BONE-FORMATION 
AFTER 
RESECTION OF THE LOWER JAW. 
BY 
B. v. LANGENBECK. 
TRANSACTIONS OF THE “GERMAN SOCIETY OF 
SURGERYSIXTH CONGRESS. 
v BERLIN, APRIL 7, 1877. 
[REPRINTED FROM THE NEW YORK MEDICAL JOURNAL. APRIL, 1878.] 
I). APPLETON & COMPANY 
5 4 9 k 5 6 1 BROADWAY. 
NEW YORK: 
1878. A HISTORY OF ENGLAND 
IN THE 
EIGHTEENTH CENTURY. 
WILLIAM EDWARD HARTPOLE LECKV, 
Author of “ History of the Rise and Influence of the Spirit of Rationalism in Europe,” “ History 
of European Morals, from Augustus to Charlemagne,” elc. 
2 vols., 12mo. Cloth, $5.00. 
Whigs and Tories. 
Godolphin and Marlborough. 
Literature under Anne. 
Sacheverell and the Clergy. 
Oxford, Bolingbroke, Swift. 
Nonconformists—Quakers. 
Parliamentary Corruption and Tyranny. 
Irish Penal Code. 
Robert Walpole. 
Drunkenness—Gambling. 
Fleet Marriages. 
Newspapers. 
Architecture,Painting, Music, and the Drama 
English Laborers. 
North American Colonies. 
SOME TOPICS SELECTED FROM iHE CONTENTS. 
Commercial Restrictions. 
Slave-Trade. 
Scotland: The Highlands, Scotch Religion, 
Progress. 
Ireland; Resources, Country Life, Politics, 
Religion, Emigration. 
I Priest-Hunting, 11-1T30. 
The Duke of Newcastle. 
Pitt—Fox. 
| Conquest of Canada. 
I Conquest of Hindostan. 
| Religious Revival. 
Observance of Sunday. 
W esley—Whitefield. 
j Religion in Wales. 
Other writers, and among them notably Lord Stanhope, have published works cover- 
ing, in great measure, the same period which Mr. Lccky has here chosen to treat of; but 
the plans, objects, and the classes of facts, on which the present history especially dwells, 
are so very different from all preceding histories as to constitute an entirely distinct pro- 
duction. Next to impartiality, nothing has so distinguished Mr. Lecky as his power of 
massing facts, and preserving their due relation and subordination. The strict order of 
chronology he in some cases departs from, for, as he observes, “the history of an insti- 
tution, or a tendency, can only be written by collecting into a single focus facts that are 
spread over many years, and such matters may be more elearly treated according to the 
order of subjects than according to the order of time.'’ This is, indeed, the philosophy 
of history; and, instead of giving a dry narrative of events year by year, it has been Mr. 
Lecky’s object “ to disengage from the great mass of facts those which relate to the per- 
manent forces of the nation, or which indicate some of the more enduring features of 
national life, and to present the growth or decline of monarchy, the aristocracy, and the 
democracy, of the Church and of Dissent, of the agricultural, the manufacturing, and the 
commercial interests ; the increasing power of Parliament and of the press ; the history 
of political ideas, of art, of manners, and of belief; the changes hat have taken place in 
the social and economical condition of the people ; the influences that have modified na- 
tional character; the relations of the mother-country to its dependencies, and the causes 
that have accelerated or retarded the advancement of the latter.” 
I). APPLETON & CO549 & 551 Broadway, N. Y BONE-FORMATION 
AFTER 
RESECTION OE THE LOWER JAW. 
BT 
B. Y. LANGENBECK, 
TRANSACTIONS OF TEE “ GERMAN SOCIETY OF 
SURGERY.SIXTH CONGRESS. 
BERLIN, APRIL 7, 1877. 
[REPRINTED FROM THE NEW YORK MEDICAL JOURNAL, APRIL, 1878.] 
NEW YORK: 
D. APPLETON & COMPANY, 
549 & 551 BROADWAY. 
1878. BONE-FORMATION AFTER RESECTION OF 
THE LOWER JAW.1 
Gentlemen : 1 am permitted to make this brief communi- 
cation through the (as I may well say) exceedingly great at- 
tention which Prof. J. R. Wood, of New York, has shown, in 
sending this preparation here from New York by his assist- 
ant, Dr. Wiggin, in order to allow it to be demonstrated. 
Dr. Wiggin must return again to-morrow to New York, and, 
although our allotted time is very brief, nevertheless I have 
deemed it necessary to present this demonstration, because 
otherwise our distinguished American colleague would have 
sent us this really grand work in vain. 
