'■mm..
/ DENTAL MEDICINE,
AS CONNECTED WITH THE
STUDY OE DENTAL SUKGERY.
A
PRACTICAL TREATISE
ox
DENTAL MEDICINE,
BEING A
COMPENDIUM OF MEDICAL SCIENCE,
AS CONNECTED WITH THE
ST™ Y OE DENTAL SURGERY:
TO WHICH IS APPENDED
AN INQUIRY INTO THE USE OF CHLOROFORM,
AND OTHER ANESTHETIC AGENTS.
SECOND EDITION,
Ueuiseb, (Eormteb, atib ©nlargeb.
BY -• ^i"**'"'''
THOS. E. BOND^A.M., M.D.,
PROFESSOR OP SPECIAL PATHOLOGY AND THERAPEUTICS IN THE BALTIMORE COLLEGE OF
DENTAL SURGERY.
PHILADELPHIA:
LINDSAY AND BLAKISTON.
1852.
B7llf
\85t
Entered, according to Act of Congress, in the year 1852.
BY LINDSAY AND BLAKISTON,
In the Clerk's Office of the District Court for the Eastern District of PennsylTania.
C. SHERMAN, PRINTER,
19 St. James Street.
THIS WORK IS RESPECTFULLY DEDICATKD,
BY HIS SON.
PREFACE
TO THE SECOND EDITION.
The author of the present treatise gave it to the public
with little expectation that it would meet a favourable recep-
tion. Indeed, but for the urgency of a friend, in whose judg-
ment he had reason to confide more securely than in his own,
he never could have overcome his reluctance to risk the expe-
riment of the publication.
In the result, however, he has been agreeably disappointed.
The unpretending volume was very generally noticed by medi-
cal reviewers, in every instance, so far as he is informed, with
decided commendation, and a practical evidence of its accepta-
bility was given in the ready sale of the edition.
The author is well aware that he is very much indebted to
the personal regard of professional friends for some of the
favourable notices of his book, and that, in other instances, he
has shared the common urbanity and indulgent consideration
with which the conductors of our best Medical Journals are
accustomed to encourage all respectable efforts to contribute
to the literature of the profession. Nevertheless, he thinks
himself authorized to believe, that, after all proper allowance
is made for the expression of personal kindness and profes-
sional amity, he may, without vanity, ascribe some portion of
Xvi PREFACE TO THE SECOND EDITION.
the commendation lavished upon the work, to its adaptedness
to supply what is felt to be a want; and he, therefore, has
determined to offer to the public a second edition.
In preparing this for the press, it was not thought advisable
to enlarge the book to an extent that would require a consi-
derable increase in the price; nevertheless, some important
matter has been added where the treatise seemed most imper-
fect.
A chapter upon Anaesthetics has been appended to the work
as originally published. The great importance of the subject,
and the interest felt in it, required that it should be discussed
in a treatise designed for the purposes for which this was
written.
The arrangement has been altered where perspicuity and
connexion required it. A great number of verbal errors have
been corrected; and the typographical execution very much
improved. A copious index has also been added.
The author sincerely hopes that the book may prove useful
to all who may do him the honour to read it.
Baltimore, September 13th, 1852.
PREFACE
TO THE FIRST EDITION.
The Baltimore College of Dental Surgery was organized
with the design of teaching Dentistry as a regular branch of
Medicine, in which relation, only, it can be regarded as a
scientific pursuit, and the practice of it esteemed as a pro-
fession.
With this view it was arranged that the Faculty should con-
sist equally of Dentists and practising Physicians, and to the
author of this treatise was intrusted the chair of Special Pa-
thology and Therapeutics. Commencing the performance of
his duties with no larger amount of knowledge of the subject
than is commonly possessed by medical men, he has been led
to discover much more importance in it than at first he could
have supposed to exist. Endeavouring to avoid the very na-
tural error of exaggerating the value of isolated facts or
doubtful statements, upon matters at once novel and from the
circumstances peculiarly interesting, he has found that many
things which at first he was disposed to regard as unlikely,
are, nevertheless, well-attested and established facts; and,
after mature investigation, he has become fully convinced that
the relations of the teeth and their appendages with other
and even with vital parts, are sufficiently important to be
carefully studied both by the Dentist and Physician.
xviii
PREFACE TO THE FIRST EDITION.
