to perform the 
different movements of mastication, though with great difficulty. 
Having now pointed out the signs by which we can ascertain 
if the jaw be luxated, we shall now speak of the manner in which 
this luxation is produced, when it occurs spontaneously, simply 
by the muscular action; and point out the muscles that force the 
condyles out of their articular cavity. Upon these points anatomists 
differ very much in opinion. 
Monro, whose opinion has been generally adopted, explains 
this phenomenon in the following manner; when the mouth is 
opened, the condyles of the jaw are carried upon the transverse 
temporal apophyses; the coronoid apophyses pass under the 
malar eminence and press upon the inferior parts of these apo- 
physes. When the masseter and internal pterygoid muscles are 
found behind the new point of support which is always the centre 
of motion; if, in this state of things, these muscles are put in 
action, they carry the condyles in the zygomatic fossa, and the 
action of the temporal muscle remains inactive, since the coronoid 
apophysis has become the centre of motion. 
This explanation is incorrect upon one point, it is that the 
coronoid apophysis does not rest upon the malar eminence in 
luxation; for we feel it in the base of the cheek, under the zygo- 
matic arch. 
Doctor Pinel (Journal of Medicine) established the centre of 
motion, by which the jaw is elevated and depressed in the arti- 
culation of the condyle with the temporal bone, around a trans- 
verse line which would pass from one branch of the jaw to the 
other; so that the masseter muscle falls perpendicularly upon 
that line. This being established, we perceive that when the infe- 
rior jaw is depressed, the masseter changes its direction, and a 
portion of its fibres approaches more or less the centre of motion. 
The masseter then, instead of carrying the chin upward and the 
condyle backward, forces the condyle forward into the zygomatic 
fossa, and the chin downward. 
Boyer, an. anatomist, thinks that luxation of the jaw is owing 
to a change of direction of the pterygoid and masseter muscles, 
in relation to the direction of the body of the bone. When the 
mouth is closed the fibres of the masseter and pterygoid muscles 
form, with the line of direction of the body of the bone, almost 
a right angle, and these muscles act with all their power; but in 82 
DISEASES OF THE MOUTH. 
proportion as the chin is depressed, the direction of these muscles 
assume an oblique, position in regard to the body of the bone, and 
then the power is divided; thus, one part acts in a parallel, and 
the other in an oblique direction. The first acts with a force in 
proportion to the depression of the jaw, and finally depresses the 
chin, elevating, at the same time, the condyle. 
All of these explanations, which at first sight appear to differ, 
are, however, the same as to their principle. In each.of them we 
discover that the ordinary motion of the elevation of the jaw is 
performed by means of a lever, the muscular power of which is 
in the middle; but as this lever changes when the jaw is very 
much depressed, then the condyle is carried so far forward that 
it takes its fulcrum between the resistance and a part of the 
power; in this condition the posterior part of the fibres of the 
masseter and pterygoid muscles, and also the temporal, cannot 
contract, on account of their great obliquity, so that luxation is 
favored, since the chin is depressed and the condyle has passed 
forward. 
In order to reduce luxation of the jaw, the patient should be 
placed upon a low seat, and an assistant should hold his head 
firmly against his breast. The surgeon now introduces his 
thumbs, enveloped in a piece of linen cloth, as far back into the 
mouth as he can possibly upon the last molares; he places his 
fingers under the chin, and dra\vs the jaw downward and back- 
ward, until he perceives that the condyles are disengaged, and 
then he elevates the chin, being careful to remove his thumbs 
from between the teeth to prevent them from being bit by the 
spasmodic contraction of the jaw. 
We will generally succeed in reducing luxation of the jaw, 
when the accident has recently occurred, by the mode of proce- 
dure just pointed out; but should we make several vain attempts 
at reducing it, we must resort to another method, which we shall 
now describe. The patient being seated as before recommended, 
the surgeon places between the last molar teeth a lever of a 
wedge shape; a bandage is then put under the chin, which an 
assistant draws very tight; thus, a lever of the first class is made 
which is proper for the reduction of the jaw. When the resis- 
tance of the muscles is very great we must overcome it by a slow 
and continued force until reduction is effected. It will be per- 
ceived that when only one side of the jaw is dislocated the wedge 
should be placed upon that side only. 
We will know when the dislocation is reduced by the noise 
that the condyles make on re-entering the glenoide cavity of the 
temporal bone, and by the disappearance of all the signs which 
characterize the displacement of the maxillary bone. 
In order to sustain the jaw in its place after it has been reduced, it will be proper to apply under the chin a bandage, and to recom- 
mend the patient to support his chin with his bands whenever he 
opens his mouth very wide, either in yawning, or for any other 
purpose. These precautions will be the more essential when the 
jaw has been easily reduced, because, in such cases, it is more 
liable to be again displaced. 
When we have not been able to reduce dislocation of the jaw 
either in consequence of its long standing or from any other 
cause, the patient is obliged to remain in that condition, this does 
not, as is stated by Hippocrates, produce death; on the contrary, 
he gradually recovers the ability of closing his mouth, and is 
even able to chew, though always with difficulty. A more or 
less prominence of the chin remains in such cases. 
DISEASES OF THE MOUTH. 
83 
Fracture of the Inferior Jaw. 
The term fracture is given to all solutions of continuity of a 
bone suddenly produced. The bones are generally fractured by 
exterior bodies, which act very violently against them ; they may 
also be fractured by muscular action. The exterior bodies 
which produce fracture of bones act by their bulk or by their 
swiftness; when they act by their bulk, they oftener produce a 
kind of crush than true fracture. But when small bodies are 
thrown with great velocity they may produce fracture of the 
bone which they come in contact with, not, as is often said, be- 
cause they force the parts to bend beyond their maileableness, but 
because the bones being struck so quick that they have not time 
to yield, and are compelled to break. 
Fractures vary according to the kind and the part of bone that 
is fractured, the direction of the fracture, and various other cir- 
cumstances which accompany them. 
The superior maxillary may be fractured in various ways, but 
fractures of this bone do not generally displace it, and require no 
dressing. They will be cured by keeping the part quiet; for this 
purpose the patient should be careful to make no exertion in 
masticating. 
Sometimes the alveolar border is so much fractured that a part 
of it is almost detached from the jaw; it then becomes necessary 
to reduce it, and to maintain it in position by means of a gold or 
silver ligature fastened to the neighboring teeth. 
The inferior maxilla is often protected from being fractured on 
account of its form, position and motion. The body, the branches 
and the neck of this bone are liable to this accident. 
In these fractures we notice a displacement of the parts, which 
varies according to the thickness of the bone. As fracture of 
the branches of the jaw is generally transverse the parts will be 
very slightly displaced. If the fracture occupy the neck of this 84 
DISEASES OF THE MOUTH. 
bone nearly the whole of the jaw will remain in its proper paw 
sition, but the condyle is carried a little forward. Sometimes the 
body of the bone is fractured upon both sides, the part then which 
is in the middle will be drawn downward and backward; there 
will be great displacement, and a great difficulty to maintain the 
parts in their proper positions will be encountered. 
To assure ourselves of the existence of a fracture of the maxil- 
lary bone, when there is no displacement to manifest the accident 
and the part fractured, we should pass the finger along the jaw, 
commencing under the chin; it will also be necessary to examine, 
with the fingers introduced into the mouth, the whole of the inter- 
nal side of the jaw-bone. If these means do not succeed, we 
should place the thumbs upon the internal side of the jaw, at a 
proper distance from each other, and the fingers under the chin; 
and if, moving the parts, crepitation be produced, the existence of 
a fracture will be established. 
Fractures of the jaw are often accompanied with a slight contu- 
sion of the soft parts; and when this happens, it will be necessary, 
after the fracture is reduced, to maintain the fractured extremities 
in apposition until a re-union takes place. Sometimes the skin 
and muscles are lacerated and suppurate, and require to be suita- 
bly dressed every day. The opening of the wound is often con- 
tinued for a long time, by the exfoliation of spiculae or portions of 
dead bone. When the dental nerve is separated, insensibility of 
the whole of the parts to which it is distributed will be the result. 
Compound fractures of the jaw, like those of other parts, are as 
various as are the causes that produce them, and are determined 
by the age and constitutional disposition of the subject; they are 
more serious when produced by fire-arms than when they are the 
result of a blowr or fall, and their treatment is as difficult as is 
their prognosis. 
Fractures of the maxillary bone, for their reduction, require 
the same general means that other bones do. Thus, they are to 
be reduced, maintained in position for a proper length of time 
after they have been reduced, the evils that accompany them are 
to be subdued, and those that might develope themselves are to 
be guarded against. In order to reduce a fracture of the inferior 
jaw, it will be necessary to apply it against the superior jaw, and 
then maintain it by means of a double or single chin bandage, as 
we may have occasion to apply it on one or both sides. 
Since it is necessary that the jaws should remain closed during 
the time that the re-union of the parts is going on, it is observed 
that the patient is compelled, during all this time, not to take 
solid aliment; hence liquids are given him by means of a sucking 
bottle, the spout of which is introduced through the space made 
by the absence of a tooth. If the patient has not lost any of his 85 
teeth, it will be necessary to extract one of them; but generally 
the cause that produces the fracture displaces one or more of the 
teeth. 
Having hastily pointed out the peculiarities that fractures of 
the maxillary bones present, and the means ordinarily employed 
for their reduction, it will be proper to notice the peculiarities of 
the phenomena in the re-union of the extremities of the fractured 
parts: the history of the efforts of the economy, which produces 
the formation of callus, naturally leads to the disease of the tis- 
sue proper of the bones. 
When a bone is recently fractured, the rupture of its vascular 
tissue causes inflammation analogous to that which appears on 
the borders of a fresh wound; and that inflammation causes, as 
it does in a wound, a series of phenomena which results in the 
restoration of the solution of continuity. 
The pain resulting from the laceration of the vascular tissue of 
the bone and the neighbouring soft parts, is sometime so severe 
as to occasion general derangement and fever. After the subsi- 
dence of the symptoms which result from the fracture, the frac- 
tured extremities should be held in exact apposition, by means of 
suitable appliances, until they unite. During the process of union, 
a swelling will be observed, about the eighth or tenth day, which 
continues and this will indicate the precise point of the fracture. 
From examinations of fractures in dead subjects, at different 
periods after the accident, the following observations upon the 
process of consolidation have been made: during the first few 
days, the fractured ends pour out a bloody liquor, which insensi- 
bly becomes serous and is absorbed. A short time after this, the 
fragments become soft, swell and .appear to be covered with a 
soft reddish substance; this substance, which is contained at the 
two fractured extremities, assumes a soft cartilaginous consistency, 
and finally becomes osseous, by forming a pad which obstructs 
the cavity of long bones and surrounds them externally. We 
evidently see, in all of that series of phenomena, a perfect analogy 
between the consolidation of a fracture and the re-union of a 
wound which is effected without suppuration. 
Fractures may unite without a retentive bandage, and even 
without perfect quietness, as is frequently seen in the lower classes 
of animals; but we observe that he callus is larger and much 
more deformed than when the re-union is effected without an ex- 
act reduction, and there will always be a considerable shortening 
of the parts. 
When it happens that a fracture does not become consolidated, 
either on account of the distance of the extremities of the bone, 
or from disease; we then observe the formation of a cartilaginous 
cicatrix upon the two fractured extremities, and that the two 
DISEASES OF THE MOUTH. 86 
DISEASES OF THE MOUTH. 
extremities are united by a kind of ligamentous production which 
produces a species of articulation. 
Diseases of the tissue of the Bones. 
The tissue proper of the bones of the jaws, the same as that of 
the teeth, is liable to the different modes of alteration that the 
bones in general are, and which we now purpose to treat of. 
Mortification of a bone may attack the exterior lama, or ex- 
tend through the entire thickness of the bone; in both cases we 
observe a series of phenomena differing very much from each 
other. 
Mortification, or Necrosis. 
Partial and external Mortification, or Exfoliation. 
When the jaw-bone, in consequence of a blow, has been de- 
nuded of its periosteum, and left exposed, it generally happens 
that more or less of the surface of the exposed bone becomes 
necrosed and is detached, sometimes in thin lamte, at other times 
in very thick ones. The process by which a dead portion is 
separated from the living bone is called exfoliation. The time 
necessary for the production of exfoliation of bone, is generally 
in proportion to the size of the part exfoliated. This process 
operates more promptly in young subjects, in whom all the opera- 
tions of the economy are in an active state, than it does in weak, 
sick, or very old persons. 
Exfoliation is executed at the point where the part affected with 
necrosis is separated from the living portion, and is the effect of 
the living portion of bone: this process is generally slow; during 
the whole time that it is going on, the wound does not heal and 
the bone remains denuded, or if the parts cicatrize it is only to 
re-open in a very short time, and to leave at least some fistulous 
openings, through which, by means of a stylet, we perceive the 
denuded bone; the suppuration always remains sanious and in a 
bad condition. When the dead osseous lama is entirely free and 
is discovered to be moveable upon the rest of the bone, we should 
endeavour to remove it. The lama of bone is often detached 
in pieces which are removed with a pair of dressing forceps; at 
other times, it is separated from the living bone in a single piece, 
and we are obliged to enlarge the wound tO'allow it room to be 
taken out. If we neglect this operation, another abscess will be 
formed, through the opening of which portions of bone, which 
have become foreign bodies, will be exfoliated. When the os- 
seous lama, which has become black and eroded, is removed, we 
discover that the surface of the bone which it covered, presents 
fleshy granulations of a vermillion red colour ; healthy suppuration 
will then be soon established, and the wound will cicatrize. 87 
In order to prevent exfoliation of bone, means which have 
always proved fruitless, have been recommended; and when ex- 
foliation has appeared to be a necessary result, it has then been 
advised to adopt various topical applications, or to perform cer- 
tain operations; thus, alcoholic tinctures and escharotics ; tre- 
paning the diseased bone and even the application of the actual 
cautery have been recommended; but all of these nearly always 
fail, and are often injurious. It would be much better in such 
cases to wait the result of the efforts of nature, than to provoke 
it by remedies which only tend to interfere with the natural 
course of the phenomena. 
If the disease be produced by a constitutional affection, as 
syphilis, it would be necessary to employ internal treatment to 
arrest its progress. 
We shall describe the progress of necrosis when it is evidently 
produced by the denudation of the bone and its long exposure to 
the air; but that disease maybe the effect of several other causes 
which tend to detach the periosteum of the body of the bone. 
Hence it may be occasioned by a violent blow, it is sometimes 
produced by an abscess, and it may finally be developed sponta- 
neously during some constitutional affections, as in syphilis, can- 
cer, scurvy, &c. In other respects necrosis is oftener developed 
in the hard and compact parts of the bone than in thin spongy 
portions, or their articulations. 
In all cases, in which necrosis appears upon the surface of the 
bone, as it necessarily occurs in the bones of the jaw, it is always 
the periosteum which is principally affected. That membrane 
inflames, swells, detaches itself from the bone, and being thus sud- 
denly deprived of its accustomed nourishment, a greater or less 
extent of its surface and thickness becomes dead. 
To understand well the different modes of necrosis, we should 
recollect, that the bones arc vascular organs in which life is kept 
up by the communication between the vessels proper and those of 
the periosteum and of the medullary tissue in the long bones, 
whence it results that life may be partly or totally cut off, when 
the sources by which it is conveyed is disturbed. 
We have given the history of partial necroses which takes place 
in the exterior of a bone, when from some cause the periosteum 
is more or less detached from it; but there are cases, though very 
rare, in which partial necroses occur in the interior of a long 
bone and involves more or less of the internal lamae. 
DISEASES OF THE MOUTH. 
Partial and Internal Necrosis. 
This disease is difficult to discover at its commencement; it is 
sometimes the result of a jolt or concussion, but it is more fre- 
quently produced by constitutional causes; in all of these cases 88 
DISEASES OF THE MOUTH. 
necrosis is owing to an alteration of the medullary tissue and to its 
decomposition. The patient at first experiences in the part a dull 
pain, which insensibly increases, and after a longer or shorter 
lapse of time, sometimes several years, the disease becomes com- 
plicated, the part necrosed which remains in the interior of the 
bone, becomes a source of continual irritation which produces 
disease through the whole thickness of the bone. The bone now 
swells and becomes altered throughout its whole tissue, deposi- 
tions which do not suppurate are formed and they occasion 
fistulous openings, some of which communicate with the internal 
cavity of the bone. The long suffering gradually destroys the 
health of the patient; he becomes troubled with fever, and suc- 
cessively with derangement in all the functions of the system 
and finally dies after years of suffering. 
On dissection the bones are found swollen, irregular and dis- 
eased throughout their whole tissue: the interior of the bone con- 
tains a necrosed lama, this is sometimes disengaged in the 
interior of the cavity of the bone, but oftener it adheres to the 
bone. It is obvious that this is always a very serious disease 
When a bone is found dead throughout its whole thickness, 
as may happen in the middle of long bones, and sometimes in the 
body of the jaw, a very extraordinary series of phenomena will 
be the result. 
Necrosis of this kind is commonly the consequence of a violent 
contusion, which has produced inflammation of periosteum and 
even of the medullary tissue, capable of decomposing those parts 
together with the bone itself. The disease may also be produced 
by a constitutional affection; and it sometimes occurs without 
any appreciable cause. 
This disease is generally difficult to discover in its commence- 
ment. The patient feels vague pains in the part affected, ac- 
companied with a kind of very troublesome numbness; abscesses 
afterwards make their appearance, these sometimes terminate in 
resolution and sometimes in suppuration. After a long lapse of 
time, the pains increase, the bones swell and become irregular 
and rough,.and abscesses which form at this stage of the disease 
produce fistulous openings, the borders of which become hard, 
callous and curled over, and discharge a sanious and reddish pus. 
The diseased bone sometimes becomes so fragile that it is 
fractured by the slightest cause. 
After a long lapse of time, several years, for instance, we dis- 
cover, by introducing a stylet into the fistulous openings, that it 
traverses the thickness of the solid part, and that it penetrates the 
centre of the bone, and then meets with a dry and often moveable 
Total Necrosis of the Body of the Bone. 89 
part of the bone. If the disease be left to itself, it sometimes 
occurs that one of the openings enlarges considerably and gives 
passage to portions, of black and porous bone. When all the 
osseous fragments have escaped, the fistulous ulcers gradually 
cicatrize and the disease is cured, leaving a deformity in the part. 
Generally the disease does not spontaneously attain such a termi- 
nation; the fistulous ulcers, being kept open by the presence of 
necrosed bone, which is unable to free itself, remain fistulous, the 
patient becomes exhausted by long suffering;-he finally expires 
in a kind of adynamic fever, or in a state of consumption. 
From an examination of the diseased part after death, we dis- 
cover a new bone, which is formed by irregular layers around 
the old bone, which is enclosed in it. We observe that the open- 
ings of the fistulous ulcers correspond to holes situated in the new 
bone, and these holes reach to the sequestra. 
This disease generally attacks the bones of the extremities; 
there are, however, some cases of necrosis of the jaw. In all 
cases the disease never attacks the articular extremities, but is 
always confined to the body of the bone. When this affection is 
discovered we should not wait until the strength of the patient is 
exhausted to extract the necrosed bone, without which a cure 
cannot take place. 
Before performing this operation we satisfy ourselves, by means 
of a sound, if the bone be completely sequestered and moveable 
in the centre of the new bone; we then enlarge one of the open- 
ings of the new bone with a chisel and mallet, and remove the 
sequestra. After all foreign bodies have been removed from the 
interior of the new bone, cicatrization will go on gradually, all 
of the fistulous openings will in time close up, and the patient will 
be cured; a deformity in the part will, however, remain. 
From what we have said of necrosis, or the death of a bone, 
it appears evident that the affection presents a great many va- 
rieties ; that it is, nevertheless, possible to class them under three 
principal forms. 
In the first form, which may attack the bones of the jaw, as it 
may all other parts, the disease consists of the mortification of an 
external lama of bone, varying in extent of surface and depth, 
and which becomes separated from the rest of the bone by the 
process of exfoliation. 
In the second form, which only attacks long bones, the osseous 
lama, affected with necrosis, is situated in the interior of the bone, 
and cannot separate itself. The constant presence of this foreign 
body in the cavity, produces disease of the whole body of the 
bone, which swells, becomes the seat of depositions that suppurate, 
and remain fistulous. Sometimes decay will be produced, and 
an opening sufficiently large to allow the necrosed part to escape 
will be formed, and a cure will in this manner be effected. 
DISEASES OF THE MOUTH. 90 
In the third form the whole thickness of the body of the bone 
is necrosed, then the deposition of calcareous phosphate, which 
is continually going on for the increase and maintenance of the 
part, still continues to be deposited, and accumulates irregularly 
around the old bone to such an extent as to form a new bone 
capable of supplying the place of the old one. Necrosis that 
thus affects the whole of the jaw between the two condyles is 
found enclosed in the new bone, which has some openings some- 
times large enough for the discharge of the sequestra. Tins form 
of necrosis presents in its organization the only example of parts 
capable of regeneration. 
DISEASES OF THE MOUTH. 
Osseous Tumours. 
The relations that exist between the hard parts of which we 
have spoken and the various affections of the soft parts have 
already been pointed out. This analogy is little astonishing when 
we are aware that these various organs are all essentially formed 
by tissues of vessels. The same resemblance too will be found 
in the diseases of the bones which we are now about to describe. 
The bones may, in consequence of exterior lesion or constitu- 
tional disease, be attacked by a kind of phlegmasia or peculiar 
irritation, tending to alter their organic structure by increasing 
their volume and density. 
When the jaw, or any other bone has been violently struck, it 
frequently happens that the periosteum, and some of the external 
lama of the osseous substance, swells and forms a tumour of 
greater or less size. Sometimes this tumour will not be promi- 
nent, but will cover a great extent of surface; it is then supposed 
to be the result of the swelling of the periosteum, and is called 
periostitis, but it is very probable that, in this case, the exterior lamge 
of the bone also contributes to the formation of the tumour. 
When the swelling of the bone is slight, and when it appears 
to be a thickening of the periosteum and external osseous layers, it 
is susceptible of being cured; but when the tumour has acquired 
a certain size, such a termination cannot be expected; it is to be 
hoped, however, that it will remain in that condition without 
making further progress. 