Prof, Wood, Surgeon to Bellevue Hospital, in New York, 
had the kindness to send me the photograph of this skull last 
fall—a skull of which the entire under jaw has been extirpated 
on account of phosphorus-necrosis, and of which the whole 
lower jaw has, in the course of a brief time, formed itself 
anew; and when, in my surgical lecture, I had showed and 
explained this photograph, 1 did not believe that a correspond- 
1 This article is a literal translation of B. v. Langenbeck’s speech on 
the subject of Reproduction of Bone, delivered in the Aula of the Univer- 
sity of Berlin, before the Congress of Surgeons, in April, 1877. The 
speech has been published in the “ Transactions of the Congress,” which 
book we have before us, and from which we have translated the entire 
address. 4 
ing preparation really existed anywhere, lie had the courtesy 
to send us this skull with the newly-formed lower jaw. I will 
quite briefly present the history of the operation, which is de- 
scribed in a short article by Dr. Wood in the “New York 
Journal of Medicine” for May, 1856, as the “Removal of the 
entire Lower Jaw, for Necrosis caused by Phosphoric-Acid 
Gas” 
A girl—Cornelia S.—sixteen years of age, formerly always 
healthy, had worked in match-factories for two years and 
a half, one of which was very badly ventilated. She was 
occupied eight hours daily in packing matches, but enjoyed 
the best of health until May, 1855. At that time there took 
place, along with toothache, a swelling of the lower jaw, with 
suppuration. The patient, however, continued her work up 
to December, 1855. 
Upon her reception into Bellevue Hospital, total necrosis 
of the right, and partial of the left, lower jaw existed, with 
profuse suppuration. The pus poured for the greater part 
into the cavity of the mouth, and outward through a fis- 
tula opening in the lower border of the mandibula. Not- 
withstanding this, her general health had remained good, 
and her appetite good, only chewing was very much im- 
peded. 
On the 19th of January, 1856, Dr. Wood made a resection 
of a part of the right lower half of the jaw, with most careful 
saving of the periosteum, and with preservation of the chin- 
portion of the lower jaw. Healing resulted -without inter- 
ruption, but it soon became evident that the entire remaining 
under jaw was diseased also, and this had likewise to be 
removed on the 16th of February, 28 days after the first 
operation. Excepting the retraction of the tongue ensuing 
upon the removal of the jaw, and the choking symptoms in- 
duced thereby, the good effect of the operation and the heal- 
ing of the wound remained uninterrupted, and in March, 
1856, the patient was able to be discharged, recovered. 
The reformation of hone was complete, and the function 
of the new lower jaw left nothing further to be desired. In 
the photograph taken at this time, you observe the admirable 
contour of the lower jaw, of which the chin-portion only re- 5 
cedes slightly. Some years later, Cornelia S. died of abscess 
of the brain, and so Dr. Wood acquired the possession of this 
skull, which stands before you, and upon which you observe 
the entire lower jaw, with extremely complete form, only a 
very little smaller than the original must have been. 
Formerly, cases of phosphorus-necrosis came into the clinic 
here not infrequently, and scarcely a term passed in which 
some jaw-resections were not performed. Thanks to the bet- 
ter ventilation in factories since 1864, scarcely any cases have 
come under observation, and it appears that phosphorus-necro- 
sis will, at no very distant time, be eliminated. 
I have performed subperiosteal resection of the entire low- 
er jaw six times—four times in consequence of phosphorus- 
necrosis, and twice in consequence of acute osteo-periostitis. 
In all these case reformation of new bones was observed, and, 
indeed, as in the case operated upon by Dr. Wood, with most 
complete-restoration of the function. 
When one extirpates the entire lower jaw from under the 
periosteum at one sitting, the chin must invariably recede. 
The room for the formation of the new lower jaw is restricted 
by muscles, namely, by the genio-glossi; the contour of the 
new lower jaw develops imperfectly, and the chin-portion of 
it retreats more or less perceptibly. In order to obviate this 
evil, I have, like Dr. Wood, made the operation at two differ- 
ent times, and at first cut out from the periosteum the smaller 
portion of the mandibula—which was, however, most diseased 
—leaving the chin and larger portion alone, and then, after 
four or six weeks, resected the remainder. But even then, as 
this photograph and the description given by Dr. Wood indi- 
cate, the lower jaw is always smaller, and the normal promi- 
nence of the chin is lacking. 
This evil is almost completely avoided, if, as Billroth has 
recommended, one leave behind in position osteophytes from 
the necrosed bone, in immediate contact with the periosteum. 