After ten years' experience as a teacher of these subjects,
he has found it absolutely necessary that a compendium of
medicine should be furnished, in which might be brought to-
gether, in a small compass, such selected information as the
wants of the Dental Surgeon demand ;—and as none has been
prepared by another, he has reluctantly undertaken the task.
The difficulty of performing it will readily be conceived,
when it is observed how much was proper and how much irre-
levant ; how cautious it was necessary to be, that no needless
matter should be introduced, and how careful that nothing
pertinent should be omitted.
Without the pretension of having done it well, the author is
yet gratified that it has been done at all.
Though particularly intended for the Dentist, the author
flatters himself that he has presented the subject in such a
form as will render it deserving the attention of the general
practitioner.
It is not the custom of our profession to consider anything
unworthy of attention that has a bearing, however remote,
upon the benevolent pursuit to which we have devoted our
lives, but to the most fastidious it may be said, that subjects
which have been thought worthy the attention of Hunter and
Rush, may be investigated by any without fear of degrada-
tion.
The Author.
Baltimore, Dec. 31, 1850.
CONTENTS.
PAGE
Introduction, . . . . . . .25
CHAPTER I.
Preliminary Considerations, ..... 31
CHAPTER II.
Etiology, . . . . . . . .34
The Atmosphere, ...... 36
Heat and Cold, ....... 37
Malaria, . . . . . . . 41
Chemical Causes, , . . . . . .44
CHAPTER III.
Symptoms of Disease, ...... 48
Progress of Disease, . . . . . .49
CHAPTER IV.
Diagnosis, ........ 52
CHAPTER V.
Treatment of Disease, ....... 59
CHAPTER VI.
Nature of Disease,
Inflammation,
Consequences of Inflammation,
61
63
71
XX
CONTENTS.
CHAPTER VII.
PAGE
Inflammation of the several parts composing the Mouth, and of
the parts adjacent, ...... 81
Phlegmon, ....... 81
Erysipelas, ........ 82
Tonsillitis, ....... 82
Stomatitis, . . . . . . . .83
Inflammation of the Gums, ..... 83
Antrum, . . . . .85
Inflammatory Fever, .... 86
CHAPTER VIII.
Treatment of Inflammation. . c-
• • • . o/
Treatment of Inflammation and Abscess of the parts composing
the Mouth, . og
Mercurial Salivation, ... q,
Cancrum oris, ... q„
Chronic Inflammation of the Gums, . . 93
CHAPTER IX.
Caries and Mortification,
Caries,
Mortification or Gangrene,
Necrosis of the Teeth,
CHAPTER X.
Ulcers,
Local and Constitutional, .
Simple Purulent Ulcer,
Vitiated Ulcer,
Callous Ulcer,
Fungous Ulcer,
Sinuous Ulcer,
Carious Ulcer,
Cancerous Ulcer,
Ulcers Dependent upon Constitutional Cause,
Venereal or Syphilitic Ulcers,
Scorbutic Ulcers,
Scrofulous Ulcer,
95
95
96
100
103
105
105
106
\m
108
109
110
111
115
115
119
121
Tumours,
CHAPTER XL
128
CONTENTS.
XXI
OURS. PAGE
Malignant—Osteo-Sarcoma, ..... 128
Fungus Hsematodes, Bleeding Fungus, Spongoid Inflammation,
Soft Cancer, Medullary Sarcoma, .... 128
Polypus, ....... 129
Benign Tumours, ....... 130
Sarcomatous or Fleshy Tumours, .... 131
Encysted Tumours, 131
Bony Tumours, ...... 132
Exostosis of the Teeth, ...... 135
Osteo-Sarcoma, ...... 137
Spina Ventosa, ....... 138
Aneurismal Tumours, ...... 138
CHAPTER XII.