In some rare cases the whole thickness of the bone takes on a 
new action, and increases in size by undergoing a change in its 
density. 
The phosphate of lime sometimes accumulates in the cells of 
the bone and gives to it the consistency of ivory, and are called 
ivory exostosis. 
At other times the density of the bone is diminished; the 
osseous layers separate and become soft; when this happens 
they bend and become deformed, as in case of rachitis. In some 91 
DISEASES OF THE MOUTH. 
cases the bone acquires a considerable size, and then the disease 
is called spina ventosa. Finally, by the progress of these various 
affections the calcareous salt may be entirely decomposed and 
absorbed; the tumour then assumes a fleshy consistency,, and is 
called osteo sarcoma. 
This last disease is very analogous to caries. It is necessary 
to enter into some detail in describing the cause and progress 
of these different affections. The causes that produce exos- 
tosis are numerous. Sometimes the disease is occasioned by a 
violent percussion; at other times it is developed in the course of 
a constitutional disease, such as syphilis, scrofula, rheumatism 
and gout; in some cases the swelling of the bone occurs without 
any appreciable cause. 
All bones are liable to exostosis. This disease generally only 
affects a part of the flat and long bones, but it often attacks the 
whole thickness of the short bones. In general, exostosis, which 
assumes great consistency, is developed in the compact substance 
of the bone, while that which is soft occurs in the spongy part of 
bones. 
When exostoses are produced by a contusion, they will only 
affect the part contused; but should they be owing to a constitu- 
tional disease, they may appear upon several bones at the same 
time. Finally, certain affections of the bones have been known 
to become general, and manfest themselves simultaneously in all 
the osseous tissues. 
Sometimes exostoses will be very slow in their progress, they 
will remain nearly stationary, and their only inconvenience is 
their size and the deformity which they produce ; at other times 
the disease makes rapid progress, impede by their presence im- 
portant functions, and are accompanied with acute pain which 
increases sometimes during the night. 
Osseous tumours may be developed somewhat in the same 
manner that tumours of the soft parts are ; they are susceptible 
of resolution and induration. The peculiar softening of the 
tumours in osteo-sarcoma and caries, is analagous to that which 
happens to scirrhous tumours when becoming cancerous. 
Exostosis which is occasioned by external causes, are not 
generally dangerous, when they only attack the superficial and 
smallest part of the long bones and when they do not cover a 
great space; they are then accompanied with pain, are very 
hard, but they are likewise very obstinate and do not yield to any 
treatment. Exostosis having the appearance of ivory is also 
developed in the compact substance of the bones; it has also been 
observed upon the jaw-bone in the middle of several long bones 
and upon the bones of the cranium. 
Osseous tumours are more serious when they are seated upon 92 
DISEASES OF THE MOUTH. 
the extremities of the bones, and when produced by a violent 
concussion in the articulation, because the continued movement 
causes the diseaes to progress. When the articular surfaces have 
acquired a certain size, it is desirable that, anchylosis would occur, 
but if the tumour continues to be painful, depositions will occur, 
afterward caries, and the disease will end fatally. All of these 
evils have been known to be seated in the articulation of the jaw. 
Exostoses arising from constitutional diseases present very 
remarkable differences. Those which are occasioned by syphilis, 
appear in the middle of some long bones; their progress may be 
arrested by proper mercurial treatment, and the tumours very 
often disappear of themselves, especially if they have not acquired 
a large size. 
Exostosis which is sometimes accompanied by'chronic rheuma- 
tism, generally makes its appearance upon the same parts as it 
does when it proceeds from syphilis, and it is often attributed to 
this latter disease. It can always be ascertained from which of the 
above diseases exostosis has been produced ; thus, when it arises 
from a rheumatic affection, this affection will necessarily ac- 
company it; it will not yield or will return after the mercurial 
treatment, and often disappear spontaneously. It is not uncom- 
mon to see exostosis to correspond or alter with the varying pains 
of the gums and teeth without there being any disease in these 
parts. 
Osseous tumours which generally make their appearance near 
the small articulations of the hands and feet in chronic gout, are 
produced by an accumulation of calcarious phosphate of these 
parts. At first they are small and often disappear of themselves, 
but they in time may become large and stationary. In other 
respects the treatment of the disease is as difficult as that which 
produced it. 
Exostoses which are produced by scrofula and rachitis are 
generally very serious, because they nearly always appear upon 
the spongy parts of the bones; hence they appear upon the short 
bone or upon the extremities of the long bones; in this case the 
bones by becoming tumefied, are softened, deformed and are very 
often affected with caries. The local disease becomes more diffi- 
cult to arrest as the general disease is the more serious which has 
occasioned. In rachitis the bones of the jaw and teeth often under- 
go a remarkable derangement; when that disease has made great 
progress in children, the lower jaw will be imperfectly developed, 
and remain short; the teeth of first dentition then decay, and 
sometimes the germs of the second are discoloured in the sockets. 
In some very rare cases, an osseous tumour, of an extraordinary 
size, will appear upon the extremity of a long bone, and which 
has been called spina venlosa. DISEASES OF THE MOUTH. 
93 
The disease often commences, without any appreciable cause, 
by a deep pain along the bone. At the expiration of a period, 
very often long, the pain increases and affects the extremity of 
the bone, which gradually swells. The tumour appears hard, and 
is insensible to the touch. As the disease progresses, the skin 
which covers the tumour bursts at its most prominent part, and 
produces an ulcer from which sanies is discharged. 
If the disease be not arrested at its commencement, by suitable 
means, it will make slow and constant progress; the tumour will 
sometimes acquire a large size, and the patient will ultimately 
sink under it. After death, we will discover that the interior of 
the tumour is formed of a soft substance resembling flesh ; its 
circumference presents a thin osseous layer, compact and con- 
taining numerous little holes in both surfaces. 
It is generally thought that this thin osseous layer is occasioned 
by the swelling and extension of the osseous lama, which would 
seem improbable when the tumour is very large. But it is more 
likely that, in this disease, the osseous substance is entirely de- 
stroyed, and that the calcareous phosphate, which is no longer 
secreted in the bone, spreads itself in the tumour irregularly, and 
gives rise to a solid structure. 
From what wze have said upon the nature, the progress and 
causes of the various osseous tumours, it will be perceived that 
the local remedies will scarcely have any effect upon them. 
When exostosis is small, it may spontaneously disappear, if the 
parts be kept quiet, if it be the result of a contusion ; or it will 
yield to proper constitutional treatment, if it has resulted from any 
general disease. If the tumour be very large, if it involves a 
great portion of the thickness of the bone, it will not be suscepti- 
ble of cure; and it is to be desired in such cases, as it sometimes 
does, that it will remain stationary. Under all circumstances, 
we should only apply surgical means when the tumour, from its 
size or position, impedes the exercise of some important vital 
functions; because the operation by which the tumour may be 
removed is always accompanied with consequences more or less 
dangerous and often fatal. 
The different kinds of osseous tumours, and especially those 
which affect the spongy part of bones, after remaining stationary 
for a longer or shorter time, are susceptible of taking on a new 
action, in consequence of being irritated ; they will then become 
painful, soften, and gradually assume the consistency of cartilage, 
afterward that of flesh. In this state, ulcers will form around the 
tumour, and discharge a serous, acrid and fetid pus. Should the 
disease be left to itself it will necessarily produce death, by sub- 
jecting the patient to a series of cancerous affections, the progress 
of which i*s such, that they can only be arrested by amputating 94 
DISEASES OF THE MOUTH. 
the part affected. It is evident that that disease which has been 
called osteo-sarcoma may attack bones which enter into the for- 
mation of the mouth, as well as that of other parts. 
Osteo-sarcoma is not always a consecutive affection of osseous 
tumours, it often occurs idiopathically, and it then constitutes a 
disease analogous to caries, of which we now propose to speak. 
Caries. 
Caries may affect all bones, but it generally attacks the spongy 
bones, or the spongy parts of the bones. It most generally de- 
velopes itself in consequence of a constitutional disease, such as 
syphilis, scrofula or cancer ; it may, however, be occasioned by 
exterior lesion, in persons who have very bad health. 
The disease generally announces itself by a dull pain in the 
parts where caries is about being developed. The pain lasts for 
a longer or shorter time, after which one or more little phlegmons 
form ; these suppurate and become fistulous ulcers. The ulcers 
are soon surrounded by soft, fungous flesh, and discharge sanies 
which leaves black stains upon the dressings. It was for a long 
time thought that this species of sanies was an infallible sign of 
caries; but it is now known that it may present itself in cases 
where there is no disease of the bone, but merely exfoliation of 
tendinous parts; while caries may exist without giving to the pus 
the property of blacking the dressings and instruments. 
We can assure ourselves of the presence of decay of bone by 
an assemblage of phenomena and especially by certain signs 
which are always present; thus, by introducing a stylet into the 
fistulous opening, we evidently discover that the bone is denuded 
and porous. If the bone be exposed, either from the removal of 
an escar, or by incisions, it will be black, spongy and rough; if 
it be pressed, a greasy and thick humour will be exuded through 
all the pores, and appears to saturate all the lamae of the bone. 
When the disease is permitted, to take its course, the bone will 
be destroyed in the same manner as it is in cancerous affection; 
the disease at the same time spreads itself and involves the neigh- 
bouring bones. The disease generally makes more rapid pro- 
gress in the spongy than it does in the compact substance of the 
bones. 
It is very seldom that caries is arrested spontaneously; and it 
is necessary to confine it, by a proper surgical operation, to the 
part affected; the most certain means to effect this is the applica- 
tion of the actual cautery, which instantly disorganizes the whole 
of the decayed part of the bone and converts it into a dry escar, 
which exfoliates and the soft parts will then cicatrize. 
All of the bones of the mouth may, from blows, gunshot 
wounds, &c. become carious; but decay of these parts is most DISEASES OF THE MOUTH. 
95 
commonly the result of syphilis, in which case, consecutive 
chancres that gradually enlarge and finally expose the diseased 
bone make their appearance upon the part affected. When the 
syphilitic affection is not arrested by a proper treatment, decay of 
the bones will sometimes make such rapid progress that a great 
part of the palate may be destroyed. Decay has been known to 
attack, at the same time, the nasal bones, and to destroy the whole 
of the surrounding parts; the face then presents a deep hole, which 
communicates with the interior of the mouth. If the disease be 
then arrested, the deformity may be corrected by false pieces. 
If I have devoted some time to the explanation of the diseases 
of the bones, it is because they are closely connected to those 
organs to which this work is particularly devoted. Desiring to 
have a knowledge of every thing which may throw some light 
upon the affections of the teeth, I have thought it necessary to 
examine the progress of the various diseases of the bones of which 
they form a part, and it is in this manner that I have collected 
sufficient information to present separately the history of disease 
peculiar to the teeth. 
Disease of the Teeth. 
SECTION VI. 
The teeth, in a state of health and beauty, are of a beautiful 
milk-white colour in children and adults; but as they advance in 
age, they become tarnished and assume an ashy or yellowish 
colour. There are some persons who preserve these organs in a 
state of health and beauty through life. 
The whiteness of the teeth appears to be owing, in a great 
measure, to the polish of their enamel. It is indeed observed that 
the yellowish or blackish hue of the teeth is often dependent upon 
a species of very fine tartar, which adheres to the little inequali- 
ties that cover the enamel surface of the teeth; so that it is only 
with the greatest attention to cleanliness that we can then prevent 
them from assuming a disagreeable colour. When the enamel of 
the teeth has a handsome polish, the tartar can scarcely adhere to 
it; the continual friction of the teeth, during mastication, is a means 
which tends to clean them. Mastication is so essential for the 
preservation of the whiteness of the teeth, that as soon as we 
abstain from it, these organs assume a dark hue and become co- 
vered with tartar, as always happens when, in consequence of 
tooth-ache, we chew on only one side of the jaws. In scorbutic 
affections, the gums swell, and the teeth become loose in their 
alveoli; they then cannot be used in mastication, and soon lose 
their whiteness. In adynamic fevers, various causes tend to 96 
blacken these organs; these causes are the defect of mastication 
the bad quality of the saliva, and the fetid exhalations which con- 
tinually arise from the stomach, which does not perform its func- 
tions, and even from the lungs. The kind of aliment which is 
eaten may also change the colour of the teeth; these organs are 
always of a blackish colour in persons who are in the habit of 
smoking or chewing tobacco, &c. The yellow colour of the teeth 
does not, however, always depend upon these various causes; 
sometimes it is the natural colour of the outer layer of the enamel, 
so that only the file can give them a lighter colour; but this ope- 
ration sometimes makes them liable to premature disease, so that, 
when the teeth are not naturally handsome, it is better to preserve 
them in that condition, than alter them in order to impart to them 
a handsomer appearance. The enamel is to the teeth what the 
cover is to porcelain, it not only serves as an ornament, but also 
to preserve them. 
We shall point out, in the third part of this work, the means 
necessary for the preservation of the teeth, and those remedies 
that are injurious to them. 
DISEASES OF THE MOUTH. 
The teeth are liable to become covered with tartar; that sub* 
stance appears to be secreted by the gums,* especially in persons 
who have these parts pale or of a livid red colour, soft and con- 
stantly bathed in viscid and abundant saliva. 
This substance amasses itself upon the teeth particularly during 
the night. At first, it is deposited in the form of a whitish slime, 
which adheres to the crowns of the teeth. If this slime be not 
removed, it hardens and soon becomes as hard as the teeth. 
Layer after layer of this substance is thus formed, until it causes 
the gums to recede and the teeth to become loose. This sub- 
stance is sometimes so abundant that it completely envelopes the 
teeth. We have seen, in the first part of this work, that a depo- 
sition of this kind, found upon a corpse, has led persons to suppose 
that the teeth of the individual were formed of one solid piece, be- 
cause the tartar then has a polish resembling that of bones; but 
generally, tartar collects upon the teeth in an irregular mass, and 
may accumulate in so great quantities as to form very large 
prominences upon the teeth. It will be readily perceived that 
constant cleanliness, and brushing the teeth with suitable denti- 
frices, are the proper means of preventing its formation. 
The Formation of Tartar. 
* Tartar, or more properly salivary calculus, is not, as M. Gariot sup- 
poses, secreted by the gums, but is a salivary deposite. For an explanation 
of the manner of the formation of this substance, the reader is referred to 
T. Bell's and other late works on the diseases of the teeth.-Eds. 97 
Persons whose teeth are most subject to the accumulation of 
tartar, are those who are of a pituitary or catarrhal constitution;* 
when they neglect to prevent its accumulation, and when this 
substance is permitted to collect for several years, the teeth be- 
come so accustomed to this covering that we often cannot 
remove it suddenly, especially during cold and damp weather, 
without producing tooth-ache and inflammation in the gums. In 
these cases we should choose warm and dry weather to remove 
the tartar gradually, and when the teeth are completely free from 
it, we may then, with proper care, prevent it from again col- 
lecting. 
DISEASES OF THE MOUTH. 
Denudation of the Teeth. 
The friction of the teeth against each other causes them to 
wear away in a very remarkable manner. We can discover 
changes in the form of the teeth, and in the exercise of. their 
functions, at different periods of life. About the seventh year of 
age, the deciduous teeth are subject to great alteration, although 
they have never exercised great force in mastication. The cut- 
ting edges of the incisores are thick, and the grinding surfaces of 
the molares are worn smooth. 
But that destruction is still more remarkable at the roots, which 
disappear entirely, as is seen in the deciduous teeth, which drop 
out of themselves. Denudation and destruction of the permanent 
teeth are not less observable, though they occur more slowly. 
The incisores are, at first, generally denticulated upon their 
cutting edges, the cuspidati and molares are furnished with tuber- 
cles or points. The rough edges of the incisores are soon disco- 
vered to disappear; they become blunt, and are gradually worn 
away in the direction in which they articulate with one another; 
thus the superior incisores are bevelled from behind forward, 
while the contrary is the case in the inferior incisores. When 
the inferior close anterior to the superior teeth, the direction in 
which the wearing away of these teeth takes place is reversed. 
At the same time that the incisores are becoming denuded, we 
observe that the points of the cuspidati and the tubercles of the 
bicuspides and molares are very sensibly worn down. Thus the 
teeth sensibly diminish in length, and often appear very short in 
old age, when the gums have not receded from them. 
* Salivary calculus accumulates on the teeth of some persons in much 
larger quantities than it does on those of others. The amount seems to be 
determined by the temperament and state of the constitutional health of the 
individual, and it varies as much in consistency and colour as it does in 
quantity. For a fuller description of this earthy deposite, see Delabarre's 
"Traite de la Seconde Dentition," and a "Dissertation," read before the 
American Society of Dental Surgeons, "concerning the Physical Characte- 
ristics of the Human Teeth and Gums, the Salivary Calculus, &c. &c."-Eds. 98 
If, during these different periods, we examine the roots of the 
teeth, we discover that they diminish in the same proportion that 
the crowns do, so that in old age they fall out, as the deciduous 
teeth do at the seventh year of age, deprived of nearly the whole 
of their roots. There is, however, this difference in these two 
sets of teeth; at the period of second dentition the alveolar cavi- 
ties contain the permanent teeth, whereas in old age these cavities 
become obstructed. 
Several circumstances may cause a variation in the mode in 
which the teeth are worn away; thus the incisores wear away 
much sooner when the molar teeth are lost, than when these 
teeth have been preserved; the same occurs when we masticate 
on only one side of the jaws. Teeth which are not used in mas- 
ticating scarcely experience any change, as may be seen in those 
teeth which have no antagonists. Some persons are affected, 
during sleep, with a kind of convulsive affection in the muscles of 
the jaw, so that the teeth are cracked by rubbing against one 
another, and are worn down very soon. It has been recom- 
mended, to counteract the effect of this spasmodic friction, to 
place a gold plate between the molar teeth. 
DISEASES OF THE MOUTH. 
Luxation of the Teeth. 
One or more teeth may be luxated, either from a blow or fall 
upon the jaw. When this happens, it will suffice to replace them 
and maintain them in their proper places, so that they may, in 
time, regain their former firmness. 
Many practiciens say that when a tooth has been luxated, it 
ceases to enjoy vitality, because its nerve has been ruptured. 
They think that the teeth are then retained in their sockets by 
adhering to the gums, as an artificial tooth which they may have 
inserted immediately after the extraction of a decayed one. But 
that opinion appears to me to be incorrect; for, whenever a tooth 
has not been entirely taken out of its socket, there remains a 
communication of vessels and nerves between it and other parts, 
it still has life, and may, by replacing it and abstaining from using 
it, become tight again in the same manner as other organs do. 
It is upon that erroneous opinion that dentists base an operation 
which is often followed with success, the reason of which it is 
necessary to explain. When a sound or decayed tooth occasions 
acute and constant pain, and it is desirable to preserve it for sake 
of appearance, the dentist will sometimes luxate it and afterward 
replace it; generally, this will dispel the pain, and the relief thus 
obtained has been attributed to the rupture of the nerve, which 
produces death of the tooth. It is easy to conceive that a sudden 
displacement, accompanied by the laceration of several parts, pro- 
duces a strong counter irritant, and that an acute pain causes all DISEASES OF THE MOUTH. 
99 
other pains of less intensity to cease, without the tooth being de- 
prived of vitality. 
When it occurs that the pain is not entirely subdued by luxa- 
tion, or when it returns a short time after, they then think that 
the operation has not been well performed, and consequently the 
nerve has not been entirely ruptured. But by a correct knowledge 
of the natural progress of organic phenomena, we know that di- 
vided parts are not necessarily deprived of life when they cease 
to be in apposition with one another; and as long as they pre- 
serve a slight adherence, if it be but by a single point, they are 
capable of uniting and regaining their former firmness, enjoying, 
as they did before, all the properties of life, both in a healthy or 
diseased condition. 
Fracture of the Teeth. 
Teeth, when much decayed, are often fractured in consequence 
of their inability of bearing the force that they are to sustain. If 
the root be sound, if it has not occasioned any pain, it may remain 
for a long time surmounted by an artificial crown. When the 
surface of the root presents asperities, these should be removed 
with a file; when there is a cavity in the middle, it should be 
filled with metal, in the manner hereafter to be described. But if 
the root be productive of acute pain, inflammation, depositions, 
&c. these symptoms should be subdued by the extraction of the 
root, or, if possible, by the actual cautery. 
Sound teeth may also become fractured from various accidents, 
either from hard bodies in mastication, or external violence. 
These fractures may only affect the crown, or be contained along 
the root; finally, the tooth may be cracked or fractured or split, 
loosening the fractured parts. When but a part of the crown of 
a tooth is fractured, the remainder of the tooth should be pre- 
served, and we have had teeth thus treated remain as long as the 
other teeth. There is no doubt, however, that a tooth which is 
naturally disposed to be affected with caries will sooner become 
diseased when fractured. 
In fractures of that kind, when one of the fragments is entirely 
separated, a re-union will never take place; but when the fracture 
is longitudinal or oblique, and when the two fractured parts still 
adhere to the gums and periosteum of the socket, they are still 
under the influence of vital action and are susceptible of a re- 
union. 
Whatever the generality of dentists may say upon this subject, 
it is certain that some simple fractures of the teeth are susceptible 
of a complete consolidation, which is effected by means of callus.* 
* We are compelled to differ with M. Gariot, with regard to the recupe- 
rative powers of dental bone; inasmuch as all observation and experience 
go to establish the fact that it is not endowed with this attribute.-Eds. 100 
Simple fractures of the teeth only require the attention that is 
necessary for all other solutions of continuity of hard parts; it is 
essential to reduce the fractured parts if they be displaced, to 
maintain them in contact with each other; time and rest will then 
favour the development of the phenomena which are to produce a 
re-union. The fractured parts are retained in position by means 
of a silken or metallic ligature placed around the tooth and at- 
tached to the adjoining teeth. 
If the tooth be broken, if there remain points which irritate the 
neighbouring parts, if it produces pain, inflammation, phlegmons, 
&c. we cannot then hope for a union, and the only remedy 
would be to extract the tooth, or to put it in such a condition so 
as not to produce any of the above evils. 
DISEASES OF THE MOUTH. 