This photograph shows you such a case. I cut out first the 
smaller part of the necrosed jaw-bone, and, after new bone 
could be distinctly felt—six weeks later—I cut out the greater 
part, with the chin-portion. The resected jaw here shows 
you that osteophytes were left almost completely around. 6 
The photograph, which is taken half in profile (August 
Matthes’s), shows you that the contour of the lower jaw is 
very complete, and that the chin stands out in the normal 
manner. 
The skull sent to us by Dr. Wood settles at once the ques- 
tion of the durability of the newly-formed bone. It has, in- 
deed, been repeatedly maintained, that the newly-formed bone, 
after subperiosteal resection, cannot be of a durable kind, but 
that it subsequently must be reabsorbed. At all events, this 
may happen, and I have myself seen it in the case of a woman 
suffering from phosphorus-necrosis of the lower jaw, much re- 
duced by long suppuration, whose lower jaw, newly formed 
after resection, was, after a twelvemonth, almost entirely re- 
absorbed. Such an absorption of bone is, however, a rare 
occurrence in my observation, and I can testify to the un- 
changed persistence after years of the new bone-formation, 
after subperiosteal extirpation, as well in the lower jaw as in 
long bones (tibia, radius, os metacarpi pollicis). 
Dr. Wood’s patient died some years after the operation, 
and yet you see the new lower jaw preserved in all its parts, 
although a trifle smaller than was the original jaw. THE 
LIFE AND WORDS OF CHRIST, 
By CUNNINGHAM GEIKIE, D. D. 
With Twelve Engravings on Steel. In Two Volumes. Price, $8.00. 
“ A great and noble work, rich in information, eloquent and scholarly in style, earnestly devout 
in feeling.’”—London Literary World. 
" The present book differs very considerably from Canon Farrar’s work in scope, and in many 
important features Dr. Geikie approaches his task from the same standpoint, that ol an unreserved 
believer in revelation, but ho takes a larger and wider view of his subject, giving a very full ac- 
count of the political history of the Jews at the period, besides a much more minute description 
of the social and religious life of the people. Indeed, the book is so exhaustive that we can scarcely 
think any scattered grains of information are left tor gleaners who may wish to follow in the same 
path.”—John Bid . 
“ The author has brought to his difficult and noble task the stores of an eloquent, well-informed, 
and devout mind. He has, in a very great degree, accomplished what he proposed, and brought 
before his readers the world in which Jesus moved ; the country in which he lived ; (he people 
among whom he grew up and ministered ; the religion in which he was trained ; the Temple ser- 
vices in which he took part; the ecclesiastical, civil, and social aspects of his time ; the parties of 
the day, their opinions and their spirit; the customs that ruled ; the influences that prevailed ; 
the events, social, religions, and political, not mentioned in the Gospels, that formed the history 
of his lifetime. &■< far as they can be recovered.”—London Standard. 
"It goes over the whole ground of the Life, beginning with the state of Palestine at the birth 
of Christ, discussing carefully every event and word, and ending with St. Luke’s account of the 
Ascension.”—JV. Y. World. 
“ The author gives a full account of the political and social state of the Jews at the time of 
Christ: of their religious and domestic life, and of the customs, spirit, ecclesiastical system and 
parties of the time. In all of these things Dr. Geikie’s work differs from Canon Farrar’s, and fitly 
supplements it.”— N. Y. Evening Post. 
“ Without disparaging in any sense the noble labors of his predecessors, we think Dr. Geikie 
has caught a new ray from the ‘Mountain of Light,’ and has added a new page to our Christology 
which many will delight to read. These volumes are full of exquisite word-painting, from which 
an artist might reproduce innumerable lifelike pictures.”—Ar 3'. Evangelist. 
“ These fresh volumes are marked throughout by a humane and devout spirit, and the type of 
churchmanship which they represent and urge is positive, but not extreme. The work is sure to 
make for itself a place in popular literature.”—N. Y. Times. 
“The chief merit of Dr. Geikie’s volumes lies in the attention paid to the surroundings of our 
Saviour’s early life. The person and works of Christ receive the chief attention, of course; but 
the background is so faithfully and vividly drawn that the reader is given a fresher idea of the 
central flgur N. Y. Independent. 
“ His style is always clear, rising sometimes into majestic beauty. His most steady point ot 
view is the relations of Christ to the elevation of the race, and he struggles to make clear the 
amazing richness of Christ’s new things—the profound character of his philosophy, and the prac- 
tical humanity that wells up out of these great deeps.”—N. Y. Methodist. 