Diseases of the Teeth and Face dependent upon Morbid Condi-
tions, either general or of other parts, . . 139
Neuralgia, ....... 139
Neuralgia Faciei, or Facial Neuralgia, . . . .141
Intermittent Neuralgia, . . . .144
CHAPTER.XIII.
Morbid Secretions of the Mouth, ..... 149
Dyspepsia, ....... 153
Syphilis, . . . . . . . .160
Exanthemata, ....... 160
Mercurial Salivation, ...... 161
Scrofula, ....... 162
Pregnancy, . . . . . . . .163
CHAPTER XIV.
Morbid Effects of Conditions of the Teeth and Gums upon the
General System, ...... 165
CHAPTER XV.
Morbid Effects of First Dentition, . . . .168
CHAPTER XVI.
Sympathetic Diseases of Dentition, .... 179
Cholera Infantum, . . . . . .180
Convulsions, ....... 183
Cutaneous Eruptions, ...... 184
2
XX11
CONTENTS.
PAGE
Intertrigo, . . . . . . 184
Crusta Lactea, or Milk Crust, . 185
Strophulus, Tooth Rash, Red Gum, . . . • 185
Second Dentition, ....... 187
Third Dentition, . . . . . 187
CHAPTER XVII.
Effects of Diseased Teeth and Gums upon Adjacent Parts and
the General System, . . . . . .188
CHAPTER XVIII.
Wounds of the Mouth and Face, .... 229
Burns, ...... 242
Fractures, ...... 245
Fractures of the Jaws, .... 247
Dislocations, or Luxations, .... 249
Dislocations of the Lower Jaw, .... 250
CHAPTER XIX.
Particular Affections of the Mouth and adjacent parts, . 253
Diseases of the Gums, . • . . 253
Epulis, ••••... 253
Parulis, .... 257
Fistula of the Gum of the Lower Maxillary, having an Exterior
Opening at the Hollow of the Chin, . . 259
Spongy or Fungoid Inflammation of the Gums, . . 260
Hemorrhage from the Gums, ... 262
CHAPTER XX.
Diseases of the Lips,
Hare-Lip,
Adhesion, ..." • . 264
Contraction, . ' 268
264
Cancer of the Lip,
268
272
CHAPTER XXI.
Diseases of the Glands and Gland-Ducts
Salivary Tumours,
Tumours of the Submaxillary Gland,
Notes of the Operation, . " 280
Tumours of the Parotid Glands, . 284
Salivary Fistula, ' ' 290
292
~i 1
CONTENTS.
xxiii
CHAPTER XXII.
PAGE
Tumours requiring Amputation of a part or the whole of the
Upper Jaw, ....... 294
Amputation of the Lower Jaw, .... 296
CHAPTER XXIII.
Diseases of the Antrum, or Maxillary Sinus, . . 305
Dropsy, or Retention of Mucus, . . . . 306
Inflammation, . . . . . . .311
Suppuration, . . . . . . . 312
Caries, Necrosis, and other Morbid Conditions of the Bony Walls, 313
Softening of the Bony Walls, . . . . .320
Exostosis, ....... 320
Fistula of the Superior Maxillary Bone, .... 322
Ozsena, ........ 326
Polypi and other Tumours, ..... 327
Insects in the Cavity, ...... 332
CHAPTER XXIV.
Diseases of the Palate, ...... 334
CHAPTER XXV.
The Use of Chloroform and other Anaesthetic Agents, . 34G
Effects of Chloroform, . . . . . .353
Modus Operandi of Anoesthetics, .... 354
Conditions Forbidding the Use of Anaesthetics, . . . 355
Anaesthesia in Dental Operations, .... 355
INTRODUCTION.