Caries of the Teeth. 
It is remarked that the organic tissue of the teeth is scarcely 
subject to any affection but caries; it does not experience- real 
exfoliation, it is not exposed to necrosis, properly so called, and 
seldom appears to be attacked with those swellings or tumours 
which constitute the various kinds of exostoses. There are, 
however, some instances when they undergo a kind of softening. 
As to caries which attacks the teeth, its progress is peculiar in 
these organs. 
It is easy to see that the disease termed erosion in the majority 
of dental works, is nothing more than caries. It makes its ap- 
pearance, generally, in rachitis and scorbutic affections. If the 
teeth, during those affections, are tender, if they have not attained 
their entire development, if they be not entirely covered with 
enamel, lastly, if their crowns be not wholly through the gums, 
they may be attacked with erosion. This disease manifests itself 
in little points or yellow or black holes which cover the surface 
of the teeth. Sometimes these little holes or depressions reach 
the osseous structure of the teeth, having pierced the thickness of 
the enamel. 
This disease is developed especially in rachitis, and is only an 
extension of the general affection of the bones, which even mani- 
fests itself upon the teeth. These organs are more readily affect- 
ed with this disease when they are far advanced in their develop- 
ment. 
The deciduous teeth, in consequence of rachitis, are sometimes 
softened, and are affected with caries as soon as they make their 
appearance through the gums. The teeth of second dentition, in 
some circumstances, while they are enclosed in their alveoli, be- 
come tarn;shed, dried up, and are never developed; the jaw then 
remains short, as it is arrested in its growth. 101 
Caries or erosion mayalso manifest itself in the teeth of childrenof 
a scorbutic diathesis, and in all cases of consumption, during which 
disease their various pans undergo a gradual wasting. 
This disease of the teeth scarcely requires any local treatment, 
the general affection which has produced it, requires our especial 
attention. When we, by care, diet, and proper medicines, have 
arrested the progress of scrofula in children, we have reason to 
hope that the teeth of second dentition will be properly developed, 
and will not be affected by that disease. 
The causes of caries are constitutional or local; the former 
depend upon a weak, catarrhal constitution, an unhealthy condi- 
tion of the gastric apparatus, and some constitutional affections; 
the latter are the result of aphthee, inflammation of the gums, 
odontalgia, the various lesions of the teeth, a crowded state of 
these organs, the vitiated condition of the saliva, the nature of the 
aliment, &c.* 
Decay generally commences upon the molar teeth. It, at first, 
consists in a little yellow spot, which afterwards blackens and 
produces pain; this spot gradually extends, the pain becomes 
more acute, and the tooth is readily affected by heat, cold, and 
acids. 
The teeth generally commence to decay at the points which 
are contiguous to one another, and we frequently see several of 
them decayed in this manner, so that it is desirable to have them 
separated from one another. It has been observed that when a 
molar tooth is decayed, the corresponding tooth on the opposite 
side of the jaw will be decayed in the same manner and at the 
same time. This important observation shows that there are 
cases in which the affection of a part will soon be communicated 
to the corresponding part on the opposite side. 
It is possible, however, that the decay might, in such cases, 
depend upon a nervous derangement, seated in the fillets of nerves 
upon both sides. The decay of a tooth also appears to commu- 
nicate the same disease to the corresponding organ in the opposite 
jaw, with which it is constantly in contact. 
It is singular to observe that as the crown of a tooth is 
destroyed by decay, the root often diminishes in the same pro- 
portion, without its having been affected with this disease, so that 
when the crown is entirely destroyed, there will be nothing left 
of the roots but some isolated fragments of about a line in depth. 
Caries often commences in the middle of the crown of the 
molares, and by its progress leaves a large hollow cavity in the 
interior of the tooth. Sometimes in the decayed tooth only a 
DISEASES OF THE MOUTH. 
* Caries is always the result of chemical action upon the organ.-Eds, 102 
DISEASES OF THE MOUTH. 
small lateral opening is visible externally, which leads to a large 
one in the interior of the organ. 
The molares generally become decayed before the incisores 
and cuspidati, the disease in these last nearly always commences 
at the points that are contiguous to the adjoining teeth. 
Various remedies have been recommended to arrest this disease. 
The first care to be taken, when the teeth present a black spot at 
the part where it is in contact with the neighboring organ, is to 
separate them with a file, applying the file so as to remove the 
decayed part. This operation often puts a stop to the disease. 
When the disease has produced a cavity in the substance of the 
tooth, it will then make rapid progress, which is favored by the 
contact of air, saliva, &c. these causes may be prevented from 
acting upon the diseased part, by filling the cavity with gold, 
silver or lead. 
The actual cautery, heated to a white heat and applied to the 
decayed part, is recommended to relieve the pain and to arrest 
the progress of the disease, because it is thought that this remedy 
is capable of completely destroying the nervous action of that 
osseous organ. This remedy does often relieve the pain, and 
would seem to arrest the progress of the decay; but the tooth is 
never entirely dead, since it remains contiguous to the neighbor- 
ing parts. The decay continues to destroy the tooth slowly; and 
at the expiration of a longer or shorter time, the tooth may still 
occasion pain. When the decay has made great progress and 
frequently occasions pain, it would be better to extract the tooth. PART THIRD. 
HYGIENE AND THERAPEUTICS. 
Having given a description of the parts which enter into the 
formation of the mouth ; having endeavoured to point out the 
particular use of each of these parts, also their general functions 
in the performance of mastication and pronunciation; having 
given the history of the various diseases to which these different 
parts of the mouth are subjected, we now propose to examine and 
point out the hygienic and medicinal remedies that should be 
employed; the one to preserve these parts in a healthy condition, 
the other to remedy the various diseases to which they are liable. 
The means made use of to preserve the health and to cure the 
diseases of the mouth are required at three epochs of life, during 
which they are especially necessary. 
The first period is during the eruption of the milk teeth ; the 
second is during the eruption of the permanent teeth; the third 
is during the remainder of life. 
SECTION I. 
The Eruption of the Teeth of First Dentition. 
The difficulty that the deciduous teeth experience in making 
their appearance through the gums, in a great number of children 
who reside in cities, depends generally upon the feebleness of 
of their constitution and their more or less nervous temperament. 
The teeth of a strong and healthy child are readily cut, and do 
not occasion the slightest derangement in the system ; they make 
their appearance at the proper time, and it often happens that 
their eruption is effected previous to the usual period. Dentition, 
in weak children, and such as are of a nervous susceptibility, who 
generally have delicate parents, is often attended with great diffi- 104 
HYGIENE AND THERAPEUTICS. 
culty, and it may produce evils which may put the life of the 
child in jeopardy. 
The eruption of the deciduous teeth, which is not generally 
announced by any symptoms in healthy children, is very remark- 
able in others by a series of very extraordinary symptoms; these 
are either seated upon the gums, in the digestive apparatus, or in 
the nervous system. 
The condition of the Gums during the eruption of the Deciduous 
Teeth. 
We observe, during the period of the eruption of the deciduous 
teeth, that the gums of sickly children are swollen and assume a 
very red hue, the saliva is secreted in great quantities, and is 
constantly flowing from the mouth. The child then experiences 
a painful sensation in the gums, which induces it to put its fingers 
constantly in its mouth, and to bite every thing which it may have 
in its hands. It has been asserted that the difficulty which the 
teeth experience in rising from the alveoli depends upon the re- 
sistance of the gums, hence attention has been directed to means 
calculated to soften the gums and to enable them to give an easy 
exit to the teeth. But that opinion is altogether erroneous; the 
evils which arise at the period of first dentition are not occasioned 
by that cause; they are produced by the difficulty that the or- 
ganism experiences in effecting the development of the germs, 
and the great nervous irritation in these parts. It is, in fact, 
observed that, when the germs of the teeth are easily developed, 
the gums appear to open of themselves, to give a free passage to 
the teeth. 
It can be easily imagined from the foregoing remarks, what 
reliance can be placed in the use of corals and other hard bodies 
designed to soften the gums; all these are, to say the least of 
them, useless, and are often productive of serious consequences. 
Thus, a nervous child laboring under dentition, is induced to rub 
his gums; should a hard substance be then placed in his hands 
he irritates the parts with it and may increase the nervous irrita- 
tion which it was designed to allay, If the use of the coral does 
not increase irritation in the gums, it is more calculated to harden 
than to soften the parts by the constant friction. 
The. means capable of opposing the Derangement of the Gastric 
Apparatus during first dentition. 
The germs of the teeth during the first six months of infancy 
which are then concealed in the alveoli, increase very gradually, 
but at the period of their eruption, their growth is very rapid. 
The jaws are forced to yield to the development of the teeth, they 105 
undergo a change in their form, dilate and enlarge very suddenly, 
especially near the alveolar border, so that the whole apparatus 
of mastication becomes a point of remarkable action during the 
whole period of the eruption of the teeth. 
It is probably from.the eruption and the shedding of the teeth 
that such a predominant vital action is produced, during the 
period of infancy about the head, either by the excess of heat of 
the head, the rapid growth of the hair during health, or by the 
various phlegmasiae during sickness, which attack the glands or 
the cellular tissue in the neighborhood of the jaws, in the mouth 
and upon the skin, covering the head and face. 
Generally the irritation of the mouth during first dentition 
extends itself along the alimentary canal, and produces derange- 
ment in the functions of the digestive apparatus. The secretion of 
saliva is much increased, loses partly its digestive properties, 
and becomes very irritating, as do all secretions in an unhealthy 
state. The food when mixed with this saliva does not properly 
undergo the first change necessary for digestion, it passes into 
the stomach which is itself irritated by nervous sympathy, and 
consequently not well calculated for good digestion. The alimen- 
tary substances which thus preserve their crude state, are con- 
veyed into the intestines which in consequence becomes irritated, 
and the food merely passes through without affording nourishment. 
Children whose digestive apparatus is deranged by first dentition, 
are attacked with frequent vomiting, a constant diarrhoea, and 
have a dislike for all kinds of aliment, and a ravenous appetite 
alternately. 
If the digestive apparatus remains for a long time in a derang- 
ed state, the child gradually grows weak, and he loses the 
strength and energy necessary to effect the development of the 
teeth, so that the cause of the disease is prolonged by the effect 
which it has produced. The child is in this way often kept in a 
consumptive state, which finally terminates fatally. 
It will be conceived that it is more easy to prevent, or arrest, 
in the incipient stage, the disorders of the digestive apparatus 
occasioned by the eruption of the teeth, than to remedy them 
when they have been of long standing. 
The best means generally, of facilitating the eruption of the 
teeth is by keeping the digestive apparatus in a healthy condition. 
This, in a great measure, is dependent upon the manner in 
which the child is nourished. 
In order that children may have a good and robust constitution, 
it is important that their food should be given in moderate 
quantities. An excess of nourishment, by overcharging the 
stomach, weakens and disposes it to frequent and varied derange- 
HYGIENE AND THERAPEUTICS. 106 
HYGIENE AND THERAPEUTICS. 
ments; there will arise less inconvenience from giving a child a 
small quantity of nourishment than from overloading its stomach 
with food, for nourishment does not depend so much upon the quan- 
tity of food taken into the stomach, as upon the proper manner of its 
being prepared for digestion. Upon this important point of the 
physical education of children, maternal solicitude is often in 
error. Very often slight colics, pain in the gums and sometimes 
merely drowsiness, occasions the child to cry, the mother then not 
being mindful of the numerous causes which may occasion this 
fretfulness, endeavours to quiet the child by giving it the breast, 
this being repeated whenever the child cries, he will then 
become both a fretful and gluttonous child. 
The mother from the continual crying of the child, very soon 
thinks that her milk is not sufficiently nourishing, she now en- 
deavours to make up for this deficiency by giving it soups, very 
often improperly made, and scarcely ever congenial to the feeble- 
ness of the child. Such diet produces humoral plethora which 
manifests itself in various parts, especially about the head. 
The diet of children should be given in moderate quantities, 
and time should always be allowed for the food to be well digest- 
ed before more is given. Without this latter precaution there 
will be found no chyle which serves for the maintenance and the 
development of the parts by imparting to the whole organism the 
degree of strength and energy of which it is capable of. 
As dentition depends upon the health of the system generally, 
it is important to neglect nothing which may contribute to that 
end; hence it will be proper to exercise the child according to 
its age and strength, and it should sleep well during the night. 
It should be borne in mind that children very easily contract 
habits which become more difficult to correct, the longer they 
are indulged in them; a child who has been awakened several 
times in the night successively, in consequence of a disease, may 
continue to wake at about the same hour after the disease has 
been removed, and if he is taken up and given the breast every 
time he awakens, it will become a habit from which it will be 
very difficult to wean him. 
If health is important for an easy eruption of the teeth, we 
cannot insist too much upon the means necessary to obtain it. 
The mother who is so very solicitous for her child, and who can- 
not hear him cry without giving something to appease him, 
does not contribute the most towards his health ; but she, who 
directs his physical education in a regular manner, and who 
does not deviate from her usual course by every little occurrence, 
promotes the health of her infant. 
By adopting these simple and easy rules we assist nature in HYGIENE AND THERAPEUTICS. 
107 
developing an original good constitution, and in correcting an 
unhealthy one. 
In this manner are diminished the number and serious nature 
of the diseases which attack childhood, among which the evils 
produced by teething, are not the least formidable. 
Should we not be able to prevent the derangements of the 
intestinal canal, which generally manifest themselves during first 
dentition, we should endeavour, as much as possible, to relieve 
them. If the diarrhoea be moderate, if the matter evacuated be 
yellow and a little fetid, it should not be arrested; this symptom 
generally continues during the most vigorous efforts made by the 
teeth in coming through the gums, and is afterwards arrested 
spontaneously. But when the diarrhoea is very active, the eva- 
cuations green, slimy, or mucous, emits an extremely insipid or 
fetid odor, we should use every endeavour to relieve those symp- 
toms of disease ; for this purpose, we may advantageously give 
several doses of ipecacuanha, mucilaginous drinks and weak 
cordials. As the treatment of this disease comes more properly 
under the province of the medical practicien, we shall not give a 
detail account of its treatment. 
The manner of treating Convulsions produced by Dentition. 
During the eruption of the deciduous teeth, there are some 
children who appear to be in a continual state of spasms, these 
are indicated by a kind of general irritation and frequent tremors 
of the limbs. If the pain of the gums during dentition be very 
great, several slight convulsions will supervene. Very weak 
children may be so often attacked with convulsions, and the pa- 
roxysm of each convulsion may continue so long that its death 
is the result. 
Children who appear to be the most subject to this affection 
are those who are offsprings of weak, nervous and sickly parents. 
They have a delicate constitution, they are generally very restless 
while asleep, and are startled by the least motion or noise. This 
original disposition is often aggravated by a great number of 
circumstances dependant upon their mode of education, and which 
tend to keep up the extreme sensibility of the patient. 
As children of this temperament are generally offsprings of 
wealthy persons, they are mostly nursed in such a manner that 
their predisposition to convulsions is generally more likely to be 
increased than diminished. 
A child of a delicate and nervous constitution should not be 
nourished by its mother when she is weak, very nervous, very 
gay or very irascible, but it should be placed under the care of a 
nurse residing in the country, who, together with the other neces- 108 
HYGIENE AND THERAPEUTICS. 
sary qualities of a good nurse, should be very kind, and be rather 
more serious than lively. 
The constant influence of a woman of this character, would 
soon subdue the irritability of the child. 
When a child has inherited from weak and nervous parents a 
delicate constitution, and a predisposition to convulsive affections, 
it wobld not be proper for it to be nourished with its mother's 
milk, fiSr this would tend to increase that disposition. We cannot 
deny that the quality of the milk partakes much of the peculiar con- 
stitution of the nurse. The milk, of a nurse who lives regularly, 
who possess soft manners, and is engaged in labor adapted to her 
constitution, is always sweet, and is always the same. The 
milk on the contrary, of one who lives luxuriously, who eats an 
abundance of acrimonious and stimulating substances, who has 
very strong passions, and who continually remains in idleness, 
furnishes milk wffiich easily undergoes a change in quality; the least 
physical derangement, or the slightest moral affection changes 
the regular mode of secretion of this fluid, and renders it irritating. 
Children have been known to be attacked with severe colics, a 
short time after their nurse had eaten too much, or when they had 
labored under any moral affection, as anger, &c. 
If the precautions pointed out by us, have not been adopted to 
destroy the predisposition to convulsions, all means should be em- 
ployed to prevent these affections which are likely to show them- 
selves at the period of first dentition. 
These means do not consist in the use of necklaces, amber and 
amulets of various kinds, accredited by ignorance and credulity ; 
but are contained in the treatment based upon hygienic principles, 
and a good physical education. Thus frequent exercise in the 
open air, bathing every day in water of a temperature regulated 
by the state of the atmosphere are indicated. The food of the 
child should be in sufficient quantities, regular, but not too abun- 
dant. It would also be advantageous to accustom it to be mode- 
rately clad and to have its head uncovered, being careful to 
avoid extremes into which those mothers fall, who leave their 
children almost naked during cold weather. The custom of 
leaving the arms of a child bare as high as the shoulders in cold 
weather, may produce serious consequence, especially if the child 
be of a catarrhal constitution. 
Some parents allow their affection for their children to carry 
them to such extremes that they seldom do what is deemed the 
most advantageous for their health. If a physician informs a 
mother that too much clothing renders a child liable to take cold 
more easily, she will then leave her child almost naked. Another 
physician who sees the evil consequences of so outrageous a 109 
practice, advise proper clothing, the child will then be smothered 
with wearing apparel and bed clothes. There is in all things a 
medium that should be observed. 
If we be unable to correct a highly nervous constitution, or to 
prevent convulsions, which may be brought on during the erup- 
tion of the deciduous teeth, it will be necessary for us to discover 
the remedies best calculated to arrest the effect of these affections. 
Among the various means proposed for the cure of convulsions 
in children, there are none possessing greater efficacy thhn the 
application of leeches to the angles of the jaws. Local bleeding 
is always calculated to diminish all nervous excitement. 
Those substances which are looked upon as the most powerful 
anti-spasmodic, such as opium, musk, camphor, &c. are certainly 
very energetic stimulants, capable of preventing convulsions by 
their counter action upon the nervous system, but in order that 
they may act beneficially, they should be given before the 
paroxysms, more for the purpose of preventing the return of con- 
vulsions than to arrest them during their attack. 
We shall not enlarge upon the remedies proper to subdue con- 
vulsions, as they come properly under the province of the physician. 
HYGIENE AND THERAPEUTICS. 
SECTION II. 
The manner of directing Second Dentition. 
A well arranged denture is much more important than is gene- 
rally supposed, for teeth badly arranged impair pronunciation 
and mastication, and are not very firmly placed in their sockets, 
because their roots are sometimes partly out of their alveoli. An 
irregular set of teeth does not exhibit that arrangement which a 
regular denture does where these organs mutually sustain one 
another, and where the jaws shut properly, which latter circum- 
stance is very important for the preservation of the teeth. Irregu- 
lar teeth are very difficult to be kept clean, they do not resist 
the various diseases of the mouth as much a# regular arranged 
organs do, and their preservation is of shorter duration. These 
circumstances together with the unseemly appearance of a 
deformed denture, should induce persons having children under 
their charge to examine their mouths often, so as to correct any 
defect in the arrangement of the teeth. We might at first be 
induced to believe that this attention is useless, since the teeth 
of country people generally arrange themselves properly, and 
remain very white and very sound without the assistance of art. 
But it should also be observed that generally the constitutions 
of country persons are such that the effort of the economy is 110 
HYGIENE AND THERAPEUTICS. 
sufficient of itself to perform all of its operations, while it becomes 
necessary to assist her whenever she appears not to possess 
proper energy. Moreover we frequently meet even among 
country persons with badly arranged dentures, in consequence 
of some trifling neglect. The effort of the organism always acts 
more favorable when assisted than when left to itself. 
The eruption of the permanent teeth is in children residing in 
cities very often attended with great pain, and requires constant 
attention. The eruption of these teeth often produces the same 
evils that are the result of first dentition. Diarrhoea and 
even convulsions often supervene during the eruption of the 
permanent teeth, but generally these diseases do not occur as 
often, and are not as fatal as when they attack children in their 
first and second years of age, at which period the organism has 
not acquired a sufficient force to resist these derangements. The 
evils attendant upon second are to be treated as those occurring 
during first dentition, which have been treated of in the preceding 
chapter. 
The deciduous teeth should be removed previous to the eruption 
of permanantes, the former often remain very firm in their sockets, 
and prevent by their presence the permanent teeth from arranging 
themselves in their proper positions. The milk teeth, however, 
should not be extracted too early, for they favor the develop- 
ment of the jaws; hence they should be allowed to remain as 
long as they are not an obstacle to the eruption of the permanent 
teeth, but when they are loose and the permanantes are about 
piercing the gums they should be extracted. 
It should be remembered that the permanent are much larger 
than the deciduous teeth, as they have on their first appearance 
through the gums attained their full size. It is also ascertained 
that at the period in which the teeth are shed, the jaws have not 
their full growth, especially near the alveolar border. 
From the foregoing observations it will be perceived that the 
permanent do not occupy the precise place of the deciduous teeth, 
but are a little to ooe side of the place occupied by the latter; so 
that the presence of the deciduous teeth, without preventing the 
eruption of the permanantes, may cause them to assume an irreg- 
ular direction. The permanent being larger than the deciduous 
teeth, are necessarily very much crowded, and with difficulty 
arrange themselves upon the alveolar border, which at the time 
of the eruption of these teeth, has not received its full size. In 
proportion as the maxillary bones increase in size, the roots of 
the teeth are developed, and these organs are then provided with 
more space in the maxillae. 
Should we neglect to extract the milk teeth, and to employ HYGIENE AND THERAPEUTICS. 
111 
other measures capable of favoring a good arrangement of the 
permanent teeth, deformities, often very serious, and always much 
easier to prevent than to remedy, may be the result. 
I however repeat, that the milk teeth should not be removed 
too early, especially when not decayed, loosened, or when they 
are not an obstacle to the eruption of the permanantes, and when 
they do not cause these to deviate from their proper places; 
because their presence contributes to the development of the 
alveolar border, which is one of the most essential conditions for 
the regular arrangement of the permanent teeth. 