D. APPLETON & CO., 549 & 551 Broadway, New York. THE INTERNATIONAL SCIENTIFIC SERIES, 
NOW IR, E HD 
No. I. FORMS OF WATER, in Clouds, Rain, Rivers, Ice, and Glaciers. By Prof. John Tvndall, LL. D., 
F. R. S. 1vol. Cloth. Price, $1.50. 
44 2. PHYSICS AND POLITICS; or, Thoughts on the Application ofthe Principles of “ Natural Selection 99 
and “ Inheritance” to Political Society. By Walter Bagkhot, Esq., author of “ The English Constitution.” 
1 vol. Cloth. Price, $1.50. 
44 3. FOODS. By Edward Smith, M. D., LL. B., F. R. S. 1 vol. Cloth. Price, $1 75. 
44 4. MIND AND BODY. The Theories of their Relations. By Alex. Bain, LL. D., Professor of Logic in the 
University of Aberdeen. 1 vol., 12mo. Cloth. Price, $1.50. 
44 5. THE STUDY OF SOCIOLOGY. By Herbert Spencer. 1 vol., 12mo. Cloth. Price, *1.60. 
“ 6. THE NEW CHEMISTRY. % Prof. Josiah P. Cooke, Jr., of Harvard University. 1 voL, 12mo. Cloth. 
Price, $2.00. 
44 7. THE CONSERVATION OF ENERGY. By Prof. Balfour Stewakt, LL. D., F. R. S. 1 vol., 
12mo. Cloth. Price, $1.50. 
“ 8. ANIMAL LOCOMOTION; or. Walking, Swimming, and Flying, with a Dissertation on Aeronautics. By 
J. Dell Peitigrew, M. D., F. R. S., F. R. S. E., F. R. C. P. E. 1 vol., 12mo. Fully illustrated. Price, $1.75. 
“ 9. RESPONSIBILITY IN MENTAL DISEASE. By Henry Maudslky,M. D. 1 vol., 12mo. Cloth. 
Price, $1.60. 
“ 10. THE SCIENCE OF LAW. By Prof. Sheldon Amos. 1 vol., 12mo. Cloth. Price, $1.75. 
“ II. ANIMAL MECHANISM. A Treatise on Terrestrial and Aerial Locomotion. By E. J. Marey. With 
117 Illustrations. Price, $1.75. 
“ 12. THE HISTORY OF THE CONFLICT BETWEEN RELIGION AND SCIENCE 
By John Wm. Draper, M. D., LL. D., author of “ The Intellectual Development of Europe.” Price, $1.75. 
“ 13. THE DOCTRINE OF DESCENT, AND DARWINISM. By Prof. Oscar Schmidt, Stras- 
burg University. Price, $1.50. 
“ 14. THE CHEMISTRY OF LIGHT AND PHOTOCRAPHY. In its Application to Art, Science, 
and Industry. By Dr. Hermann Vogel. 100 Illustrations. Price, $2.00. 
44 15. FUNGI; their Nature, Influence, and Uses. By M. C. Cooke, M. A., LL. D. Edited by Rev. M. J. Berkeley, 
M. A., F. L. S. With 109 Illustrations. Price, $1.50. 
“ 16. THE LIFE AND GROWTH OF LANGUAGE. By Prof. W. D. Whitney, of Yale College, 
Price, $1.50. 
“ 17. MONEY AND THE MECHANISM OF EXCHANGE. By W. Stanley Jevons, M. A., 
F. R. S., Professor of Logic and Political Economy in the Owens College, Manchester. Price, $1.75. 
44 18. THE NATURE OF LIGHT, with a General Account of Physical Optics. By Dr. Eugene Lommel, 
Professor of Physics in the University of Erlangen. With 188 Illustrations and a Plate of Spectra in Chromo- 
lithography. Price, $2.00. 
44 19. ANIMAL PARASITES AND MESSMATES. By Monsieur Van Benedkn, Professor of the 
University of Louvain, Correspondent of the Institute of France. With 83 Illustrations. Price. $1,50. 
44 20. ON FERMENTATIONS. By P. Schutzkn berger, Director at the Chemical Laboratory at the Sor- 
bonne With 28 Illustrations. Price, $1.50. 
“ 2 1. THE FIVE SENSES OF MAN. By Julius Bernstein, O. 6. Professor of Physiology in the Uni- 
versity of Halle. With 91 Illustrations. Price, $1.75. 
“ 22. THE THEORY OF SOUND IN ITS RELATION TO MUSIC. By Prof. Pietro 
Blaserna, of the Royal University of Rome. With numerous Woodcuts. 1 vol., 12mo. Cloth. Price, $1.50. 