The body of every animal is wisely contrived and perfectly
fitted for the purposes it is intended to subserve. Every part,
however minute, is necessary to the complete performance of
the work of the whole; and a beautiful unity of purpose, and a
necessary dependence of parts, are observable throughout the
organization.
So remarkable is this unity, and so certain this dependence,
that a naturalist, by examining a fragment 'of any one of the
bones of an animal, may determine the character of the indivi-
dual it represents. Having ascertained the size, figure, &c, of
any bone, he may infer, with infallible certainty, that every
other part of the body to which it belonged was formed in
perfect proportion to this part, and with strict reference to the
purposes for which this particular portion was designed. Should
a naturalist ascertain that a single bone presented to him was
constructed for purposes of prey, he would immediately infer
that a beast so provided must have had strong muscles and
bones of the neck and jaws, to enable it to hold and tear the
animals upon which it was intended to subsist; hind legs of
such a formation as to enable it to spring upon its prey; claws
to seize and hold it, and a digestive apparatus suited to the re-
ception and assimilation of the food thus procured.
Those who are familiar with the writings of Cuvier, will not
need to be reminded of his beautiful reasoning upon this sub-
ject.
The body of man must then be regarded as a unit, and
though, for the convenience of description, we speak of its mul-
3
26
INTRODUCTION.
titude of parts, it is a single organization, fed by one aliment,
nourished by one blood, vitalized through one nervous system,
directed to a common purpose, subject to one sovereign will,
and pervaded by a general law of continuance, decay, and dis-
solution.
As one part of the body is identified with all the others, it is
necessary that a certain organic consent shall subsist between
the several parts, in order that they may act in concert in car-
rying on the business of life. For instance, the eyes must act
together: the muscles of the trunk must aid the muscles of the
limbs, and many more agreements of motion, infinitely compli-
cated and astonishingly rapid, must subsist between different
members of the body.
The body has more to do than to perform certain acts by
which it may be continued in being. It is, from its nature
liable, and from its condition exposed to injuries. It is con-
tinually assailed by enemies from without and within. It has,
therefore, certain -signals of suffering, and is endowed with cer-
tain aptitudes, through which any part more particularly attack-
ed may receive succour from the rest. Moreover, the parts being
connected together by extension of common tissues, by blood-
vessels and by nerves, the morbid conditions of one may readily
be propagated to another. All this concert of parts, whether
healthy or morbid, is called sympathy ;* though, in the case of
healthy action, improperly so—and constitutes one of the most
interesting and beautiful peculiarities of organized structures.
In many instances the dependence of one part upon another
is so direct, and the mode of communication so obvious, that
there is no difficulty in detecting the process of sympathetic
action or suffering that may be observed between them. In
other cases, this concert of action depends upon undiscovered
links of union, and is known to exist only upon the evidence
of common observation. Besides this sympathy of parts, there
is a general interest of the whole organism in the welfare of all
its parts; and severe or long-continued suffering in any one,
* Ivi, with, ttxBoc, suffering—fellow-suffering.
INTRODUCTION.
27
however comparatively unimportant, will commonly induce a
general derangement of health, and may involve the whole body
in serious and even fatal disorder.
Although in many cases no change in the structure of mor-
bidly sympathizing parts might be discovered upon autopsic*
observation, yet there is good reason to believe that sympathy
is in fact a transfer or propagation of actual molecular change;
and every physician knows that a disorder, primarily of little
importance, may prove fatal by involving vital organs in a sym-
pathy of disease.
It cannot therefore be predicated of any organ, that its suf-
fering is necessarily unimportant to the health of the whole
system, since experience shows that the danger of almost all
disorders depends very much upon the sympathies likely to be
established in the course of their progress, and that the impor-
tance of these sympathies is not always determined by that of
the organ originally involved.