Neither should we regard a slight deviation of the permanent 
teeth, dependent upon a defect of position; because we daily see 
that these teeth become regular as the alveolar border enlarges; 
hence we should avoid unnecessary meddling with them, as they 
will, in time, regulate themselves. 
The extraction of the deciduous teeth, at the period of second 
dentition, is very easily accomplished, as they are then devoid of 
roots, and are, for the most part, very loose; a ligature will often 
be sufficient for this purpose. When these teeth are firmly retained 
in their sockets, a small hawk's-bill forceps may be used to re- 
move them. If the deciduous teeth have not been removed at the 
proper time, they will remain in the mouth for a considerable 
length of time, and appear to be retained by the permanent teeth 
which are situated on each side of them ; some effort will then 
be required to extract them. This phenomenon generally happens 
to the cuspidati: persons who retain the cuspidati of first and 
second dentition are said to have double teeth. It is not rare to 
witness this class of teeth, appertaining to both dentitions, remain 
in the jaws through life-time; they are, in such cases, situated 
one before the other, the front ones sometimes so prominent as to 
produce a very repulsive appearance. If we extract, no matter 
at what period, one of these, the other will by degrees occupy 
the place destined for it, either in consequence of the constant 
pressure of the lips, or by that of the tongue. It often happens that 
the permanent teeth are more rapidly developed, or are propor- 
tionately larger than the jaws, they then, being unable to arrange 
themselves properly, are very much crowded together, and are 
very irregular. An arrangement of this kind occasions very 
serious inconveniences. The teeth which are crowded together 
cannot be easily cleaned, the saliva often of a bad quality, and 
the alimentary substances insinuate themselves between the teeth, 
remain there for a time, and cause them to decay. A great 
proof of the correctness of this opinion is, that the teeth nearly 
always commence to decay at the parts which are in contact 
with each other, and that teeth which are naturally separated, 112 
remain much longer in a healthy state than those do which are 
crowded together. 
Every dentist has witnessed the bad effects of a crowded 
denture, and some have felt the necessity of sacrificing a sound 
tooth for the preservation of the rest; the tooth thus sacrificed is 
generally the first bicuspid.* This operation would at first appear 
very improper, and it cannot be imagined how we can extract 
four sound teeth which have produced no pain. But if we reflect 
upon the important advantages that result from this mode of 
practice, we will discover that they have not been dearly bought. 
Its first good effect is the removal of one of the principal causes 
of caries of the teeth. It is well known that when a tooth decays, 
the progress of that disease frequently produces an insupportable 
pain, causes the adjoining tooth to decay, and, after suffering 
with the tooth-ache for a time, puts the patient under the neces- 
sity of resorting to the operation of extracting a tooth which can 
no longer be retained. If the operation of extraction be a long 
time deferred, if the greater portion of the tooth be destroyed, 
finally, if the patient have not recourse to a skilful dentist, the 
tooth will crumble away, and he will still retain a root which 
produces the same pain, and which can only be removed with 
difficulty. The extraction of teeth which are very firmly situated 
in their sockets should occasion no alarm; for there is a method 
of loosening them sufficiently, so as to enable us to extract them 
with facility and without much pain ; it consists in placing a large 
ligature around the neck of the tooth, and allowing it to remain 
for several days, so as to loosen if. 
After a tooth has been extracted, the place which it occupied 
gradually closes up, by the approximation of the teeth on either 
side of the aperture. The obliteration of the aperture made by 
the extraction of the tooth can be greatly facilitated by placing a 
ligature around the teeth on each side. The other teeth may, if 
crowded, be separated by the use of ligatures. 
When the teeth have thus been separated, they can be more 
easily cleaned, and their preservation will be greatly enhanced. 
HYGIENE AND THERAPEUTICS. 
Manner of correcting Irregularities. 
When the permanent teeth, either through negligence or 
unavoidable circumstances, have assumed an irregular arrange- 
ment in the maxillae, the dental art still furnishes several means 
of correcting this deformity ; but recourse should be had to them 
as soon as possible, for the difficulty of remedying the evil 
increases with the age of the subject. 
* See Bourdet, p. 66, vol. 1. HYGIENE AND THERAPEUTICS. 
113 
Irregularities of the teeth arise from their inclination outwardly, 
inwardly, or laterally, or from disorder occasioned by their 
transposition. These various species of mal-arrangement of the 
teeth require different means for their correction. 
Mal-arranged teeth may be made to assume their proper posi- 
tions, either by means of a slow and constant process unaccom- 
panied with pain, or by an operation which is attended with some 
pain, but which acts more promptly, and which consists in luxating 
the organ and retaining it in its proper place until it has regained 
its solidity in the alveolus. When the permanent teeth cannot 
arrange themselves regularly, for want of room, a tooth must 
then be sacrificed. It will be necessary to enter into a detailed 
account of the use of the various means of regulating teeth. 
A tooth which has taken a mal-direction may always be brought 
into its proper position by a very slight effort, if sufficiently long 
applied. If we reflect upon the nature of this phenomenon, we 
will be surprised to see with what slight effort parts can be made 
to alter their course. It is in this manner that we sometimes 
witness the most extraordinary changes in the organism. Thus, 
in scrofulous affections, which are always accompanied with a 
condition of general debility, the effects of which manifest them- 
selves particularly in the osseous system, we see the bones gradu- 
ally yield to the constant weight of the body, or to the repeated 
action of the muscles which are attached to them, so that the 
bones become bent in various directions; analogous effects are 
artificially produced upon the teeth. Hence, when we design 
to change the direction of a tooth, we pass a ligature around the 
neck of the organ, near the gum; the tooth then becoming loosen- 
ed, will easily yield to the means which are made use of to give 
it the desired direction. 
We should observe that in this operation it is not merely an inert 
power that we are to overcome, but an active force, the direction 
of which we are to change, and this can be easily accomplished. 
From the foregoing observations we can understand how a liga- 
ture often suffices to reduce a tooth which is very much thrown 
anterior or posterior to the dental arch. For this purpose, the 
ligature is to be attached to the neighboring teeth, and then passed 
around the organ to be regulated ; the humidity of the mouth 
swells the thread, this shortens, and thus the tooth is forced into 
the desired direction. The thread should be renewed or tightened 
every day. If this means should not prove effectual, a gold or 
ivory plate should be used; the plate should be applied to the 
tooth which is to be regulated, at the same time resting against 
the neighboring teeth; it should contain several holes, through 
which ligatures should be passed. This fixture must vary in its 114 
HYGIENE AND THERAPEUTICS. 
construction, to suit the peculiarities of the case, and its success 
greatly depends upon the judgment of the dentist. It would be 
too fastidious to detail every operation of which the teeth are 
susceptible. 
If the patient should be unwilling to be incommoded by the 
constant use of a ligature or plate in his mouth, the irregular 
tooth can be brought into its proper place with the key; but this 
is attended with danger. If great precautions be not taken in 
performing this operation, if it be not effected gradually, we would 
be liable to break the tooth. In order to avoid accident in the 
performance of this operation, a ligature should, several days 
previously, be lied around the neck of the tooth; it should be renewed 
daily; in this way the tooth will become loosened, and be more 
readily brought, by means of the pelican, into the desired position. 
The teeth which are decayed should be extracted ; but if all of 
the dental organs are sound, we should remove the first bicuspides ; 
these teeth are situated near the middle of the mouth, and their 
loss can scarcely be detected. When sufficient space has thus 
been obtained, the teeth must be brought into their respective 
places, in the manner we have just mentioned. 
To separate teeth which are crowded, we may place between 
them threads or wedges, the size of which must be increased as 
the organs separate from one another.* 
SECTION III. 
Means used for the Preservation of the Teeth and other parts of 
the Mouth, at different periods of life. 
Persons who are sickly, especially those laboring under de- 
rangement of the digestive apparatus, should pay especial care to 
their mouth; the saliva, in such individuals, is generally very 
acrid, and deposites, upon the teeth, tartar in a greater or less 
quantity. These causes tend to decay the teeth. 
The surest means of preventing, or at least of greatly retarding 
that serious evil, is to clean the teeth every morning and after 
each meal. This practice might at first appear very troublesome, 
but if we once accustom ourselves to it, we will perform this 
duty easily and regularly. 
The proper manner of cleaning the teeth is to first rinse the 
mouth with water, (tepid in winter,) containing a few drops of 
brandy or cologne, and then brush the teeth wTith a brush of the 
* For a description of better and more adequate means for remedying the 
evils here treated on, the reader is referred to Fox, Bell, Delabarre, and other 
more modern authors upon the subject.-Eds. 115 
HYGIENE AND THERAPEUTICS. 
proper stiffness. It would also be well to clean the tongue with 
a tongue scraper whenever there has been any slime deposited 
upon it during the night; the mouth should again be rinsed. 
Persons who do not clean their teeth daily, and those upon 
whose teeth tartar easily collects, should use a dentifrice. Those 
sold in shops, composed of ingredients which are not known, 
should not be used; they are generally made by persons who are 
ignorant of the proper means of preserving the teeth; hence it 
frequently happens that the substances of which they are com- 
posed are more calculated to injure the enamel of the teeth, than 
to preserve it. It is true that those powders frequently clean the 
teeth very well, but it is nearly always at the risk of their pre- 
servation. I have convinced myself by analysis, that most of 
the powders and opiates, sold in shops, contain brick-dust or fine 
grit,' and cream of tartar, which is a tartrite of potash, and other 
various acid substances. Fine grit, which is nothing more than 
powdered flint or stone, is too hard, and wears away the enamel 
very fast. 
The habitual use of acids will certainly destroy the teeth, as 
these organs are composed of the phosphate and carbonate of 
lime. If the teeth were not living organs capable of resisting the 
action of agents which tend to injure them, when these agents do 
not possess a certain degree of energy, it is evident that acids 
would not fail to injure them; because it is well known that when 
a tooth is dead, the enamel and bony structure can be completely 
destroyed by strong acids, and the very weak acids will destroy 
that part of the teeth which are composed of the carbonate of 
lime, as this salt is readily decomposed by any acids. 
But although the vital action of the teeth resists that cause of 
destruction, it however should not be abused, for it is always to 
be feared that those destructive agents will act energetically upon 
the teeth of delicate persons, the various parts of whose mouth 
do not enjoy a great force of re-action, and particularly upon teeth 
already attacked with incipient caries. 
It is from the well known evil effects of these powders and 
opiates that many persons have substituted for them powdered 
charcoal or tobacco, calcined crust of bread, &c. These sub- 
stances possess no injurious qualities, the only objection which 
can be alleged against them is their disagreeable taste and color. 
It is at present an easy matter to compose powders or electuary 
dentifrices which have all the advantages to be desired in such 
preparations, that is, which clean the teeth without exercising too 
much friction upon their enamel, which possess an agreeable 
odor and color, and which even possess the power of imparting 
a handsome rose color to the gums and lips. We shall at the 
end of this part of the work give several formulae of these powders. 116 
HYGIENE AND THERAPEUTICS. 
We should accustom ourselves in cleaning the teeth after each 
meal; a tooth-pick made of quill or wood should be used so as to 
remove particles of food which may have remained between the 
teeth. They must then be wiped with a towel and the mouth 
should afterwards be rinsed. 
Notwithstanding all of these precautions, it often happens that 
tartar which easily and in quantities collects upon the teeth of 
some persons, will insinuate itself between the teeth, collect upon 
their posterior surfaces and around their necks where it is difficult 
to remove, when the motions of the tongue are insufficient to pre- 
vent its accumulating at these points, recourse should be had to 
a dentist. The mouth should be examined at least twice a year, 
so that any disease w'hich may attack the teeth can be arrested 
in its early stage. 
As decay generally commences at the parts of the teeth which 
are in contact with each other, and announces itself by a black 
spot; such teeth should be separated with a file so as just to 
remove a sufficient portion of each organ as will admit of the 
introduction of a tooth-pick.* 
The enamel of a tooth, generally, should not be removed, and 
the file should only be resorted to in urgent cases. Teeth should 
never be filed merely to improve their appearance. 
Persons possessing good teeth cannot take too much care to 
preserve them, and they should always avoid cracking hard bodies 
with them. Straining the jaws is always calculated to loosen 
the teeth, and often breaks off a portion of the enamel, which is 
often accidently fractured, either from some hard substance in 
our food, or from blows and falls. A person called upon me who 
had luxated eight incisor teeth in endeavouring to reach the first 
floor of a house, seizing alternately with his right hand and teeth 
a sheet which had been fastened to the window, his left hand 
being tied behind him; he had nearly reached the window when 
his teeth gave way. He luxated eight incisor teeth and fell with- 
out receiving any other injury. When I saw him the incisores 
were nearly out of their alveoli, and the cuspidati on the right 
side were much loosened. I replaced his teeth and retained them 
in their position with a ligature, I prescribed a gargle composed 
of the decoction of pomegranate skin, myrrh, rose leaves and 
white wine; at the end of six days they had re-united to the alve- 
oli, but there was for a long time a weakness in the parts. 
These precious organs should be used with great care, if we 
wish to preserve them for a long time. 
* When teeth are separated with a file, the operation should be performed 
so as to prevent the subsequent approximation of the organs, as recommended 
by the author in another place.-Eds. HYGIENE AND THERAPEUTICS. 
117 
All sudden changes of temperature often exercised upon a 
part, weakens its action and alters its organic structure. The 
old adage, if the glass of wine drank after soup deprives the 
physician of a crown, it gives one to the dentist, reminds us of an 
error too often committed. The injurious practice of drinking 
cold drinks after eating hot food, hastens the destruction of the 
teeth, especially when these organs are already diseased. I can- 
not too often repeat that it is a practice equally injurious to the 
mouth as well as the stomach, and the evil is greatly increased by 
drinking ice water after eating hot food. 
The daily use of the tooth brush will generally prevent the 
formation of tartar, although it is not always sufficient in 
preventing the deposition of that substance upon the posterior 
surfaces of the teeth where the brush cannot easily reach. Tar- 
tar, when first deposited upon the teeth, is very soft, slimy, and 
can be easily removed, but if it be allowed to remain it will soon 
become hard; sometimes it will be deposited in thin, brownish 
hard layers, and adhere very tenaciously to the teeth, at other 
times it collects in a yellowish and porous mass. 
The teeth of some persons are more subjected to depositions 
of tartar than those of others. It is scarcely ever seen upon the 
teeth of young healthy persons, while those who have a weak 
constitution, who are subject to catarrhal affections of the mouth, 
whose stomach is in a bad state, whose digestion is difficult, whose 
mouth is constantly inflamed, aphthous, and whose saliva is of a 
bad quality, have nearly always the necks of their teeth encrusted 
with this substance, particularly when such persons do not pay 
special attention to these organs. 
There are several reasons which prevent persons who have 
bad teeth from cleaning them, such as inflammation, pain, &c., 
and these affections also contribute to a more rapid production of 
tartar. Cleaning the mouth should not be a matter of indifference, 
particularly with persons whose teeth are not sound. 
When the teeth are covered with tartar, the whole of this sub- 
stance should not be removed at once, its removal should occupy 
several sittings, allowing two or three days to elapse between 
each sitting; if the whole of this substance be removed at once, 
the teeth being deprived of a covering to which they had become 
accustomed, would be sensitive, and inflammation and tooth-ache 
would be the result, more particularly in cold and damp weather. 
Hence when the mouth is in a very bad state, warm and dry 
weather should be chosen to operate upon it. 
Tartar is only injurious when collecting around the necks of 
the teeth, it forces the gums from them, in this way the teeth 
being deprived of a support, become loosened; but independent of 118 
HYGIENE AND THERAPEUTICS. 
this and the very disagreable appearance of teeth covered with 
yellow or black tartar, the presence of that substance is not as 
injurious as it is generally supposed to be. We scarcely ever see 
caries form under a layer of tartar, it is even probable that teeth 
which are in an unhealthy condition, effected with little black 
spots, flaws, &c., and very sensitive to the action of heat, cold 
and acids, are protected by the tartar which is deposited upon 
those parts where the enamel is defective, it then acts as a plug 
in incipient decay, it arrests or slackens the progress of disease. 
I have known parsons who could not have the tartar removed 
from their teeth without causing serious injury to the mouth; in 
such cases I cautiously remove merely that which is near the 
gums, or which has,insinuated itself under them, without scraping 
the surface of the te^th to give them a white appearance, which 
is always injurious. 
If it be necessary for persons who have not a good set of teeth 
to be very careful in keeping their mouths clean, those who wear 
a partial or complete set of artificial teeth should likewise be so. 
Artificial teeth should be kept very clean so as to prevent their 
being covered with tartar, from tarnishing and from emitting a 
very disagreable smell. These teeth from their constant reten- 
tion in a warm, humid place, become black and corrode, as they 
are not endowed with vitality to resist decomposition ; they should 
be often removed and cleaned. 
Independent of the care which is taken for the preservation of 
the teeth, it also becomes necessary to pay some attention to the 
gums when they are not in a healthy state. We frequently 
observe that the gums of persons of a delicate and catarrhal con- 
stitution are soft, slighly swollen, readily bleed and of a livid red 
hue; the teeth very often in such cases not being firmly fixed in 
their alveoli, are very loose and appear to be on the point of drop- 
ping out. This purely catarrhal disposition is regarded by most 
dentists as a scorbutic affection, and under this impression they 
advise the use of anti-scorbutic elixirs. These preparations are 
composed of a tincture of some gummy or resinous and aromatic 
substances ; they are generally very proper in that affection. We 
shall give at the end of this part of our volume recipes of such as 
appear to us to be the most useful for that condition of the gums, 
and the most proper to impart to them their firmness and natural 
color. 
It is important to remember, that the above condition of the 
gums is not always a local disease, it is frequently dependent upon 
a constitutional affection which it will be proper to subdue by the 
Care required by the Gums. HYGIENE AND THERAPEUTICS. 
119 
use of tonics, visits to the country, exercise, fresh air, and all 
other remedies capable of imparting vigor to the system. 
W hen the affection of the gums is truly of a scorbutic character, 
we must especially insist upon the internal use of crusiferous 
plants, and chewing of cochlearia. 
In all cases this fungous state of the gums also requires 
particular care relative to the daily cleanliness of the mouth. 
We should not use a brush which is too hard, and it should be 
used with precaution, so as not to injure the tissue of the gums; 
it would also be advisable to use the brush in a vertical direction 
instead of horizontally, as it is generally used, for without this 
precaution we would be liable to destroy that elevated portion of 
the alveolus which is situated between the teeth, by divesting it 
of the gum which covers it. 
Caries. 
Caries is, without doubt, an affection the most injurious to the 
teeth, and it is important to discover it at its commencement, so 
as to prevent or at least retard its progress. The first sign that 
is discovered when a tooth is about to decay, is a small black 
spot, this generally appears upon the side contiguous to the adjoin- 
ing tooth. The teeth in the above case should be immediately 
separated and the black spot removed; this mode of treatment 
will often remedy the disease, or at least retard its progress and 
prevent its communication to the neighboring tooth. 
The disease at other times attacks the grinding surfaces of the 
teeth, it first consists of a black spot and very soon forms a cavity 
in the organ, and becomes painful to the impressions of heat and 
cold. If on introducing a probe into thq decayed cavity no pain 
is experienced, and if its external orifice is not larger than the 
interior of the cavity, it should be plugged with metallic leaf so 
as to protect the cavity from the air and thus greatly retard the 
progress of the disease. The tooth should be frequently examin- 
ed, to discover if the plug has fallen out, in consequence of the 
cavity becoming enlarged, and if this be the case it should be re- 
filled, provided there exists no cause to prevent it. 
When there is a cavity upon the lateral surface of a tooth, and 
it is capable of receiving a plug, the operation should be resort- 
ed to, but if the organ be painful and the cavity larger externally 
than it is internally, it will be useless to attempt the operation; it 
will be only necessary to keep the cavity clean. When the teeth 
which have been plugged occasions pain, the plug should be 
removed. 
Other methods, such as the actual and potential cautery, have 
been recommended to arrest caries. The use of these remedies 120 
HYGIENE AND THERAPEUTICS. 
is designed to destroy the dental nerve; but they do not en- 
tirely destroy the vitality of the tooth, and the progress of the 
disease is not completely arrested. The inconveniences attendant 
upon this mode of treatment is the excessive pain it produces, 
and the great precaution necessary in its employment. 
Remedies for Tooth-ache. 
Any cause capable of diverting the mind may relieve tooth- 
ache. Any violent mental emotions, in persons of nervous sus- 
ceptibility, are capable of controlling this disease; in this manner 
persons are often relieved of tooth-ache on approaching the door 
of a dentist, and also by the confidence placed in various charms, 
intended for the purpose of relieving the pain. 
The application of narcotics, alcoholic tinctures, and essential 
oils, to the diseased organ, and sinapisms and plaster of cantha- 
rides to the temples, will also relieve it. If the pain be a nervous 
or rheumatic affection, the above remedies may relieve it entirely, 
and the pain will not return again, or at least not until the lapse 
of a long period ; but should the affection be the result of decay, 
the relief will only be temporary. It sometimes happens that 
tooth-ache produced by caries will be relieved spontaneously, or 
by the use of those remedies which we have just mentioned, and 
the organ will continue to decay, without giving rise to any 
further pain. 
The actual cautery has also been proposed to relieve pain 
arising from caries; this remedy is not successful, nor is its use 
always free from great injuries. 
It is not uncommon to see persons, some of whose teeth are 
longer than the others, which arrangement is the result of injuri- 
ous consequences. It sometimes occurs that those teeth which 
are the longest, cause their antagonists, by their repeated action 
upon them, to become loose and often very painful; should we 
not be aware of this fact, the pain experienced might be attributed 
to a disease in the painful tooth. There is no other mode of re- 
medying this evil, but filing the teeth down upon a level with each 
other, so that the jaws can close accurately, touching at every 
point. 
I have met with some cases of this kind which were pointed out 
to me, and which had given rise to improper treatment upon the 
diseased teeth. This error is analogous to that which sometimes 
happens in cases of wry neck from paralysis of the sterno-mastoid 
muscle, when the disease is thought to exist upon the side to which 
the head is drawn by the sound muscle. HYGIENE AND THERAPEUTICS. 