D. Appleton & Co. have the pleasure of announcing that they have made arrangements for publishing, and have recently 
commenced the issue of, a Series of Popular Monographs, or small works, under the above title, which will embody th*e 
results of recent inquiry in the most interesting departments of advancing science. 
The character and scope 01 this series will be best indicated by a reference to the names and subjects included in the subjoined 
list? from which it will be seen that the cooperation of the most distinguished professors in England, Germany, France, and the 
United States, has been secured, and negotiations are pending for contributions from other eminent scientific writers. 
The works will be issued simultaneously in New York, London, Paris, Leipsic, Milan, and St, Petersburg. 
The International Scientific Series is entirely an American project, and was originated and organized by Dr. E. L. 
Youmans, who spent the greater part of a year in Europe, arranging with authors and publishers. The forthcoming volumes 
are as follows: 
PROSPECTUS. 
Prof. W. Kingdon Clifford, M. A., The First Principles of the 
Exact Sciences explained to the Non-Mathematical. 
Prof. T. H. Huxley, LL. D., F. R. S., Bodili/Motion and Con- 
sciousness. 
Dr. W. B. Carpenter, LL. D., F. R. S., The Physical Geogra- 
phy of the Sea. 
Prof. Wm. Odltng, F. R. S., The Old Chemistry viewed from 
the New Stand-point. 
W. Lauder Lindsay, M. D., F. R. S. E., Mind in the Lower 
Animals. 
Sir John Lubbock, Bart., F. R S., On Ants and Bees. 
Prof. W. T. Thisklton Dyer, B. A., B. Sc., Form and Habit in 
Flowering Plants. 
Mr. J. N. Lockyer, F. R. S., Spectrum Analysis. 
Prof. Michael Foster, M. D., Protoplasm and the Cell Theory. 
H. Charlton Bastian, M. D., F. R. S., The Brain as an 
Organ of Mind, 
Prof. A. C. Ramsay, LL. D., F. R S., Earth Sculpture; Hills, 
Valleys, Mountains, Plains, Rivers, Lakes; how they were 
produced, and how they have been destroyed. 
Prof. Rudolph Virchow (Berlin University), Morbid Physiolo- 
gical Action. 
Prof. Claude Bernard, His'ory of the Theories of Life. 
Prof. H. Saint-Claire Devillk, An Introduction to General 
Chemistry. 
Prof. Wurtz, Atoms and the Atomic Theory. 
Prof. Dk Quatrefages, The Human Race. 
Prof. Lacaze-Duthiers, Zoology since Cuvier. 
Prof. Bkrthklot, Chemical Synthesis. 
Prof. C. A. Young, Ph. D. (of Dartmouth College), The Sun. 
Prof. Ogden N. Rood (Columbia College, New York), Mod- 
ern Chromatics and its Relations to Art and Industry. 
Dr. Eugene Lommel (University of Erlangen), The Nature of 
Light. 
Prof. J. Rosenthal, General Physiology of Muscles and Nerves. 
Prof. James D. Dana, M. A., LL. D., On Cephalization; or, 
Head-Characters in the Gradation and Progress of Life. 
Prof. S. W. Johnson, M. A., On the Nutrition of Plants, 
Prof. Austin Flint, Jr., M. D., The Nervous System, and its 
Relation to the Bodily Functions. 
Prof. Bernstein (University of Halle), The Five Senses of Man. 
Prof. Ferdinand Cohn (Breslau University), Thallophytes 
(A/gee, Lichens, Fungi). 
Prof. Hermann (University of Zurich), On Restoration. 
Prof. Lkuckart (University of Leipsic), Outlines of Animal 
Organization. 
Prof. Liebreich (University of Berlin), Outlines of Toxicology, 
Prof. Kundt (University of Strasburg), On Sound. 
Prof. Rees (University‘of Erlangen), On Parasitic Plants. 
Prof. Stkinthal (University of Berlin), Outlines of the Science 
of Language. 
P. Bert (Professor of Physiology, Paris), Forms of Life and 
other Chemical CandiUons. 
E. Alglave (Professor of Constitutional and Administrative 
Law at Douai, and of Political Economy at Lille), The 
Primitive Elements of Political Constitutions. 
P. Lorain (Professor of Medicine, Paris), Modern Epidemics. 
Prof. Schutzenberger (Director of the Chemical Laboratory 
at the Sorbonne), On Fermentations. 
Mons. Freidel, The Functions of Organ * hemistry. 
Mons. Debray, Precious Metals. 
Prof. Corfield, M. A., M. D. (Oxon.), Air in its Relation to 
Health. 
Prof. A. Giard, General Embryology. 
D. APPLETON CO., Publishers. 549 551 Eroadway, A/. K