The facts above stated are universally admitted by the medi-
cal profession, and for the most part are recognised as impor-
tant practical truths ; so much so, that the study of particular
parts as isolated from the rest, with a view to treat certain local
affections as independent phenomena, has long since fallen into
disuse, and every physician and surgeon is expected to become
conversant with all of medicine, as necessary to the proper care
of any one of the organs of the body. An oculist, unless a
thorough physician, would be utterly unqualified to treat dis-
eases of the eye: the obstetrician must extend his knowledge
far beyond the uterus, if he would claim any participation in
the fellowship of science.
Until very recently, however, the treatment of diseases of
the Teeth seems to have been considered less a proper specialty
of medicine, than a mere mechanical craft, requiring in the
operator little more than manual dexterity and physical force.
Surgeons and physicians were generally profoundly ignorant of
the importance of these organs to general health, and were con-
* Awtsc—u>4, one's own eye—actual sight of the parts of a dissected body.
28
INTRODUCTION.
tented to leave them to the care of any who were willing to
take charge of them. Even now diseases of the teeth are rarely
mentioned in the medical schools, and an eminent professor of
surgery has publicly confessed himself incompetent to teach
students how to extract them.
In the course of time, however, men of inquiring minds and
studious habits, finding themselves in the practice of a rude and
imperfect art, the deficiencies of which were continually forced
upon their observation, have been constrained to investigate the
relations of the teeth to surrounding and distant parts. Well-
read medical men, waiving the general practice of the profes-
sion, have turned their attention to dentistry, and of necessity
have applied their previous information to the augmentation of
dental pathology and therapeutics; and, finally, the manage-
ment of the teeth has come to be an acknowledged specialty of
medical science, and is rapidly advancing in public and profes-
sional consideration.
It is thus that other departments of the healing art have
gradually won their way to their present position and impor-
tance. Within a period comparatively recent, surgery in all its
branches was regarded by physicians with sovereign contempt"
Barbers were the operators, and mountebanks and old women
dressed the sores. Midwifery was, if possible, held to be yet
more despicable, and even within a few years, an eminent
body of scientific physicians have declared obstetrics to be un.
worthy the attention of a polite gentleman.
It is unnecessary to say that surgery and obstetrics are now
the leading branches of the profession, and are zealously prac-
tised by men of the first talents, and greatest scientific and
literary acquirements.
To our country belongs a large share of the honour of placing
these two departments of medicine upon their proper level
with other professional pursuits.
The depressed condition of surgery and midwifery was the
consequence of the vulgarity and ignorance of those who prac-
tised in these departments of medicine, and the bad reputation
thus acquired was a formidable obstacle in the way of those
INTRODUCTION.
29
who attempted to elevate them to the dignity of scientific pur-
suits ; but patient continuance in laborious and honourable effort
has eventually succeeded in accomplishing the desired result.
The practice of Dental Surgery was long degraded, from
causes precisely similar to those evil influences which so long
depressed kindred branches of the art. Disregarded by edu-
cated men, it necessarily fell into the hands of the ignorant and
rude, and precisely as surgery and midwifery have gradually
emerged from their barbarous state and attendant disrepute,
dentistry is now winning its way against all opposition, to its
proper consideration. It is a matter of honest pride, that our
country is again foremost in this laudable work.
The purpose of the present work is to treat of Dental Surgery
as a distinct and proper specialty of medicine, and to present
to the reader a digest of information, prepared with particular
reference to the morbid connexions certainly existing between
the teeth and the rest of the body.
These connexions are far more important than is generally
supposed by physicians or dentists. The reader of the following
pages will probably be surprised to find so large a variety of
disorders treated of as directly or indirectly concerned in the
production of pathological conditions observed in the mouth;
and his surprise will perhaps be greater to find so many and
so serious diseases of other organs traced to their primary seat
in morbid conditions of the teeth. Yet the object of the author
has been to condense this treatise as much as consistency would
permit, and to admit nothing foreign to the subject properly
under consideration.
3*
TREATISE ON DENTAL MEDICINE.
CHAPTER I.
PRELIMINARY CONSIDERATIONS.