121 
The manner of replacing Lost Teethe 
There are few parts of the body that can be replaced by artifi- 
cial substitutes as completely and as advantageously as the teeth, 
and consequently there are few branches of surgery in which artifi- 
cial substitutes are as usefully employed. An artificial crown can 
be placed upon a sound root remaining in the alveoli; one or several 
isolated teeth may be replaced in this manner. Several teeth, 
united together, can be inserted upon one or both sides of the 
alveolar border, and finally upon both the upper and lower jaws at 
the same time. 
Artificial teeth can be fabricated and adjusted so as to answer 
the purposes of the natural organs, both in appearance and pro- 
nunciation. They may also be so firmly attached as to be useful 
in mastication. 
The principal condition necessary for the insertion of artificial 
teeth, is firm and healthy gums. 
If the gums be diseased, they should be restored to health before 
the insertion of the artificial teeth. If the dentist be unable to 
accomplish this, he should not risk his reputation by inserting teeth 
which will never be of any utility. 
It is principally in the insertion of artificial crowns upon natural 
roots, that we should regard the condition of the gums, and guard 
against a catarrhal or aphthous state of the mouth; for when the 
gums are unhealthy, the artificial teeth will produce inflammation, 
and from the pain that they produce, it would be necessary to 
remove them ; such circumstances bring discredit upon the den- 
tist, who is liable to be taxed either with ignorance or dishonesty. 
Artificial teeth should be fabricated of such substances as will 
not readily decay. Where a single tooth is to be inserted, a 
natural tooth would be preferable ; one should be selected so as to 
be adapted to the aperture in the dental arch without requiring 
much filing; this precaution will enhance its durability. The 
fear which some persons entertain, of catching the disease of the 
subject from whose mouth the artificial tooth has been taken, is 
groundless, as the tooth is thoroughly cleansed before it is inserted. 
When we propose to insert several teeth, or a complete denture, 
the tooth of the hippopotamus must be used, taking care to pre- 
serve, if possible, the enamel for the anterior face of the denture. 
For the insertion of several artificial teeth, the metallic paste 
used by M. Dubois-Chemant should be used; it, in many respects, 
* The improvements in the manufacture and manner of inserting artificial 
teeth, since the publication of this work, have been very great, and for the 
knowledge of which, the reader is referred to more modern works upon the 
subject.- Eds. 122 
HYGIENE AND THERAPEUTICS. 
is preferable to ivory. This paste, which is porcelain, is not so 
liable to change and is much lighter than the sea-horse tooth, and 
it can be made to assume a color corresponding to the natural 
teeth, and also that of the gums. These teeth, however, are also 
liable to become disordered in time, and much more so when the 
digestion is bad, and the saliva of a bad quality; hence persons 
wearing artificial teeth cannot be too cautious in keeping them 
clean. 
Manner of remedying Defects in the Palatine Arch. 
A loss of a portion of the palatine arch, especially when it 
extends to the posterior part of the arch, constitutes one of the 
most serious evils incident to the mouth. There will be, in such 
cases, a direct communication between the mouth and nasal 
fossae, deglutition and pronunciation can only be performed with 
great difficulty. Openings in the palatine arch are frequently 
met with, accompanied by hare-lip; they are frequently occasioned 
by gun-shot wounds, and venereal or cancerous ulcers. 
Unnatural openings in the palatine arch should not be attempted 
to be remedied, until the disease which has produced them has 
been completely cured. Thus, those which accompany hare-lip 
in young subjects may close of themselves, after a re-union of the 
divided lip has been effected; those which result from a loss of a 
part of the maxillary and palate bones may also contract very 
much during the cicatrisation of the lip. 
The opening in the roof of the mouth, after the diseases of those 
parts have been cured, occasion evils of a too serious nature for 
a remedy not to be desired; this is generally effected by placing 
a metallic plate, called an obturator, over the aperture; it is 
attached in various ways, as we shall hereafter describe. 
For a long time the object attained by obturators was the 
closing up of the opening in the palatine arch, to prevent the 
passage of aliment into the nasal fossae, and to remedy the nasal 
sound of the voice; but those fixtures did not remedy other 
inconveniences which are occasioned by a loss of a part of the 
palate. The palate is not merely a partition with the uvula 
attached, designed simply to separate the anterior from the poste- 
rior part of the mouth; it is a flexible body which facilitates 
deglutition, which prevents the passage of aliment into the posterior 
nares, and which greatly favors pronunciation; hence it is not 
merely a hole that is to be closed up, but a moveable organ that 
is to be replaced, so that it can assist in the motions necessary in 
deglutition and pronunciation. To obtain these requisitions, human 
industry has of late years succeeded in constructing mechanical 
fixtures which leave but little room for further improvement. 
We shall have occasion to speak of these fixtures in another part 
of this work. HYGIENE AND THERAPEUTICS. 
123 
The use of sponge to sustain obturators should be discarded, 
as this substance, becoming impregnated with saliva, will corrode 
and occasion a disagreeable smell. It also swells and becomes 
difficult to remove. Obturators sustained by metallic fixtures are 
free from the above objections, and they can be readily removed 
so as to be cleaned, which should be done daily; negligence in 
keeping these fixtures clean might occasion serious consequences. 
SECTION IV. 
Various Powders, Opiates, and Elixirs to clean teeth, relieve tooth- 
ache and cure diseased gums. 
We propose to give some formulae, composed of two or three 
substances, the virtues of which are well known, and which when 
mixed do not destroy each other's effects. 
All powders or elixirs which are composed of drugs having 
analogous and sometimes very inappropriate effects are not as 
useful as a mixture of two or three simple substances, the efficacy 
of which have been tested. 
Tooth Powder, No. 1. 
ft Prepared Terra Sigillata, § vi. 
Cream Tartar, § ij. 
Cloves, 9 i. 
No. 2. 
ft Pumice Stone, § vj. 
Cream Tartar, § ij. 
Carmine Lac, § i. 
Cinnamon, 3 ij. 
No. 3. 
ft Dragon's Blood, § i. 
Red Coral, § iv. 
Fine Carmine, 3 ss. 
Orange Peel, 3 ij- 
N. B. The last powder possesses the property of imparting to 
the lips and gums a handsome rose color, which will remain upon 
them during the greater part of the day. 
We cannot be too careful in porphyrising these different sub- 
stances, so as to reduce them to an impalpable powder; particular 
notice should be had to the quantities of each substance. If these 
precautions be discarded, the powder will be disagreeable in the 
mouth, and injurious to the teeth. If the dentist has not sufficient 124 
HYGIENE AND THERAPEUTICS. 
experience in preparing tooth powders, nor the necessary conve- 
niences, he should apply to a good apothecary. 
Opiates. 
To make opiates one of the above powders can be taken and 
mixed with a sufficient quantity of honey. 
Elixir for the Mouth, Mo. 1. 
ft Brandy, Spirituous Vulnerary Water, each § viij. 
Essential Oil of Mint, gtt. iv. 
See also the Abat Ancelot's elixir, in Baume's work on the teeth. 
N. B. This elixir may be aromatised with amber or rose, 
instead of with the oil of mint. Some dentists put a small portion 
of sulphuric ether in their elixirs. 
Odontalgic Elixir, Mo. 2. 
It Cloves, Opium, Cinnamon, each 3 ij. 
Pyrethrum, 5 j« 
Resin, § ss. 
Brandy, § viij. 
Elixir for the Gums, Mo. 3. 
ft Vulnerary Water, § viij. 
Spirit of Scurvy Grass, § i. 
Essential Oil of Cloves, gtt. iv. 
See the tincture of gum lac, in Baume's work. 
These elixirs are generally colored with cochineal, gum lac, 
the bark of the orcanet root, &c. and aromatised with any of the 
essential oils. 
Instruments and Materials used for cleaning the Teeth. 
Brushes, roots, sponge, and coral sticks are employed for 
cleaning the teeth. 
Brushes. 
Brushes should vary in stiffness according to circumstances; 
thus, delicate females, who take great care of their mouths, and 
whose teeth are easily cleaned, should use a soft brush; men who 
clean their teeth but seldom, require a hard one. It will be found 
convenient to have an assortment of brushes, so as to use such as 
may be most proper under different circumstances. 
Roots. 
Roots, which are sometimes used to clean teeth, also possess 
some advantages; they are generally softer than brushes. When HYGIENE AND THERAPEUTICS. 
125 
there is danger of detaching the gums from the teeth by repeated 
transverse movements, it will be found convenient to clean the 
teeth with roots, rubbing them in the direction of their length. 
Various kinds of roots are prepared for cleaning the teeth. 
Generally such that are very fibrous are used; the liquorice root* 
is preferable, in many respects, to any other; the lucerne root,f 
which is frequently used for the teeth, possesses a bitterness that 
is very difficult to boil out. Whatever species of root be used, it 
should be boiled for a long time in water. 
The roots should be sound, straight, and of a proper thickness. 
They should be cut in pieces of six inches long, and after being 
sufficiently boiled and slowly dried, should be formed into brushes 
with a penknife, or repeated blows of a hammer. The marsh- 
mallow root, which is sometimes used, is not as good as the lu- 
cerne or liquorice root, as it becomes brittle when dried. 
The roots thus formed into brushes are generally dyed red, by 
placing them for about 12 hours into a hot decoction of Brazil 
wood and of cochineal; they are then washed and dried.J We 
may also give them an agreeable odor and taste, by putting them 
for several hours in spirits of wine, aromatised with one of the 
essential oils. The roots, after being prepared, should be kept 
from moisture and heat. 
Sponges. 
Sponges which are used for cleaning the teeth should be Very 
fine, round, and of the size of a pigeon's egg ; and they should be 
thoroughly cleaned. They are sometimes colored; but they are 
generally preferred in their natural state. 
Coral Sticks. 
Coral sticks are seldom now used to clean the teeth, as 
they are too hard. They are made of the powdered dentifrice 
which we have before spoken of, and a sufficient quantity of mu- 
cilage of gum dragon, formed into sticks of about three inches 
long, and three or four lines in diameter. 
The details into which we have entered, upon these various 
preparations, may appear trifling; but they are not uninteresting 
to the dentist. It is necessary that he should be informed of the 
care to be taken in the preparation of the various materials used 
in his profession, so that he can properly prepare them.§ 
t Beame's decoction for coloring brushes made of roots is composed of the 
following ingredients:-Brazil wood, 4 ounces; cochineal, 2 drachms ; 
alum, 4 drachms; water, 2 pounds. 
§ A good brush and floss silk, as recommended by Dr. L. S. Parmly, are pre- 
ferable to any other means that can be employed for cleaning the teeth.-Edi, 
* Glycyrrhiza glabra. 
t Medicago. PART FOURTH. 
OPERATIONS. 
We shall speak, in the last part of this work, only of those 
operations which appertain especially to the dental art; others 
have been indicated in the second section, when speaking of the 
diseases which require them. 
For the advancement of operative medicine, surgeons have 
divided the science into different branches. The science of medi- 
cine is indeed too comprehensive for one person to acquire a 
sufficient skill to perform all operations with equal success, and 
to obtain experience in each branch. Hence some have devoted 
their attention to midwifery, others to the treatment of the diseases 
of the eye. In large cities, there are always some physicians who 
devote themselves to the treatment of syphilitic diseases, affections 
of the breast, diseases peculiar to women and children, &c. 
These divisions of the healing art would certainly be the means 
which would promote the rapid improvement of the medical 
science, if all who devoted themselves to each branch possessed a 
general knowledge of medicine. 
It cannot be too often repeated, that to whatever branch of the 
healing art one wishes to devote himself, if it be merely to cut 
corns, if that branch would be sufficient to keep one occupied, it 
is essential that he should have a knowledge of anatomy, physi- 
ology and general nosology, and to know the resources to be furnish- 
ed from medicines, without which no information will be added to 
the general doctrines of the science, by his particular observations. 
Some practiciens have acquired manual dexterity, very necessary 
in many cases; buttheir experience does not contribute to the 
advancement of the science. 
Persons who devote themselves to the treatment of diseases of 
a part of the system, often think that it is only necessary for them 
to have a knowledge of the structure and functions of that part, 
and the diseases to which it is liable. They do not reflect that 
there is no part which enjoys an isolated action-that the phenome- 127 
na of health and disease which each part presents, depend upon 
the general principle of life, and that in many cases a local affec- 
tion requires a general as well as a local treatment. It is often 
the whole of the organism which it is necessary to modify, so as 
to remove a local derangement. 
When the practice of the medical science is divided into different 
branches, which are separately cultivated by men who are in- 
formed upon the basis of organic principles, it can be said that 
these men aid in a common undertaking, that they furnish materials 
for the same science, and that they equally contribute to its pro- 
gress ; while those who are strangers to the structure and laws of 
the organism, and who practise the different branches of medicine, 
only divide the medical science by destroying all of its connections; 
they are guarded by an uncertain routine, and their observations, 
as well as their experience, are lost, because they are unable to ex- 
plain them reasonably. 
If it be necessary to divide the healing art into different branches 
for its advancement, it is particularly so in a branch that requires 
manual dexterity-in operative medicine. He who unites to this 
branch a detailed knowledge of his art, and the information neces- 
sary for practitioners of every branch of medicine, will hold a 
distinguished place in the science, and will elevate a branch of the 
healing art, which has been too long pursued by impudent and 
ignorant practiciens. 
OPERATIONS. 
SECTION I. 
The method of Cleaning Teeth and instruments necessary for that 
Operation. 
The operation of cleaning teeth often requires great precaution. 
Hence we should neglect none of the conditions laid down in the 
practice of all surgical operations, it should be performed tuto 
cito and jucunde. However trifling may be an operation, it will be- 
come painful and very fatiguing if the necessary precautions be 
discarded. 
Before commencing the operation, the dentist should have 
every thing which he may require in readiness. He should be 
provided with a suitable chair, with a head piece to support the 
head of his patient, and he should pay strict regard to the 
cleanliness of every thing around him. 
He should wash his hands in the presence of his patient, so as 
not to disgust him when operating. The small instruments 
which are laid before his patient should be very clean, and have the 
appearance of being new, so as to remove the idea of their ever 128 
OPERATIONS. 
having been in the mouths of other persons. Alt of these precau- 
tions may appear trifling, and be judged by men of but little 
delicacy to be of no importance, but the generality of ladies re- 
quire them, and if they be omitted, the patient may become disgust- 
ed and the operation will appear longer and more painful than it 
really is. 
If on the contrary, the dentist has neglected nothing to render 
the operation as agreeable as possible, when he directs the 
patient to change his position from lime to time and allow a few 
moments to rest, the time occupied in the operation will pass 
away imperceptibly. He should also be careful to place himself 
in such a position so as not to breath upon his patient's face. 
After having observed all these precautions, and having seated 
the patient in the operating chair, placed upon his shoulder a 
napkin to wipe the instruments with, and put before him a chair, 
or table, containing a basin and a glass of tepid water to rinse the 
mouth with, he may then commence the operation in the follow- 
ing manner. Standing to the right of his patient, the dentist 
takes a scaler, which he holds as he would a pen, and commences 
cleaning the inferior molares of the left side. 
With the thumb and index finger of the left hand the lips are 
held apart and the instrument is supported. The instrument is 
placed upon the middle of the tooth, directing its cutting edge 
near the gum and sometimes below it when the tartar has accu- 
mulated at that point, it is then with some force drawn from below 
upwards, bringing with it a portion of the tartar; this manoeuvre 
is repeated until the tooth is perfectly clean. If there are any 
depressions or holes into which the tartar has accumulated, he 
should not be too eager to remove it, for fear of destroying the 
slight layer of enamel which covers the tooth at that point. 
All of the molar teeth are to he cleaned in the same manner 
as just described and with the same instrument. For the removal 
of tartar which has lodged in the interstices of the teeth, a curved 
instrument with a sharp point should be used. 
For the removal of tartar from the cuspidati, an instrument of 
a different shape is required, but the manner of using it is the 
same as directed for the molares. The instrument should always 
be introduced below the gums so as to remove the tartar, the 
presence of which if allowed to accumulate at that part wmuld 
very soon loosen the teeth. Instruments of the shape of a knife 
blade, but having different curves are used to remove tartar from 
between the front teeth. 
When he has finished cleaning the molares, cuspidati and 
incisores of the left side, he may proceed to clean those on the 
right side in the same manner, but he must stand on the left side OPERATIONS. 
129 
of the patient. He should direct the patient from time to time to 
rinse his mouth, in order to remove portions of tartar which have 
been disengaged from the teeth. 
Having cleaned the anterior surface of the teeth in the inferior 
jaw, he should next remove the tartar from their posterior surface, 
for which instruments of different forms are required. In order 
to clean the posterior surfaces of the cuspidati and incisores, the 
patient should be directed to lean forward, the operator can then 
distinctly see the tartar and remove it without injuring the gums. 
To clean the teeth in the superior jaw, the dentist proceeds in 
the same manner and with the same instruments as already des- 
cribed for cleaning those in the inferior jaw. He should com- 
mence with the molares of the left side, and with the thumb and 
index finger of the left hand, should hold the lips apart, the 
thumb serving as a support to the instrument which is used in the 
manner of a lever, the index finger should retain the cutting edge 
of the instrument when raised to detach the tartar, so that the 
instrument cannot injure the soft parts. 
The tartar should also be removed from the posterior surfaces 
of the superior teeth. The posterior surfaces of the incisores and 
cuspidati of the superior jaw are rarely covered with tartar, the 
constant motion of the tongue in mastication and pronunciation 
tends to remove it, as it is deposited upon them, and the saliva not 
remaining long at the posterior surfaces of these teeth, cannot 
deposite much tartarous substance. 
When tartar is very thick upon a tooth and adheres to it very 
strongly, he should not use too much force to detach it in a single 
piece, because he would be liable to loosen the tooth, but it should 
be removed by pieces with a sharp pointed instrument. 
Although the operation of removing tartar from the teeth is 
not difficult, yet it requires practice, so as to accomplish it pro- 
perly and skilfully. 
When tartar has amassed itself upon the teeth of persons whose 
mouths are tender, whose gums are engorged, and whose 
teeth are slightly loosened, and also upon the teeth of such as are 
subject to inflammation, catarrh, and aphthae of the mouth, it 
should not be removed from these organs at one sitting, the co- 
vering to which they have been accustomed, for fear of evils by 
the sudden shock produced upon the teeth, and the effect of the 
atmosphere to which they have been unaccustomed. 
Notwithstanding the great care we may take in cleaning the 
teeth, it often happens that they will retain a yellow hue, this is 
their natural color; hence it would be very unwise to scrape them 
under the impression of removing this hue, for we would be 
removing the enamel, which it would be important to preserve 130 
OPERATIONS. 
The enamel of teeth is of different shades, and it is myopinion that 
the whitest are not the best; they have always appeared to me 
to be more liable to break and to decay. 
SECTION II. 
The various methods of Filing Teeth. 
Teeth are filed for the purpose of separating such as are 
crowded, and which announce, by black spots, their liability to 
decay; to remove incipient caries; to shorten a tooth which is 
longer than the adjoining organs, and which prevents the proper 
adjustment of the jaws ; to destroy asperities which are a source 
of irritation to the tongue, &c. The file should be used with 
great care, as it is always at the expense of the substance of the 
tooth which is removed, and it is therefore only to be resorted to 
to prevent a greater evil. Teeth should never be filed to enhance 
their beauty. 
The teeth of children should never be filed, especially their 
permanent teeth; because the enamel, at an early age, has not 
acquired sufficient thickness to bear, without injury, the action of 
the file, and it is always to be apprehended that the osseous struc- 
ture of the teeth will be exposed, which would cause them to be 
very sensitive and liable to premature decay.* 
From whatever cause we may be induced to file teeth, the 
person should be properly seated, and his head kept in a steady 
position, so that the operator may perform the operation regularly 
and without jolting. 
If we wish to remove a superficial decay from the lateral side 
of a tooth, we should examine if the adjoining tooth be also de- 
cayed; if this be not the case, we should use a safe-sided file. 
If, on the contrary, the corresponding side of the adjoining tooth 
be likewise decayed, we should use a file having two cutting sur- 
faces. The operator should stand on the right side of his patient, 
and hold his file in the same manner as he has been directed to hold 
his instrument when scaling the teeth. 
If we design to use the file upon the superior incisores, the 
superior lip should be raised with the index finger of the left hand, 
and the thumb of the same will afford a support to the right hand 
with which the file is held. The file should be held straight, and 
its movements should be gentle; when it catches between the 
teeth, it should be cautiously disengaged, otherwise the instrument 
or the tooth would be liable to be broken. 
* The enamel of the teeth, always acquires its full thickness previously to 
the eruption of the organs.-Eds. 131 
If we wish to file the inferior teeth, the file should be held with 
the thumb and middle finger of the right hand, and the index fin- 
ger should be placed upon the edge of the instrument; the lip 
should then be depressed, the thumb of the left hand and index 
finger of the same hand will serve as a support. The file, during 
the operation, should be occasionally dipped in water, so as not 
to heat the tooth too much by its constant motion. 
If caries be superficial, it should be entirely removed ; but if it 
extends very much upon the front part of the organ, we should 
merely separate the decayed tooth from the neighboring one, so 
that the disease may not be communicated to it. 
In filing the lateral surfaces of the teeth, we should always 
leave a shoulder near the gum, in order to prevent the aperture 
made with the file from closing. 
When a tooth has been filed uniformly through its whole length, 
and the whole of the diseased part has not been removed, we 
should, by holding the file obliquely, remove a part of the poste- 
rior face of the tooth, without making a wide separation upon its 
anterior surface, and in this manner the whole of the disease can 
be removed. 
When the disease is upon the anterior part of the lateral surface 
of the tooth, and penetrates deeply into the osseous structure, we 
should separate it from the adjoining tooth, and remove the decay 
from the interior of the cavity; it may then be cauterised, and 
plugged if practicable. 