The human body is liable to changes which more or less
disturb the regular and healthful performance of the many
functions* necessary to the completeness of its life, or in other
words, to disease. These changes are commonly attended
with alterations of the phenomena which experience autho-
rizes us to regard as natural or normal, or in other words, by
symptoms, f which indicate the character and seat of the
change which produces them.
When parts thus diseased are inspected, we generally per-
ceive alterations in their usual appearance and structure. Not
unfrequently, however, the changes are too obscure to be de-
tected by our present means of investigation.
Many attempts have been made to define the essential nature
of disease, but all have necessarily failed. It is impossible to
frame with philosophical accuracy a definition of disturbed or
altered conditions, since we do not perfectly understand the
nature of the organs, and the mode of their acts. We cannot
understand the ultimate cause of morbid phenomena, while
* By function is meant the particular part which each organ performs in
the mechanism of life. The liver is an organ, its function is to secrete bile.
f Symptoms are those observable differences from the healthy performance
of function which lead us to suspect and often to detect disease.
32 PRELIMINARY CONSIDERATIONS.
ignorant of the essential nature of life itself, as manifested in
the healthy performance of function.
It is important to the student to know that medical lan-
guage does not pretend to the precision of abstract philosophi-
cal science. Medical definitions are not to be regarded as ac-
curately stating the nature of things, but simply as descrip-
tions which may serve for practical purposes. This fact has
been forgotten by many eminent medical writers, and their
efforts to be absolutely accurate have often led to serious mis-
takes, and always to confusion of ideas and contradiction of
facts. The study of essences belongs to metaphysics, not to
practical science, and having failed to reach any important
truth by analyzing mind, it will hardly prove successful in its
attempts upon the body.
We wish it then to be clearly understood, that medical terms
are to be received in a conventional sense, and that, while they
serve sufficiently well to convey what knowledge we have of
curative science, they will not bear the test of strict philosophi-
cal examination. For example, the word life, as used by medi-
cal writers, does not mean the essential vital principle, but the
aggregate of the functions of the body: not the ultimate cause
which sets the machinery in motion, but its effect in the pro-
duction of organic acts. Disease means all the morbid phe-
nomena observed in a case, together with the structural
changes upon which these phenomena depend, and any other
more remote injury which may be concerned in their pro-
duction. Thus a patient may complain of nausea; this sick-
ness may be consequent upon defective digestion; the defective
digestion upon interruption of the function of the liver; the
interruption of the hepatic* function upon change of structure
in that organ; and that change of structure upon more minute
pathologicalf conditions. Strictly speaking, we might regard
all this train of evils as symptoms merely of some obscure
and inappreciable change which constitutes the disease, but in
* LJepar—the liver.
f Pathological—**8k, suffering, xoy*(, discourse; that which relates to
diseased conditions.
PRELIMINARY CONSIDERATIONS.
33
that case the word would be of no practical use. These in-
stances may suffice to illustrate our meaning, and the student
may be saved from much embarrassment by keeping the fact
thus presented always in his mind. Many false theories and
much bad practice have resulted from attempts to philosophize
in medicine. It is an experimental science, embodying the
results of long experience and protracted investigation. As
such it is true, and worthy of all confidence. It is impossible
to tell why any medicine produces its effect—we do not under-
stand the 'philosophy of it; but we know what effect it does
produce, and that knowledge is sufficient, and very much more
important.
I will not trouble my readers with a recapitulation of the
many definitions of disease proposed by eminent writers ; let it
suffice to say, that all of them are improper, and many of
them strangely absurd. We can describe disease readily enough,
but we cannot detect and exhibit its primary elements. Pro-
bably we would not be practically wiser if we could do so.
Life, then, may be considered as the effects produced by or-
ganization. Health, the regular and orderly development of
these effects. Disease, disorder and irregularity in their mani-
festation, or impediment to the accomplishment of one or
more of them.*
Physiology^ has to do with the performance of healthy or
natural acts, and physiological medicine or hygiene with the
preservation of health. Pathology is the science of diseased
conditions. Therapeutics,% the art of applying remedies for the
cure or relief of disease. Anatomy! is the study of the body
as an organized machine. Surgery,|| manual or mechanical
medicine. Etiology,\ the science of morbific causes.