If we wish to shorten a tooth which is longer than the rest, 
we should use a flat file, being careful not to jar the tooth during 
the operation. If the organ to be filed is very much longer than 
the rest, the filing should be done at several'sittings; thus, we 
should file off about a half line; three months after we may re- 
move a half line more, and so on until the tooth be made of the 
desired length. Using this precaution, we will be able to remove 
nearly the thickness of two lines of the substance of the tooth, 
without any inconvenience, whereas were we to attempt it at a 
single operation, the tooth would be liable to acute pain and 
premature decay. By performing the operation at intervals of 
three or four months, it appears that the osseous part of the tooth 
which is beneath the enamel becomes thin, takes on an ivory 
consistency and is truly changed into a kind of enamel. The 
same phenomenon happens in such cases as we witness in old age 
when the crown of the tooth is more than half worn away, and 
without the protection produced by the economy, the spongy por- 
tion of the tooth would be exposed. It then appears that masti- 
cation and perhaps the effects of the atmosphere gradually hardens 
the osseous tissue of the organ, and give the grinding surface the 
OPERATIONS. 132 
consistency and appearance of enamel. If the enamel is not 
reformed upon the exterior of the organ, as is the opinion of 
physiologists, it is not certain that that substance can be reformed 
in the interior, or at least that the subjacent osseous tissue is not 
susceptible of taking on a consistency analogous to the enamel, 
and capable of supplying its place as the enamel is destroyed. 
OPERATIONS. 
SECTION III. 
The use of the Actual Cautery. 
We cannot derive as much benefit from cauterising the teeth 
as has been advanced by several writers. It is in many cases 
insufficient to put a stop to tooth-ache, which is occasioned by 
decay ; it often exasperates the pain, and if the decay has made 
great progress, its application is apt to render the teeth brittle 
and less liable to be preserved. 
Neither is the dental nerve as easily destroyed by this means 
as it has been asserted, or the death of the tooth produced, by 
which the pain and the progress of decay may be arrested. The 
tooth remains in connection with the vital action of all the parts 
to which it adheres, and it is not until we extract it, that we can 
hope to break off all connections with the neighboring parts, and 
to reduce it to a state of entire death.* 
The action, however, of a remedy as energetic as that of fire, 
is sometimes attended with salutary effects ; thus, it may, in some 
cases, suddenly relieve tooth-ache, it may arrest the progress of 
incipient decay, and in such cases it produces the same effect 
that it does in all other bones where its application is attended 
with advantage. The use of the actual cautery becomes indis- 
pensable in arresting certain hemorrhages. We shall point out 
the manner of using this remedy and certain precautions necessary 
to be observed in its application. 
After having removed with the file the greater part of the de- 
cay, if we wish to put a stop to the disease with the actual cautery, 
we should be supplied with cauterising irons of different shapes, 
and from these, one of a proper form should be selected. The cau- 
terising irons should be adjusted to their handles by means of a 
screw, so that it may also serve as a burnisher or plugger. When 
they are to be used as cauterising irons, they should be adjusted 
to a cork handle; this substance, being a non-conductor of heat, 
will allow of their being heated and used with safety. 
*The use of the actual cautery has long since been almost altogether 
abandoned. For the destruction of the nerve in a tooth, excision is far 
preferable to either of the methods here mentioned.-Eds. OPERATIONS. 
133 
The person whose tooth is to be cauterised, should be seated, 
and his head supported against the back part of the chair. While 
the iron is heating in a furnace placed near the patient, the 
cavity of the tooth should be cleaned out and wiped perfectly dry 
by means of a lock of cotton placed upon the extremity of a 
suitable instrument. The neighboring part may be protected 
from injury by the use of a napkin. The operator should separate 
the lips with his left hand, which will also serve as a support to 
his right hand when applying the cautery. When every thing is 
in readiness, the operator applies the instrument, heated to a 
white heat, to the diseased part, allowing it to remain but a few 
seconds; this should be repeated as often as the extent of the 
disease may require. If, after the expiration of a proper time, 
we perceive that the disease is about making further progress, 
we should again have recourse to the same remedy. 
After the cavity has been cauterised, it should be plugged, 
when in a proper condition to undergo this operation. 
We should not cauterise a tooth which is very sensitive to the 
touch, or the impression of heat or cold, because the operation, 
in such cases, would only increase the pain. We should, in the 
first instance, endeavor to remove the sensibility of the part, by 
the use of the alcoholic tinctures of which we have spoken in the 
third part of this work. A piece of cotton is to be saturated 
with the tincture, which should be made lukewarm, if the natural 
temperature of the liquid occasions pain; the application ought to 
be repeated several times during the day. This mode of treat- 
ment is generally more successful with the inferior than with the 
superior teeth; because the liquid, in the former case, can more 
easily penetrate the spongy part of the tooth and reach the nerve. 
If this mode of treatment should not succeed, it will not be at- 
tended with any inconvenience. After we have succeeded, by 
any means which may have proved most successful, in destroying 
the sensibility of the teeth, we may endeavor to arrest the disease 
by the application of the cautery. When all of the above direc- 
tions fail, we must resort to extraction; this mode of treatment 
most persons who have decayed and painful teeth generally adopt. 
It is only in particular cases, as young women who are fearful of 
spoiling their beauty, and public speakers, whose front teeth are 
necessary for a distinct pronunciation, and the absence of which 
is always unseemly, that we should recommend the trial of all 
other means before resorting to that of extraction. 134 
OPERATIONS. 
SECTION IV. 
When the decayed part of a tooth is smaller at its orifice than 
it is internally, it may be plugged; this operation should not, in 
such cases, be neglected, as the disease can in this way be ar- 
rested, and the tooth sometimes be preserved for many years. 
In order that a tooth may be advantageously plugged, it is 
essential that it has never occasioned pain from the contact of heat 
or cold, and from the retention of aliment in the diseased cavity. 
When the diseased part is not sensitive, and the cavity is of the 
proper shape to retain a plug, it should be perfectly filled, so as 
to protect it from the action of the juices of the mouth, and the 
contact of air, both of which greatly favor the disease of the 
tissue of the tooth. Without resorting to that operation, which 
is attended with no inconvenience, the decay will always progress; 
it will be communicated to the adjoining teeth, and will produce 
a very disagreeable breath. 
If the decay of the organ be painful, we should, before plugging 
the cavity, endeavor to destroy the sensibility in the manner we 
have described in the preceding chapter. 
When all the necessary conditions exist for plugging a tooth, 
the person should be seated, and the interior of the decayed 
cavity wiped; for this purpose an instrument of the proper shape, 
having a denticulated extremity, wrapped with a piece of cotton, 
should be used. After the cavity has been wiped with the cotton, 
the patient should be directed to keep his mouth open, so that the 
saliva may not re-enter the decayed cavity ; the greater portion 
of the decay should now be removed with suitable instruments, 
and the tooth plugged after having again perfectly cleaned the 
cavity with a piece of cotton. 
To fill the diseased cavity, leaves of lead, gold, or silver are 
used; one of these metals is rolled between the fingers into a soft 
ball, much larger than the cavity, and then introduced and packed 
firmly into it with proper instruments. When the cavity is filled, 
the superfluous metal is to be cut off with a cutting instrument, 
and the surface of the plug is then to be polished with a burnisher. 
If lead be used, the burnisher should be heated so as to burnish 
the surface of the plug more readily. 
If, previous to plugging the tooth, the cavity appears inte- 
riorly very smooth, it may be made rough with an excavator, so 
that the plug will be more secure. If the tooth, after being plug- 
ged, should become painful, the plug must be removed, and the 
sensibility destroyed by the remedies already recommended ; the 
tooth may then be re-plugged. 
Manner of Plugging Teeth. 135 
OPERATIONS. 
SECTION V. 
Luxating teeth, like the application of the actual cautery, 
is not as advantageous as many writers have supposed; it can 
be practised only in few instances, and it is not always attended 
with success. 
The operation may be attempted upon a tooth slightly decayed, 
which causes great pain, and which the patient is desirous of 
preserving. This operation is also sometimes practised in order 
to bring an irregular tooth in its proper position. 
The incisores, cuspidati, and bicuspides, are the only teeth that 
can be successfully luxated, because their roots are single. This 
operation, when practised upon the molares, occasions bloody 
effusions in their alveolar cavities, which may produce depositions, 
and necessitate the extraction of the teeth. 
To be successful, the operation should only be practised upon 
young persons, who have good health, and whose gums are in a 
healthy condition; it is also essential that the tooth to be luxated 
be but slightly decayed. When all these conditions are fulfilled, 
the operation, when performed with skill, will be attended with 
success, of which I have assured myself, from the repeated opera- 
tions I have performed. 
The manner of luxating a decayed tooth is similar to the 
operation of extraction, requiring two attempts; for when we 
intend to extract a tooth, we first luxate it with the pelican, or 
English key, and then extract it with a pair ofhawk's-bill or straight 
forceps. 
It will be necessary to place upon the luxated tooth a piece of 
linen, so that, by the slight pressure of the jaws when closed, it 
will be retained in its proper position. The patient should be 
cautioned against using it in masticating for several days; it will 
be also necessary for him to use a tonic, or astringent wash. 
When the incisores or cuspidati are luxated, it will be proper 
to secure them to the neighboring teeth with a silken ligature. 
If the teeth are naturally separated, or if there be a vacancy 
near the tooth to be luxated, occasioned by the loss of an organ, 
we should fill up the space at the side of the tooth, with a small 
piece of linen, which should be attached to the neighboring 
teeth, this will serve to maintain the luxated tooth in position. 
In this operation the dental nerves and vessels, are nearly 
always ruptured, which generally relieves the pain. The tooth 
which has been luxated will never regain its primitive solidity in 
the alveolus, unless it has been completely raised from the socket. 
If it has remained in continuity with any part, even if it be with 
Manner of Luxating Teeth. 136 
a portion of the gum, this will suffice to keep up the continuity of 
the vital action. The tooth will again receive some fillets of 
nerves ;and vessels, by means of which, life will be kept up and 
the ruptured parts will cicatrice and resume their primitive 
firmness. 
Dentists who luxate decayed teeth to relieve tooth-ache, and 
to arrest the progress of decay, think that complete extraction, 
and the luxation of a tooth which shall have but a very slight 
attachment to the jaws and alveolus, is one and the same thing; 
there is, however, a very great difference, as much as there is 
between the life and death of a part. I have never seen a tooth 
which had been entirely extracted and replaced, to have regained, 
I will not say life, for that is altogether impossible, but merely its 
firmness; and I think that we should regard those cases which 
purport to establish the opposite opinion, to be at least as very 
doubtful. 
The luxation of teeth, for the purpose of re-dressing such as are 
inclined inwardly, outwardly or laterally, presents more difficulty 
than when the operation is merely designed to preserve an aching 
tooth. The operation in the former case is very difficult and 
rarely successful. It can, indeed, be readily perceived, that a 
tooth which is inclined inwardly, or outwardly, cannot be easily 
regulated, because the alveolar cavity which is formed according 
to the direction of the tooth, cannot be changed to receive the 
organ in a vertical direction ; teeth which have their lateral 
surfaces presenting anteriorly or posteriorly, are less difficult to 
be regulated, and in some circumstances the operation may be 
tried. 
Before regulating a tooth, we should employ all means capable 
of loosening it; hence we should turn it slowly with the straight 
forceps, using great precautions so as not to break it. When the 
tooth has been placed properly, it must be retained in its position 
by securing it with ligatures to the neighboring teeth. A tooth 
when growing irregular can be easily made to assume its proper 
position, but when it has once entirely taken an irregular position, 
the operation becomes more difficult to perform. 
OPERATIONS. 
SECTION VI. 
Extracting Teeth. 
Though this operation may appear simple and easily performed, 
it however generally requires great experience, address, a correct 
knowledge of formation of the mouth, and the various peculiarities 
which are met with in the teeth and their arrange ment and diseases. OPERATIONS. 
137 
An ignorant and daring dentist often extracts the first tooth 
which may be pointed out to him as the seat of a violent pain, 
sometimes that tooth is sound, and the pain which continues after 
the operation, soon appears to seat itself upon another organ. 
We should not extract a tooth which is painful, unless we are 
convinced that the pain is depended upon caries. If we think 
that we can by some remedy relieve the pain and preserve the 
diseased organ, this should be mentioned to the patient, and the 
advantages and inconveniences that may result from the practice, 
also pointed out to him, and should he prefer having the organ 
removed, it can then be done. 
We can ascertain, in cases of tooth-ache, which is the diseased 
organ, by probing or striking the tooth. Hence, when a tooth is 
pointed out as the seat of an excruciating pain, if the operator is sure 
that the organ is not decayed, or if the decay which he may dis- 
cover in the tooth be not sensitive to the touch of a probe, and if 
on striking or sounding the tooth, no pain is felt, he may be assur- 
ed that the pain is not seated in that organ. Dentists would 
frequently be led into error were they blindly to follow the direc- 
tions of persons who consult them, and extract all teeth that might 
be pointed out to them as the seat of the pain which they ex- 
perience. Persons will often tell the dentist that the pain is in the 
upper jaw, while the aching tooth is in the inferior jaw, and they 
will often insist that a sound tooth is the only one that aches, 
while beyond it will be the tooth really painful and decayed. 
There are many cases in surgery, where the pain is not felt im- 
mediately in the diseased part. 
To probe a tooth, we must be provided with flexible probes of 
various forms, so as to introduce them easily between the teeth, 
and to discover the cavity produced by caries. 
We may sound a tooth by repeatedly striking it with a steel 
instrument. When the dentist has discovered in this way that a 
tooth is the seat of pain, it will not be a sufficient reason for him 
to advise its removal, because the pain may depend upon inflam- 
mation, rheumatism, or it may be a peculiar nervous affection; we 
should also ascertain by means of a probe, if there be any decay 
in the organ. Sometimes caries exists without our being able to 
detect it, from the orifice of the disease being in contact with the 
adjoining tooth; several circumstances may,in such a case, assist 
an intelligent practicien in forming his opinion; thus he will see 
whether there is any inflammation in the gum, whether the same 
tooth is always painful when touched, if it be sensitive to the 
action of heat and cold, if the corresponding organ on the opposite 
side, or its antagonist, be decayed, &c. 
Teeth which are decayed, partly destroyed by disease, or when 138 
there is nothing left of them but their roots, which generally pro- 
duce a disagreeable breath, should always be extracted. Various 
kinds of instruments, many exhibiting ingenuity on the part of the 
inventors have been constructed for the extraction of teeth, 
though all of these instruments may facilitate the extraction of 
teeth, yet there is one thing which they cannot supply, to wit: 
the skill of the operator. Good practiciens always operate with 
a few instruments, and they attach no merit to their beauty; 
their best instrument is often the one to which they have been in 
the habit of using. The choice of instruments, however, is not 
altogether a matter of difference ; a few of the most useful ones 
should be selected, and a skilful use of them should be acquired, 
for it is this which characterises the good workman. 
Whatever may be the instrument used, there is a certain 
precaution to be regarded in the extraction of teeth or roots, 
which is not to use too much violence. When we have taken a 
proper hold of the tooth, we should extract the organ gently, so 
that the parts to which it adheres may successively be detached. 
When the operation is undertaken too precipitately, which is re- 
garded as skilful, we render ourselves liable to fracture the teeth 
and alveoli, or to lacerate the gums. 
There is a physical principle in the performance of this opera- 
tion, which should be remembered, it is this, when a body is dis- 
tended more rapidly than it can yield to the force applied, it will 
break. Hence the motions used in the extraction of teeth should 
be slow and constant; if these precautions be followed, we will very 
seldom fracture teeth in extracting them. This accident though 
often trifling, often brings discredit upon the reputation of the 
operator. 
OPERATIONS. 
Some practiciens generally, for the extraction of teeth, make 
use of this instrument, while others prefer the pelican. Both of 
these instruments can be advantageously applied in some cases, 
while in others different instruments will be required. 
This instrument which is a very ingenious one, consists of a 
semi-circular movable hook, adjusted at right angles to the ex- 
tremity of a steel shaft, the other extremity of this shaft is the 
handle of the instrument. It is very useful in the extraction of 
molar teeth which are not too much decayed to sustain the 
required force in the operation. The sole objection to this instru- 
ment is, that the fulcrum rests upon the gum over the tooth to be 
extracted and also upon that over the adjoining organ; the tooth 
in consequence of this, if much decayed, will be liable to break, 
unless the instrument be very skilfully used. 
Garengeofs Key. OPERATIONS. 
139 
The motion of the instrument must not be too sudden, as it is 
capable of producing a force which none of the parts to which it 
is applied can resist. The power which this instrument produces 
upon the jaw is so great that serious injuries have often been 
inflicted in attempting to remove those teeth, the roots of which 
diverge and then approximate at their extremities. An intelligent 
dentist can generally discover teeth which have such roots; 
hence when he sees a molar tooth inclined inwardly or outwardly, 
with a short crown, and when the alveolus is thick, he will en- 
deavour to relieve the pain and arrest the progress of the disease, 
for he may, in attempting to extract such a tooth, either break it, 
or remove with it a portion of the jaw. It would be better for a 
patient to be allowed to complain of a dentist not being able to 
extract a tooth than to say that he had been injured by him. In 
this manner a dentist preserves his reputation, and finally acquires 
a well founded confidence. I have during the course of my 
practice, several times refused extracting certain painful teeth, 
explaining to my patient the motives for doing so; they after- 
wards applied to dentists who were as intrepid as they were 
ignorant, and who removed the teeth, together with a portion of 
the jaw, and in this manner produced serious inconveniences. 
These charlatans sometimes succeed, but transient success, ob- 
tained by an ignorant and bold manner, is not to be envied, for 
such rashness may often terminate in serious consequences. 
In order to use Garengeot's key, the patient must be seated in 
a chair, and his head properly supported upon the head piece of 
the chair. The operator, standing in front of his patient, takes 
the instrument in his right hand, and places the hook under the 
gum, as far forward as possible. He should place a piece of 
paper, folded several times, upon that part of the gum which is 
to support the fulcrum of the instrument, to secure the parts from 
injury. All things being properly arranged, a slow and gradual 
semi-turn is to be given to the instrument, and the tooth will soon 
yield to the motion, if it presents none of the obstacles before 
mentioned. 
Teeth are often entirely extracted with this instrument; but it 
would be advisable, after having luxated the organ, to suspend 
its use, for fear of fracturing the alveolus, or tearing the gum, and 
to complete the operation with the straight forceps. The fulcrum 
of the key is generally placed upon the external side of the dental 
arch; there are, however, cases in which it would be more proper 
to reverse its situation. The screw which goes into the hook being 
movable, allows it to be placed upon either side of the instrument. 
Hooks have been so constructed as to move in any direction, 
others have been formed into various shapes; but none of these 
possess any advantage. 140 
OPERATIONS. 
After the tooth has been extracted, the blood should be allowed 
to flow for some minutes, the patient should, however, be caution- 
ed against sucking the gums, as it may produce an obstinate 
hemorrhage; the gums should then be pressed with the fingers, so 
as to bring the parts together, and the mouth rinsed with water 
and vinegar. 
Pelican. 
The pelican consists of a hook attached to the middle of a 
handle. This instrument is difficult to use; but, to one accus- 
tomed to it, it possesses great advantages. It is principally 
intended for the removal of the bicuspides and molares. 
Straight Lever. 
The straight lever is an instrument analogous to the pelican' 
with this exception, that the action of the former is in the direction 
of the shaft, while that of the latter is in a lateral direction; so 
that the lever is used for the extraction of the front teeth, and the 
pelican or English key is employed to remove the posterior ones. 
Straight Forceps. 
This is the best instrument for the removal of the incisores, 
cuspidati, and gag-teeth of the superior jaw. The operator must 
stand in front of his patient, and taking the instrument in his right 
hand, he should place it upon the organ as far up beneath the 
gum as possible, it should be held in the hand sufficiently tight, 
not to allow it to slip from the tooth; a rotary motion should 
then be given to the instrument, so as to detach the tooth from 
its alveoli, and it then should be drawn perpendicularly. 
Hawk? s-beak Forceps. 
This instrument is not often used, neither is it very certain in 
the removal of teeth. It may be used to disengage teeth which 
have started from their alveoli, and which are so entangled be- 
tween the adjoining teeth, that they cannot be extricated with the 
fingers. It may also be used to extract stumps which are loose. 
The Fish Tongue. 
This instrument is used only for the removal of the wisdom 
teeth. The curve of its shaft admits of its being easily introduced 
into very narrow mouths. When using this instrument, the ope- 
rator stands on that side opposite to the tooth which he wishes to 
extract. He introduces the point of the instrument between the OPERATIONS. 
141 
second and third molares, forcing it as near the gum as possible, 
he then uses it in the manner of a lever, making a fulcrum of the 
second molar tooth. The wisdom teeth are generally very easily 
extracted, they have but two roots which are often united, having 
the appearance of a single root. The greatest difficulty expe- 
rienced in extracting these teeth, arises from these organs being 
situated very far back in the mouth, and from the smallness of 
the mouth of the patient which prevents the operator from adjust- 
ing the instrument with facility. We should be careful and not 
allow the instrument to slip, as we W'ould be liable to injure the 
mouth of the patient. 
Crow's-Foot. 
This instrument is very useful in extracting isolated roots. 
The superior hook of this instrument, is for the purpose of being in- 
troduced under the root to be extracted, the inferior hook rests upon 
the molar tooth anterior to the root which may then be raised 
out of its socket. When there is no tooth to serve as a fulcrum, 
we can use the instrument as a punch. The smaller hook may 
also be used to remove fragments of roots which are not very 
solidly attached to the sockets. 
From what has been said in relation to the use of the different 
instruments for extracting teeth, it may be perceived that this 
operation can be performed with the pelican, the straight lever, 
the English key, the straight forceps, the fish-tongue, the crow's- 
foot and the hawk's-bill forceps, upon all classes of teeth as well as 
roots; it will be only necessary to know when to use each of these 
instruments and to acquire a skilful use of them. 
Notwithstanding the precautions that may be taken in the ex- 
traction of a tooth, a part of the alveolus or gum which adheres 
to it will be also removed. This will rarely produce any serious 
injury ; we should, however, always detach such portions of bone 
and gum, before showing the tooth to the patient, as it will create 
unnecessary uneasiness, and will prevent him from saying, as it 
is often said, that the dentist had extracted with the tooth a por- 
tion of the jaw-bone; this is a trifling accident which it is not in 
the power of the dentist to foresee or prevent, but which often 
reflects discredit upon his reputation- 
Certain dentists have publicly announced that they are able 
to remove teeth with an astonishing facility, without producing 
the least pain, either with their fingers, or with the point of their 
sword. It should be remembered that if those dentists do really 
possess this superior skill, they would not be obliged to expose 
themselves publicly like charlatans; for the public would soon 
hear of their skill, which they would test by giving them their 
patronage. 142 
OPERATIONS. 
They employ a man who presents himself to the operator, and 
who feigns that he has the tooth-ache, and he places in his mouth 
a large molar tooth slightly decayed, with very large roots, and a 
little bladder filled with blood. The dentist after examining the 
tooth, places himself before his patient, and with the point of his 
sword pricks the bladder, the patient then spits out a bloody tooth 
which is exhibited to the astonished bystanders. 
If a person having a tooth which is difficult to extract, 
were to apply to these dentists, he would tell him that the tooth 
ought not to be extracted, inasmuch as it can be preserved; he 
then requests his patient to call upon him at his tavern, where he 
performs his operation like other dentists. 
It should also be remembered that the teeth of many persons 
who consult them, are very much loosened, and can be easily 
extracted, which often may be done simply with the fingers; 
with such cases the confidence of the public is readily gained, 
and the dentist then finds that he can easily dispose, at a good 
price, of his elixirs and opiates, which possess most extraordi- 
nary virtues. 
SECTION VII. 
Accidents which may result from the Extraction of Teeth.* 
Various accidents and some of a very serious nature sometimes 
occur from the extraction of teeth, notwithstanding the skill and 
care with which the operation may be performed. These injuries 
may happen during or after the extraction of the tooth. The 
injury may be confined to the tooth, or it may consist in lesions 
of the neighboring parts, or the whole organism may be more or 
less affected by this operation. 
The most common injury resulting from the extraction of teeth, 
is the fracture of the tooth; this is most likely to occur when the 
tooth is much decayed. Teeth that have become brittle from 
cancerous, rachitis, scorbutic, syphilitic affections, the immoderate 
use of mineral acids, old age, &c., are very liable to be broken 
in endeavoring to extract them. The fracture of a tooth may 
also depend upon the size, divergency or convergency of its roots, 
and its attachment to some part of the jaw. Although it is diffi- 
cult to foresee the causes which are productive of fracture, we 
should, however, be very cautious in extracting those teeth that 
have short and thick roots, and such as present high prominences 
above the alveolar border. 
*See M. Duval's dissertation upon this subject. OPERATIONS. 
143 
The molar teeth are sometimes so firmly situated in their 
sockets to which they adhere very strongly, that they or the 
instrument will break in attempting to extract them ; but this 
occurrence is owing to the too sudden motion given to the instru- 
ment. 
Sometimes in attempting to extract a tooth, two teeth united 
together will be removed ; but this accident, which it is impossible 
to prevent, is fortunately of rare occurrence. 
The removal of a permanent for a deciduous tooth, or a sound 
organ for a decayed one is only the result of the ignorance of the 
operator. A sound tooth may be accidently removed by the 
patient suddenly moving his head, which will cause the hook of 
the instrument to slip from the diseased tooth that was to have 
been extracted. It is common for a portion of the gum to be 
removed with the tooth to which it adhered very strongly; gene- 
rally this is of little importance, it is how'ever sometimes followed 
by hemorrhage, or inflammation. Inflammation of the gums may 
also be the result of contusion of the parts produced by the fulcrum 
of the instrument; to avoid this, the fulcrum should be supplied 
with a pad. 
The pain occasioned by the extraction of a tooth may give 
rise to inflammation and its consequences ; hence, when we ope- 
rate upon a person of an irritable, or catarrhal constitution, during 
cold and damp weather, and the operation is attended with 
severe pain, we cannot be too careful in preventing or subduing 
the inflammation that may be produced. 
A portion of the root of a tooth which may remain at the 
bottom of the socket, will generally be very soon covered by the 
soft parts, and no evil consequences will result from it. The re- 
moval of a portion of the alveolar border is likewise generally 
unattended with evil consequences, but these accidents sometimes 
do produce inflammation, which it becomes necessary to prevent 
when possible. 
When we have cause to anticipate inflammatory symptoms 
after the extraction of a tooth, we should endeavor by suitable 
means to prevent them ; thus the bleeding should be promoted 
for a time by the use of tepid water, after which an acidulated 
gargle, rendered slightly detersive by the addition of spirits, ought 
to be used. If inflammation occurs in defiance of our precautions 
to prevent it, we should endeavoi' to limit it, and to affect reso- 
lution by the employment of antiphlogistics, such as diet, rest, 
soothing drinks, blood letting, cataplasms, emollient gargles, &c. 
The inflammation sometimes will terminate in an abscess 
which will expel the portion of the root which is leit in the socket, 
or the little spicula of the fractured alveolar border. Sometimes 144 
the inflammation will extend to the fractured bone and exfoliation, 
and a fistulous opening, will be produced which can only be reme- 
died by the removal of the necrosed portion of bone. 
When a portion of the jaw has been fractured by suddenly 
removing a large molar tooth, we should endeavor to prevent 
the inflammatory evils in the manner before indicated, and main- 
tain the fractured splint piece in position, so that it may become 
consolidated to the body of the bone, like all simple fractures. 
There is no evil resulting from the fracture of a portion of the 
alveolar border, so serious as that which occasions an opening 
into the maxillary sinus, either by the extraction of a tooth, the 
roots of which penetrate this cavity, or from the fracture of a 
portion of the floor of this cavity. If an accident of this nature 
occurs in a young subject of a good constitution, we have reason 
to hope the opening will in time close up; in contrary cases, we 
may apprehend that the wound will remain fistulous. 
If the mouth be opened very wide during the extraction of a 
lower tooth, and the dentist presses very much upon the jaw, 
luxation may be the result. Luxation of the jaw should be im- 
mediately reduced, in the manner we shall describe, when speaking 
of that accident. 
OPERATIONS. 
Hemorrhage. 
The hemorrhage that follows from the ruptured vessels, after 
extraction, is slight and salutary; it tends to prevent inflamma- 
tion, and it would be unsafe to arrest it suddenly, as it is some- 
times done by the use of cold acidulated water, immediately after 
the removal of the tooth. Nor should the parts, rendered sensitive 
by the operation, be irritated, if we wish to avoid inflammatory 
symptoms. 
Hemorrhage generally stops spontaneously; it does however 
happen, that the blood continues to flow so long, or so often re- 
occurs, as to become dangerous, if it be not arrested, which may 
be done by cold and acidulated gargles. If the bleeding resists 
the above mode of treatment, a compress of cotton, agaric, &c. 
dipped in acid, powdered resin, or gum arabic, ought to be applied 
to the part. In very obstinate cases, recourse should be had to 
the actual or potential cautery. The most obstinate hemorrhages 
are not generally such as are produced by the violence used in 
removing the tooth, or from the laceration of the gums; but they 
are occasioned by a fungous state of the gums, and a scorbutic dia- 
thesis of the system; in the latter case the hemorrhage frequently 
returns. 
The transient tears that sometimes follow the extraction of a 
superior tooth, merely shows that the nervous irritation is extend- OPERATIONS 
145 
ed along the nose as far as the lachrymal gland, but is not indica- 
tive of an immediate relation of the tooth with the ball of the eye, 
as some persons suppose. 
The pain attendant upon the extraction of a tooth sometimes 
produces, in very nervous persons, syncope, a general trembling, 
and even convulsions. It sometimes excites a nervous attack, or 
a paroxysm of epilepsy, in persons who are subject to them. It 
may also produce abortion with very nervous females. 
SECTION VIII. 
When the natural organs are so much decayed as to require 
extraction, there remains no other means of repairing their loss 
than to substitute artificial teeth. Persons who have been so 
unfortunate as to lose their teeth at an early age are capable of 
appreciating the advantages of artificial ones; these are especially 
desirable to public speakers, and to women, who are desirous of 
preserving, as long as possible, all the attributes of beauty. 
When artificial teeth are well executed and properly adjusted 
to the mouth, they do not merely bear a strong resemblance to 
the natural organs, but they are useful in masticating and speaking. 
Various materials have been used to manufacture artificial 
teeth from; as human teeth, the tusks of the large terrestrial and 
amphibious animals. Hence they are manufactured from the 
teeth of the hippopotamus, the elephant, the sea-cow, and even 
from the tibula of the beef. Artificial teeth are also manufactured 
from mineral paste. The human teeth are at present very seldom 
used, those of the sea-horse, and those manufactured from the mine- 
ral paste, have been substituted for them. 
A human tooth, artificially set, answers very well when we 
wish merely to replace an incisor or cuspidatus; but when it is 
necessary to insert a portion or an entire set of teeth, the tusk of 
the hippopotamus is generally preferred ; teeth made of this sub- 
stance are whiter, not so porous, retain their color longer, and 
resist the action of the saliva for a longer period than the teeth of 
other animals will. That substance, however, does not possess 
the advantages which are found in the teeth composed of Messrs. 
Dubois and Chement's mineral paste. These two gentlemen have 
discovered a mineral paste, which is preferable to any other sub- 
stance for the manufacture of artificial teeth. It is hard, and not 
susceptible of decomposition, as it is a kind of porcelain; it can 
readily be carved and made to imitate the gums upon which the 
teeth are to rest, by adapting it, when soft, to the plaster moulds. 
Artificial Teeth. 146 
OPERATIONS. 
These pieces can be made to resemble, in shade and color, the 
gums and the teeth along side of which they are to be placed. 
I have, for several years, used this composition, and I have 
found it to possess all the advantages to be desired in the manu- 
facturing of sets of artificial teeth. I have purchased of M. 
Dubois-Chement, of Paris, the recipe for making this composition, 
which I am not allowed to lay down in this work. 
The Instruments necessary for the Manufacturing of Jlrtificial 
Teeth. 
To manufacture artificial teeth, the dentist should be provided 
with the following instruments, viz. a large vice, several saws to cut 
the bone or ivory of which teeth are made, files, flat and half round, 
rasps to shape out the pieces, &c. He should also have a jewel- 
ler's small vice, compasses of different sizes, fine files of all shapes, 
several small saws, gravers, scrapers, drills, pumice stone to 
polish with, pincers of several shapes, cutting forceps, a draw- 
plate to manufacture metallic ligatures of different sizes, punching 
forceps to pierce holes in metallic plates, and several other little 
instruments which he may find useful to him. These are the prin- 
cipal instruments which a dentist should have, not merely to serve 
for the manufacture of artificial teeth, but also for obturators and 
other artificial pieces, designed to remedy some deformity of the 
visage. 
The dentist should be very familiar with the use of all of these 
instruments; but should he have so much business as not to be able 
to do his own mechanical work, he should employ a good work- 
man, whose work he should direct, and which the dentist should 
himself finish. 
Single and sets of artificial teeth may be made and adjusted in 
different ways, according to the part they are to occupy, the 
particular disposition of the parts, &c. Teeth can be inserted 
with a pivot, a screw, a ligature, and with a spring. We shall 
point out the cases in which these different ways of inserting 
teeth are proper, and the manner in which they are effected. 
Different kinds of Artificial Teeth. 
Pivot Teeth. 
Single artificial teeth, placed upon a root by means of a pivot, 
are the most secure, and bear a greater resemblance to the natural 
teeth, than when inserted in any other manner; but teeth cannot 
always be inserted upon a pivot. The incisores and cuspidati of 
the superior jaw are nearly the only teeth which will admit of 
being replaced by an artificial crown, sustained by a pivot, be- OPERATIONS. 
147 
cause these teeth have but one straight root, and are sufficiently 
strong to receive a pivot; fortunately these teeth are generally 
found in a condition to be replaced in this manner. We cannot 
so advantageously pivot the cuspidati, and especially the incisores 
of the lower jaw, because their roots are short, and flattened 
laterally. The inferior bicuspides may be replaced by artificial 
crowns, as they have generally a single and round root, while 
the roots of superior bicuspides are generally bifurcated, which 
will not admit of this mode of insertion. The loss of the bicus- 
pides not being easily observed, there is seldom any necessity of 
supplying them by artificial substitutes. 
When the crown of a tooth is broken, or greatly destroyed 
with caries, and the root is in a proper condition to receive a 
pivot, the remaining portion of the crown must be filed down upon 
a level with the gums. When the remaining portion of the crown 
is very strong, we should first file as near the gum as possible, a 
fissure upon its anterior, and if possible its lateral surfaces ; then 
with a pair of cutting forceps the crown may be easily removed, 
the root may then be smoothed off with a half round file. 
To enlarge the dental canal a drill is made use of with which 
the soft and decayed parts are removed, and a hole of about three 
or four lines in depth is effected. If the interior of the root be 
redish, and if it be sensitive, we can destroy the sensibility either 
with the actual cautery, with essential oils, or alcoholic tinctures. 
When the root is prepared, the artificial crown must be adjusted 
so as to resemble perfectly the natural teeth, and it should be 
perfectly adapted to the root. In order to adjust the pivot near 
its proper place, we should adopt the following method ; a piece 
of paper, cotton or any other analogous substance should be 
placed into the cavity of the root; the substance thus introduced 
must be cut level with the root, and then blackened with ink. If 
the artificial crown be now placed exactly in the position which 
it is to occupy, there will be a black spot upon it at the point 
where the pivot should be inserted. The crown should then be 
drilled at the point marked with the ink, the drill should be direct- 
ed in such a manner that it will pass through near the middle of 
the posterior part of the tooth. A piece of round pure gold of a 
proper length, and somewhat larger than the hole in the crown, is 
to be forced through the hole and rivetted on the posterior part of 
the crown. That portion of the pivot which is to be inserted into 
the canal of the root, should taper down to a point, and present 
along its sides, notches made with the file, so that the thread or 
cotton which is wrapped around it may remain secure. Some 
force should be required to insert the pivot in the canal of the 
root, and when the artificial crown is properly adjusted, it should 148 
OPERATIONS. 
have the appearance of coming out from the gums. When the 
root upon which the artificial crown is to be inserted, is sound, and 
there exists no cause to produce inflammation, a pointed screw 
pivot can be made use of, which may be screwed in by turning 
the crown, or with a screw-driver: the artificial crown should 
fit closely to the root. 
A root which is very much decayed and which presents a 
large canal, can be put in a condition to receive a pivot; in order 
to effect this, the root should be plugged, a hole should then be 
drilled in the middle of the plug, and into this canal the pivot 
should be inserted. If it be impossible in consequence of the state 
of the root to insert the artificial crown very securely by means 
of a pivot, the crown may be secured to the adjoining tooth with 
a ligature. 
It sometimes happens that the pivot occasions great pain a 
short time after its insertion; in such cases it should be with- 
drawn and made shorter, after which it can be re-inserted. The 
artificial crown should not be longer than the natural organs, and 
it should be made thin by removing part of its posterior surface, 
so that it cannot touch the lower teeth when the jaws are closed. 
The presence of an artificial tooth, frequently produces inflam- 
mation which may terminate in a deposition upon the gum over 
the neighboring organ. When the inflammation cannot be ar- 
rested by the use of tonic and astringent washes, we should wait 
until the inflammation subsides, and the root has regained its 
former solidity in the socket, when we can replace the artificial 
crown without producing further inconvenience. 
Pivot teeth are generally made of natural teeth prepared by 
proper macerations, and sawed off near their crown. They 
should resemble in form, size and color, the teeth which they are 
to replace. The enamel should be removed from their posterior 
surfaces so as to make them thinner, and so that they may not 
be so liable to break in inserting the pivot. 
The teeth of the hippopotamus are often used for the manufac- 
ture of artificial teeth ; when they are well selected and properly 
worked, they resemble very closely the natural teeth, and are 
more solid than natural teeth artificially set. We can also impart 
to them the hue that may be desired, by soaking them for a longer 
or shorter time in a strong decoction of tea or coffee ; in this way 
they can be made to resemble the adjoining teeth. In manufac- 
turing these teeth, the enamel should always be preserved upon 
their anterior surfaces, so that they may retain their color and 
polish for a long time. OPERATIONS. 
149 
Teeth retained by Ligatures. 
If we wish to insert a tooth, and there is no root remaining in 
the gum, we can fasten the artificial organ to the adjoining teeth, 
by drilling two holes in the sides of the artificial tooth, opposite 
the teeth between which it is to be placed, and passing ligatures 
through these holes. It is sometimes difficult to obtain a natural 
tooth of the same class as the one which has been lost, or one 
which will be properly adapted to the vacancy; we will then be 
necessitated to make one from the tooth of the hippopotamus. If 
the anterior border of the alveolus is partly destroyed, which fre- 
quently happens, the artificial tooth should be supplied with an 
artificial gum, to which a reddish color, in imitation of the natural 
parts, must be given. We can also, in similar cases, mount a 
natural tooth upon a sea-horse base, which is to be a substitute 
for the gum. All of these pieces are attached, by means of liga- 
tures, to the neighboring teeth.* 
SECTION IX. 
Artificial Blocks of Teeth. 
When we wish to replace several teeth adjoining one another, 
they should be carved from one solid piece, and if the patient has 
roots remaining which are capable of receiving pivots, these teeth 
should be inserted in the same manner as directed for a single 
artificial tooth, by inserting pivots into all of the roots which are 
capable of retaining them; but when there are no roots, the piece 
must be sustained by ligatures. Artificial teeth which are to be 
retained in the mouth with ligatures, should accurately fill up the 
space between the teeth to which they are to be made fast; for if 
they be too large they will force the teeth back and loosen them; 
if, on the other hand, they be too narrow, the same accident may 
also be produced. 
Care must be taken that the artificial block be not longer than 
the rest; if it appertains to the superior jaw, the teeth should be 
bevelled off upon their posterior surfaces, so as not to interfere 
with the inferior teeth when the jaws are closed. 
To insert a partial set of artificial teeth, we must file down 
level with the gums all roots which are sufficiently sound to re- 
ceive pivots; we must then place a piece of wax upon the space 
to be occupied by the teeth, directing the patient to close his jaws, 
* The' practice of fastening one or more artificial teeth with ligatures to 
the adjoining teeth, has long since been done away with.-Eds. 150 
OPERATIONS. 
so that the impression of his inferior teeth may also be made in 
the wax, the whole should then be carefully withdrawn. Plaster, 
mixed to a proper consistency with water, should be poured into 
the wax impression and made to extend a few lines beyond the 
wax. The plaster should remain for about one hour to dry. Two 
depressions must be made upon the extended portion of the plaster 
and oiled; fresh plaster should then be poured into these depres- 
sions and extend over the other side of the wax; in this manner 
we obtain a mould of the inferior and superior jaws. The plaster 
should now be placed before a fire and the wax melted from it; 
the impression of the parts to be supplied with teeth should be 
carefully taken, as the correct adaptation of the teeth to the alveolar 
border depends altogether upon this. 
When the mineral paste is used, it can be correctly adapted to 
the model, and carved when in a soft state. 
If the sea-horse bone be used, the base must be first adjusted to 
the mould, and the teeth must be afterwards carved. 
The front teeth may be replaced by natural organs, mounted 
upon a base of the sea-horse tooth, which will also serve as an 
imitation of the gums. 
M. Bourdet recommends natural teeth to be inserted into a base 
after the manner of the adaptation of the natural organs into the 
alveoli; the anterior face of the artificial base should be enamelled 
and made to imitate the gums in form and color. The natural 
teeth are secured in the sockets of the artificial base by means of 
pivots, and mastic should be placed between the sockets and teeth. 
This is an ingenious mode of inserting teeth, but it is difficult to 
execute properly. 
To enamel gold, it will be necessary that this metal should be 
of a certain thickness, which would make the teeth expensive, and 
it is difficult to imitate the color of the gums upon this metal; this, 
added to its price, renders it objectionable. 
Several natural teeth may be inserted by uniting them with a 
gold wire, which is made to pass through their sides, as advised 
by M. Fauchard. They may also, as recommended by the same 
author, be inserted by adjusting to their posterior surface a little 
gold plate, which is to be secured by means of a pin which should 
be rivetted to the tooth and to the plate. When teeth mounted 
in this manner are well executed, they will be very strong, and 
present a very handsome appearance; but it must be observed 
that we cannot insert partial sets of natural teeth, mounted in any 
way, unless the breach into which they are to be inserted is suffi- 
ciently high to receive them. When teeth have been lost for a 
long time, the organs in the opposite jaw are forced out of the 
sockets from a thickening of the bottom of their alveoli, and have OPERATIONS. 
151 
the appearance of having elongated. Moreover, they not being 
used in mastication, are not, like the rest of the organs, worn 
down, and they are always longer than them; from this cause we 
are obliged to make very short artificial teeth from sea-horse bone 
or mineral paste, and we are compelled to file the edges of the 
antagonising teeth, so as to give to the artificial piece a sufficient 
thickness. 
If there be one or more good roots remaining in the mouth, 
these will afford a most favorable means of supporting the artificial 
teeth. If there be two roots which correspond to the extremity 
of the artificial piece, their canals should be drilled, and a screw 
or pivot should be passed through the artificial piece into the 
roots, as has been recommended for the insertion of pivot teeth. 
When there are no roots in the mouth of the patient, the artifi- 
cial piece must be attached to the adjoining teeth with ligatures. 
Artificial teeth may be placed in the superior jaw when there 
exists only one tooth to fasten to. In this case, Bourdet recom- 
mends us to make the artificial piece in such a manner that it will 
embrace the natural tooth, to which it should be secured with a 
ligature; the other side of the piece should be deeply grooved out, 
so as to take a firm hold of the gums; in this way there will not 
be so much danger of injuring the natural tooth. When there 
are several isolated natural teeth, the artificial piece should con- 
tain as many grooves, and the ligatures should be fastened to 
those teeth which are situated in the posterior part of the mouth. 
When there are two or three sound teeth contiguous to one 
another upon one side of the mouth, the artificial piece should 
contain a groove which should embrace the natural teeth, and be 
secured to each of them. The dentist will have to be governed 
by his judgment, and vary the mode of fastening the teeth accor- 
ding to the peculiarities of each case. 