In the present treatise, it is our purpose to examine the
etiology, pathology, and treatment of morbid conditions, with a
special reference to practical dentistry.
* Roche and Sanson, Nouveaux Elements, f $uokc—time.
5
50
SYMPTOMS OF DISEASE.
those which are more rapid, for the reverse is very frequently
the case. The terms acute and chronic have reference to dura-
tion and not to intensity.
As a general rule, all diseases abate their severity early in
the morning, and increase it in the evening. This increase is
called an exacerbation ; if very severe, a paroxysm. This last
term has a peculiar meaning when applied to intermittents.
The phenomenon of intermission is one of the most curious
and inexplicable of all observed by the physician. The dis-
eases characterized by this peculiarity consist of an indefinite
number of attacks or paroxysms, each of which, after having
exhibited a succession of conditions, disappears, leaving no
symptom of disease, except the exhaustion of the patient be
considered such. After a certain time of intermission or ex-
emption, another attack is sustained, and so the disease pro-
gresses, by alternate paroxysms and departures. Each parox-
ysm consists of a chill or cold stage, a fever or hot stage, and
a sweating stage, in which the fever disappears, and the inter-
mission commences.
If there be a paroxysm in every twenty-four hours, the dis-
ease is called a quotidian ;* if it occur on alternate days, a
tertian, f if there be two days of intermission, a quartan,J &c.
Sometimes there will be two paroxysms a day, a double quo-
tidian ; sometimes there will be a paroxysm every day, but the
time of access corresponding on alternate days; this is called
a double tertian. Sometimes there will be a double paroxysm
upon alternate days, with a single paroxysm upon the interme-
diate day; this has been called a triple tertian. Many other
modifications of periodicity occur in the disease, but the inter-
mission is distinct in all. The quotidian and tertian are by
far the most common forms of ague. Cases have happened
in which the paroxysm has returned after an intermission of
two weeks, and continued to occur regularly for months to-
gether.
It not unfrequently happens that the paroxysms occur regu-
* Quotidian—quotidics, daily. -f- Tertian—tertius, third.
J Quartan—quartus, fourth.
SYMPTOMS OF DISEASE.
51
larly, but do not present the ordinary succession of chill, fever,
and sweat, but merely cause excessive pain in some sensitive
part, usually occupying but little space. This pain obeys the
law of intermission and periodicity as other forms of parox-
ysms do, and is known as intermittent neuralgia.*
It is very important that the dentist should be well acquainted
with this form of disease, as it frequently occurs in the teeth
and parts about the jaws, &c, and may be easily confounded
with toothache from local causes; a mistake which has caused
the infliction of much unnecessary pain, and the loss of valu-
able teeth.
Remittent diseases are characterized by a remarkable diur-
nal abatement of their symptoms, not amounting to intermis-
sion, but apparently analogous to it. Some of the most fatal
diseases which afflict the human family are of that class. For
example, yellow and bilious fever.
Certain diseases always present the same symptoms, and in
the same order, and perseveringly run through them all un-
checked by treatment, or the circumstances of age, sex, con-
stitution, &c, which powerfully control other diseases. The
small-pox, measles, hooping-cough, &c, are examples of this
class. They arise from specific causes, and are sometimes
called specific diseases, though this term includes other dis-
orders of entirely different character.
* Neuralgia, from vtupos, neuros, a nerve, and axyo;, algos, pain.
52
CHAPTER IV.
DIAGNOSIS.
Diagnosis* is the art of following symptoms to their proper
pathological cause, and ascertaining the character, location,
and extent of disease, of which they are the signs. This, of
course, involves the discrimination of one kind of disorder from
all others, and is often extremely difficult, sometimes impossible.