Various kinds of Ligatures used to fasten Artificial Teeth. 
Ligatures which are made use of to fasten artificial teeth are 
made of gold, platina, silver, flax and silk. 
The metallic ligatures are stronger and more durable than 
those made of other materials; but they become loosened, injure 
the teeth by producing in time a groove around them. We can 
partly remedy this inconvenience by using very pure metal, by 
making the spring flat before using them. These ligatures are 
moreover objectionable on account of the patient being unable 
to renew them without the assistance of the dentist, which pre- 
vents them from cleaning the artificial teeth as often as it is neces- 
sary to do. 152 
OPERATIONS. 
Though silken and flaxen ligatures are not as durable as metal- 
lic ones, they are, however, preferable to them, from the circum- 
stance of the patient being able to change them. Moreover 
these ligatures will last as long as it is necessary for them, as it 
will become essential to change them after a certain time.* 
Artificial Dentures. 
SECTION X. 
Persons who have teeth very much diseased often lose them 
entirely at a very early period in life. They endeavor, by the 
means that have already been pointed out, to preserve them as 
long as possible. Artificial teeth are placed in front of the dental 
arch, to replace the incisores and cuspidati, which have been lost, 
and are secured to such roots as are in a healthy condition, or 
are attached to the neighboring teeth, which offer sufficient strength 
for a proper support, but in time these points of attachment will 
give way. The peculiar constitution which has given rise to the 
decay of the first teeth, continues to act upon the remaining 
organs, which one after another become carious, or loosen and 
finally drop out, after repeated inflammations, so that they are not 
only unable to support the artificial teeth, but they themselves 
require to be replaced by artificial substitutes. 
When one or both jaws are deprived of teeth, artificial organs 
formed of one solid piece are resorted to. The manner of fabri- 
cating and inserting pieces of this kind, varies, according as they 
are intended for the superior, or inferior jaw, or for both jaws at 
the same time. 
Dentures for the Inferior Jaw. 
If all of the teeth have been removed from the inferior, and 
there still remains a sufficient quantity of these organs in the 
superior jaw, a complete denture composed of one solid piece 
may be inserted in the inferior jaw. When the artificial piece is 
well made, and correctly adapted to the alveolar border, it will 
be retained in position by the lips, the cheeks, the tongue, and its 
own specific gravity, as to require no other support. It will re- 
quire some time for the person to become accustomed to its 
presence, and then he will be able to perform with it all the 
functions of the natural organs, both in speaking and eating. 
An artificial piece for the inferior, should be extended farther 
* The improvements made in this branch of the art, since the publication 
of this Treatise, render the directions here laid down, insufficient as a guide 
to the student or young practitioner.-Eds. OPERATIONS. 
153 
back and be thicker than is required for the superior jaw ; it will 
be advantageous to make it of a heavy substance. Hence it may 
be carved out of a piece of sea-horse tooth, or made of a sea- 
horse base, or of a platina or gold plate, mounted with natural 
teeth. An inferior denture should be six lines high in front and 
should exceed this heighth near their extremities. The teeth can 
be made of the natural heighth, and the rest of the piece be left 
for the gums. It is also important that it should embrace properly 
the contour of the alveolar border at every point, and that it be 
a little elevated along the coronoid apophysis against which it 
can rest. 
Artificial teeth adjusted in this manner can be readily taken 
out and cleaned, and replaced by the wearer. 
Dentures for the Superior Jaw. 
When the superior jaw is totally deprived of teeth while the 
inferior still retains many of these organs, though this fortunately 
seldom happens, we cannot so readily adjust an artificial piece, 
as it will naturally tend to fall out by its own weight. They 
are, in cases of this nature, obliged to be supported by a spring, 
which must be attached to the inferior jaw. 
When the last molares of both sides of the inferior jaw have 
been lost, there will exist a most favorable condition for the sup- 
port of the artificial piece. In such cases two pieces of sea-horse 
tooth are to be properly adapted to the parts where the molar 
teeth were situated; to these are to be attached springs which are 
to give support to the artificial teeth in the superior jaw. The 
two artificial pieces should be connected by a metallic band, 
which must pass along the internal side of the alveolar ridge 
behind the inferior teeth. If the dental arch has been wasted 
away, if the inferior lip constantly covers it, we may likewise 
secure the two inferior pieces by means of a metallic band, nar- 
rower than the first, and made to pass anterior to the teeth, and 
give to it a gum color, so that it may not be so easily detected. 
The bands should be so adapted as not to irritate the gums or 
tongue; a few holes might be punched in it, and ligatures passed 
through them and secured to the natural teeth. 
The two inferior pieces of sea-horse should contain a groove 
upon their anterior extremities, so as to embrace the natural teeth 
to which they are contiguous; this will render the artificial pieces 
more securely situated in their proper places, they should also be 
pierced with holes to receive the springs which are to sustain the 
superior denture. When the molares of the lower jaw still re- 
main, a metallic band is adapted to the inner circle of the inferior 
alveolar arch, with its extremities turned over the molar teeth, 154 
OPERATIONS. 
and terminating upon their anterior face, by a prolongation in- 
tended to receive springs which are to support the superior 
denture. 
If there be but a few isolated teeth, or several contiguous to 
one another remaining in the inferior jaw, we should, as has been 
advised by Fauchard, make the artificial piece of a solid block, 
with grooves to allow of its being passed over the natural organs. 
This artificial piece must then be attached to the superior one by 
means of springs; this mode of application does not differ from 
the manner of inserting a double set of teeth. 
The superior artificial denture should be of a less thickness, and 
lighter than those intended for the inferior jaw ; the former are 
only necessary to be four lines high, giving to the teeth, however, 
their natural width. It is not necessary that this, like the inferior 
denture, should occupy the whole space that the natural teeth had 
done; but it should only be sufficiently long to contain merely 
twelve teeth, and it ought, in other respects, to be made as light as 
possible. 
In order that the artificial piece may remain steadily in the 
mouth, it should be well adapted to all the inequalities of the gums 
and hollowed out so as to embrace the contour of the alveolar 
border. The spring that is to connect the superior and inferior 
teeth do not differ from those used in sustaining a complete set of 
dentures of which we shall now speak. 
Double Set of Teeth. 
When all the teeth of both jaws have been lost, we can insert 
a double set of teeth, sustained by springs ; but, to effect this, there 
should be neither a tooth or root remaining. Should there be any 
tooth remaining in the mouth, we ought not to hesitate to extract 
it, in order that persons may enjoy the advantages to be derived 
from an entire double set of artificial teeth. It is important that 
the two artificial pieces should be plumb upon the alveolar border; 
to accomplish this, we should place a piece of wax between the 
jaws to obtain a correct form of them, and from this, a mould 
should be procured. 
The two pieces should only occupy the same extent of surface 
as the natural teeth had done, so as to allow sufficient space for 
the springs to act freely. Thus they should extend only as far 
back as the part occupied by the first molar, inclusively. 
Double sets of teeth may, as in partial sets, be made of various 
materials, some are composed of natural teeth mounted upon a 
sea-horse or metallic base. These kinds of teeth are difficult to 
make; but they possess the advantage of being easily removed, 
cleaned, repaired with facility, and of retaining, or enamelling 
anew, their base of a gum color. OPERATIONS. 
155 
Dentures formed of the sea-horse tooth, when well carved out 
of a well selected material, and when the enamel has been pre- 
served upon the anterior face, produce a very handsome appear- 
ance, their beauty and extreme whiteness is perhaps a fault. 
They are also too heavy, especially for the upper jaw. 
The best material for making artificial teeth, is without doubt, 
M. Dubois-Chement's mineral paste. It is light, easy to form in 
the desired shape, and can be made of any color desired, both to 
imitate the gums as well as to assume the natural color of the 
teeth. 
From whatever materials dentures may be fabricated, we 
should always have the superior set lighter and higher than the 
inferior, both being of the proportions which we have indicated 
in the preceding articles. 
The springs intended to fasten the two sets are constructed of 
various materials ; such as steel or gold bands, pieces of whale- 
bone, and gold wround in a spiral form. 
Platina is now mostly used for the construction of springs. A 
method has been discovered by which this metal can be separated 
from all foreign substances, and especially from arsenic, which 
it always contains, and renders the metal brittle and difficult to 
work. This metal is preferred on account of its hardness and 
unalterableness ; and also because it is not so expensive as gold. 
Steel springs, recommended by Fauchard, are very good on ac- 
count of their elasticity, but their liability to rust by the moisture 
of the mouth, notwithstanding all precautions that may be taken 
with them, is a sufficient cause to induce us to abandon their use 
entirely. 
Whalebone springs are without doubt the most objectionable 
of all others; the moisture, to which they are constantly exposed, 
deprives them of their elasticity in a short time, but they are often 
used for the sake of economy. 
Pieces of whalebone, used for the purpose of springs, should be 
sound, and their exterior surface should be preserved; as this is 
the most polished and the most elastic part of the bone, the springs 
should be taken from the mouth nightly, and kept in straight 
position, in order that they may retain their elasticity; with such 
precautions they will last a long time. 
When metallic springs are used to maintain the teeth in the 
mouth, they should be made of a narrow gold or platina plate, 
or of wire made into a spiral form. Both of these methods can 
be very usefully employed; but preference is to be given to the 
wire in spiral shape, for such springs will sustain the set of teeth 
without pushing them as much forward as the metallic plates 
would do. 156 
OPERATIONS. 
When springs are made of narrow strips of metal, they should 
be thin and elastic. Each extremity of the springs is placed into 
a depression made upon the artificial piece, intended to receive 
these, and are there rivetted. 
Spiral springs are placed into a deep fissure made upon the 
external surface of the extremities of the upper and lower sets of 
teeth; two holes are made in these fissures, to receive the ligature 
or rivets with which the springs are secured. To secure all the 
advantages of pronunciation and mastication, which are to be 
derived from the use of artificial teeth, it is not only necessary 
that they should fit well and be perfectly adapted to the alveolar 
border, but it is necessary that the person who wears them, should 
become accustomed to their presence. Time and patience are 
the only means of obtaining this end. It will require at least six 
months before they will remain very steadily in the mouth, and 
for them to serve all the purposes of the natural organs. 
SECTION XL 
Obturators. 
The causes which produce unnatural openings in the palate, or 
which occasion a division or even destruction of the palate, and 
also of the uvula, proceed, generally, from hare-lip, gun-shot 
wounds and syphilitic affections. 
Seeing an opening which produces a communication between 
the mouth and nasal fossae, the first idea which presents itself is to 
close the opening, so as to prevent the passage of aliment into the 
nasal fossae, and to remedy the defect in articulation of words. 
Openings in the palatine roof appear to be of very rare occur- 
rence among the ancients, they were merely affected with a sepa- 
ration of the bones which sometimes accompanies hare-lip. 
Obturators are not spoken of by the Greeks and Latins, nor those 
who first wrote upon surgery; it was not until the use of fire 
arms, and more particularly since the prevalence of syphilitic 
diseases, that openings in the palatine roof commenced to be of so 
frequent occurrence. Obturators were first mentioned by Alex- 
ander Petronius, in his treatise upon venereal affections; this 
author recommends the opening in the roof of the mouth to be 
closed with wax, cotton, or a gold plate, without telling us in 
what manner the plate should be sustained in position. It was 
not until ten years after the appearance of the writings of the 
author just mentioned, that Ambrose Pare exhibited in his work 
on surgery, drawings of obturators. Improvements have been 
made in them from time to time, and now they have arrived to OPERATIONS. 
157 
such a state, that there is scarcely any room for further improve- 
ment. 
Obturators were formerly used simply for the purpose of closing 
the opening in the palatine arch, and were made of various forms 
and sustained in different ways. We shall describe these different 
obturators, and point out the peculiar advantage that each of them 
possess. 
When we wish to fabricate an obturator, we should first take a 
correct impression in wax of the parts to which it is to be applied. 
A plaster model is then obtained from the wax impression, and 
the plate of which the obturators is to be formed correctly, should 
be adjusted to this mould. 
The plates may be of silver, gold or platina, the latter is pre- 
ferable as it is more lasting. 
Obturators sustained by Si>onge. 
Obturators of this kind were first described by Ambrose Pare, 
they are composed of a plate the form and size of which corres- 
pond to the opening in the palatine arch. Upon the convex side 
of the plate are soldered two small pieces of metal, several lines 
long, separated from each other, and which approach at their 
extremities. Between these two metallic pivots is placed a piece 
of fine sponge, which is secured in position by the elasticity of 
the pivots. The sponge should be very dry, and its size should 
be in proportion to the opening in the roof of the mouth; when 
the sponge is introduced into the opening, and there it swells and 
retains the plate firmly against the palatine arch. 
The only change that has been made in obturators sustained 
by sponge is, that, in some cases, the sponge is attached to the 
plate by means of ligatures passing through holes made in the 
middle of the plate, and in others, it is pierced by a screw with 
a cup attached to the end of it; this method is much the safest 
plan of confining the sponge to the plate. 
These obturators are subject to great inconveniences; they 
are rarely retained in their place with the force required ; the 
mucous which is soaked up by the sponge, does not fail to under- 
go a decomposition, which constantly produces a bad smell in the 
nose and mouth, and it may even excoriate the edges of the 
opening in the palatine roof, upon which the sponge rests. It is 
necessary to remove the obturator often, in order that it may be 
cleaned, and it is well known that to dislodge it, requires some 
force, which bruises, and even tears the borders of the opening. 
These different objections were so great as to cause the use of 
these kinds of obturators to be abandoned. 158 
OPERATIONS. 
Obturators attached to the Teeth. 
Bourdet thought that openings in the palatine arch, resulting 
from the various constitutional affections would, in time, close; 
hence he preferred the use of such obturators as were applied 
against the roof of the mouth, without any portion entering into 
the opening. It is certain that during the process of cicatrisation, 
we may expect a contraction of the opening, but when once that 
process is accomplished, the opening will remain stationary. 
The borders of the opening is sometimes very long in cicatris- 
ing, either in consequence of new spiculse of bone, which are yet 
to be exfoliated, or on account of feebleness of the patient; it is also 
very probable that the constant passage of air and aliment through 
it, very much retards the cure of the ulcer. Hence a gold, or 
platina plate, placed over the opening, will answer the purpose of 
an obturator, and will facilitate the progress of cicatrisation. 
Obturators intended to cover the opening, without penetrating 
into it, are made of plate, having an arm going off from each side, 
and fastened to the molar teeth by means of clasps. 
Obturators sustained by a Spring. 
Obturators sustained by a spring, come next to those sustained 
by sponge, in point of simplicity. They consist of a platina plate, 
having, upon its convex side, a spring with two branches. When 
the obturator is to be placed in the mouth, the two branches of 
the spring are brought together with a pair of pincers, in order 
to introduce them into the opening in the palatine arch; when 
they are inserted, they branch off from one another, and rest upon 
the edges of the opening, and in this manner retain the plate in 
its position. 
These obturators present greater inconveniences than those 
which are sustained by a sponge; the springs rest obliquely upon 
two points of the borders of the opening, and press upon them; 
the obturator, moreover, cannot be removed without using some 
force, which always bruises the parts, and sometimes lacerates 
them. All of these objections, notwithstanding its simplicity, are 
sufficient for us to discard the use of this species of obturator. INDEX- 
PART FIRST. 
STRUCTURE OF THE MOUTH. 
PAGE. 
Sec. I.-Osseous Apparatus, 6 
The Superior Maxillary Bone, 1 
The Palate Bones, 9 
The Inferior Maxillary Bone, 11 
Sec. II.-Dental Apparatus, 14 
Description of the Teeth. Development of the Teeth, . . 17 
Shape of the Teeth, 21 
Denudation of the Teeth, 23 
Structure of the Teeth, 24 
Sec. III.-The Muscular Apparatus, 25 
Temporalis. Masseter. Pterygoideus Internus, . . .26 
Pterygoideus Externus. Digastricus. Mylo Hyoideus, . 27 
Genio Hyoideus. Genio Glossus. Platysma Myoides. Levator 
labii superioris, et alee nasi, 28 
Levator labii Superioris. Levator Anguli Oris. Zygomaticus 
Major. Zygomaticus Minor. Depressor Anguli Oris. De- 
pressor Labii Inferioris. Buccinator, 29 
Orbicularis Oris. The Structure of the Lips and the interior of 
the Mouth, 30 
The Posterior wall of the Mouth or Palate. Glosso-Staphilus. 
Peristaphilius Internus. Peristaphilius Externus, . . .32 
Pharyngo-Staphilius. Palato-Staphilius. The Superior and In- 
ferior Walls of the Mouth, 33 
The Tongue and its Muscles. The Stylo-Gloss us. The Hyo- 
Glossus. The Lingual, 34 
Sec. IV.-Salivary Glands. Parotid Gland, 35 
Maxillary Gland. Sublingual Gland, 36 
Sec. V.-Nervous and Vascular Apparatus, 37 
Arteries. Veins. Lymphatic Vessels and Glands, . . .38 160 
INDEX. 
PHYSIOLOGY OF THE MOUTH. 
PAGE. 
Sec. I.-Mechanical Function of the Apparatus of Mastication. The 
Adaptation of the Superior Maxilla for Mastication, . . 39 
The Tnferor Jaw, and the Action of the Muscles that are at- 
tached to it, 41 
Sec. II.-Organic Function of the Apparatus of Mastication, . . 43 
PART SECOND. 
DISEASES OF THE MOUTH. 
Sec. I.-Diseases of the Mucous Membrane of the Mouth. Chaped 
Lips, 47 
Aphthae of the Mouth, .48 
Scurvy, 49 
Angina, 53 
Sec. II.-Diseases that have their seat in the substance of the various 
parts of the Mouth, 54 
Epules, 55 
Ozena of the Maxillary Sinus, 5G 
Polypi or Fungi of the Maxillary Sinus, 59 
Wounds, Ulcers, Tumours and other Diseases of the structure 
of the different parts of the Mouth, 60 
The Lips.-Imperforation of the Mouth, .... 60 
Contraction of the Mouth. Hare-lip, . . .61 
Swelling of the Lips, 63 
Affection of the Fraenum of the Tongue. Affections of the Tongue, 63 
Intumescence of the Tongue, 64 
Doubling over of the Tongue. Gun-shot Wounds in the Mouth. 
Compound Wounds, 66 
Sec. III.-Diseases of the Salivary Glands and Conduits, and affections 
peculiar to the Lymphatic Glands, 68 
Ranula, .69 
Affections of the Lymphatic Glands which encompass the Jaws, 70 
Of Scirrhus and Cancer in the Mouth, 72 
Cancerous Tumours of the Lip. Cancer of the Cheek, . . 73' 
Sec. IV.-Some affections simply nervous, or of a Rheumatic Nature, 74 
Tic-Douloureux, 76 PAGE. 
Sec. V.-Diseases of the Jaw Bone, 78 
Luxation, ... 79 
Fracture of the Inferior Jaw, 83 
Diseases of the tissue of the Bones. Mortification, or Necrosis. 
Partial and External Mortification, or Exfoliation, . . .86 
Partial and Internal Necrosis, 87 
Total Necrosis of the Body of the Bone, 88 
Osseous Tumours, . 90 
Caries, 94 
Sec. VI.-Diseases of the Teeth, 95 
The Formation of Tartar, 96 
Denudation of the Teeth, 97 
Luxation of the Teeth, 98 
Fracture of the Teeth, 99 
Caries of the Teeth, 100 
INDEX. 
161 
PART THIRD. 
HYGIENE AND THERAPEUTICS. 
Sec. I.-The Eruption of the Teeth of First Dentition, . . .103 
The condition of the Gums during the eruption of the Decidu- 
ous Teeth. The means capable of opposing the Derange- 
ment of the Gastric Apparatus during first dentition, . 104 
The manner of treating Convulsions produced by Dentition, . 107 
Sec. II.-The manner of directing Second Dentition, . . . 109 
Manner of correcting Irregularities, 112 
Sec. III.-Means used for the Preservation of the Teeth and other 
parts of the Mouth, at different periods of life, . . .114 
Care required by the Gums, • 118 
Caries, 119 
Remedies for Tooth-ache, 120 
The manner of replacing Lost Teeth, 121 
Manner of remedying Defects in the Palatine Arch, . . 122 
Sec. IV.-Various Powders, Opiates, and Elixirs to clean teeth, re- 
lieve tooth-ache and cure diseased gums. Tooth Powder, 
No. 1. No. 2. No. 3, 123 
Opiates. Elixir for the Mouth, No. 1. Odontalgic Elixir, No. 
2. Elixir for the Gums, No. 3. Instruments and Materials 
used for cleaning the Teeth. Brushes. Roots, . . 124 
Sponges. Coral Sticks, 125 162 
INDEX. 
PART FOURTH. 
OPERATIONS. 
PAGE. 
Sec. I.-The method of Cleaning Teeth and instruments necessary 
for that Operation, 127 
Sec. II.-The various methods of Filing Teeth, . . . .130 
Sec. III.-The use of the Actual Cautery, 132 
Sec. IV.-Manner of Plugging Teeth, 134 
Sec. V.-Manner of Luxating Teeth, 135 
Sec. VI.-Extracting Teeth 136 
Garengeot's Key, : . . 138 
Pelican. Straight Lever. Straight Forceps. Hawk's-beak 
Forceps. The Fish Tongue, 140 
Crow's-Foot, 141 
Sec. VIL-Accidents which may result from the Extraction of 
Teeth, . _ . .142 
Hemorrhage, 144 
Sec. VIII.-Artificial Teeth, 145 
The Instruments necessary for the Manufacturing of Artificial 
Teeth. Different kinds of Artificial Teeth. Pivot Teeth, 146 
Teeth retained by Ligatures, 149 
Sec. IX.-Artificial Blocks of Teeth, 149 
Various kinds of Ligatures used to fasten Artificial Teeth, . 151 
Sec. X.-Artificial Dentures. Dentures for the Inferior Jaw, . . 152 
Dentures for the Superior Jaw, 153 
Double Set of Teeth, 154 
Sec. XI.-Obturators, 156 
Obturators sustained by Sponge, 157 
Obturators attached to the Teeth. Obturators sustained by a 
Spring, 158