When one or more local symptoms are prominent beyond
others, we may sometimes ascertain at once the seat of the dis-
ease, but even in such cases we must not decide until we shall
have ascertained whether these local symptoms are primary or
sympathetic; an inquiry which often requires much general
knowledge of disease, and a capacity for close consecutive rea-
soning.
When our attention is first called to a patient, we often en-
counter a large number of symptoms of different kinds, proceed-
ing from various organs, and all calling for relief. In the midst
of this general outcry of organs, the attentive observer will ge-
nerally detect one voice of distress more earnest than the rest,
and directing his inquiry to the part thus designated, he fre-
quently will come at once upon the cause of the general trouble.
The local signs are always the most important, and withal,
often the most obscure. The first thing to be done, then, in
the conduct of diagnosis, is to ascertain whether there are any
local signs; next to discover, whether any or all of them are
sympathetic, and if so, of what primary affection ; and lastly to
consider whether the general and sympathetic symptoms cor-
roborate our suspicions, that is, whether they can all be ac-
counted for upon the supposition that we have found the local
A/* Kivcs-x.ce, I know through, or thoroughly.
DIAGNOSIS.
53
cause, and whether any are absent which are uniformly or com-
monly concurrent with similar conditions to those supposed to
exist.
It sometimes happens that diagnosis will detect disease in
two or more organs simultaneously, or complication.
It would of course be impossible for any man to conduct a
diagnosis properly upon a case of disease unless he should
be acquainted with diseased conditions generally, and particu-
larly with the relations and sympathies of parts. The dental
surgeon is not prepared to investigate symptoms occurring in
the mouth until he can detect those which are sympathetic, and
trace them to their source. Were he guided only by a promi-
nent local symptom, he might make serious mistakes. For in-
stance, a female may complain of violent pain in a tooth, which
may in fact be entirely due to sympathetic connexion with the
uterus, and not at all dependent upon any diseased condition
of the tooth in which it occurs.
The mode of distinguishing dental diseases and those of the
parts adjacent to the teeth and mouth is fully set forth in works
of dental surgery. I will, therefore, omit any particular di-
rections upon this subject; but I would earnestly urge upon
every dentist to extend his knowledge until it shall embrace
the entire subject of diseases and their cure.
Independently of the necessity of diagnosing the local affec-
tions, it is always important to ascertain those conditions which
are immediately represented by general symptoms: or more
correctly, it is always important to ascertain how far the ner-
vous centres and vascular system are participating in a disor-
der. A number of symptoms, very variable and difficult to be
described, announce general nervous sympathy and the degree
in which it exists, but the connexion of the vascular system
with a diseased state, is for the most part determined by the
pulse* i. e. by the beating of the arteries due to the propulsion
of blood through them.
The artery which is generally examined for this purpose is
* Pulsus.—Lat.
5*
54
DIAGNOSIS.
the radial, which is of sufficient size, and passing near the sur-
face at the wrist is most conveniently situated for examination.
The frequency, quickness, force or resistance, volume, and any
peculiar sensations given by the pulsation, are all subjects for
observation, and contribute to the discovery of the nature, seat,
and degree of disease.
Since the days of Galen, judicious and successful physicians
have paid much attention to the pulse as a guide to correct
diagnosis and practice, and although it is too common in this
day to hear the inferences drawn from it decried as uncertain,
yet the fact is, that to those who know how to interpret its
communications, the pulse furnishes the most valuable of all
our means of diagnosis.
In order to understand the morbid pulse, it is necessary to
be well acquainted with its healthy conditions, for it is only by
comparing its pulsations with the natural standard that we are
able to detect morbid variations.
The pulse differs in frequency at different periods of life. In
infancy it is much more frequent than in mature life, and be-
comes slower in old age. In infants* under two years of age
the number of pulsations is above one hundred in a minute;
in adult age, about seventy, and somewhat less in advanced
life. These numbers, however, are susceptible of great varia-
tion. Whylt mentions a case where a healthy woman had a
pulse of one hundred and twenty ; and instances have been
known where the natural pulse has amounted to only thirty-six
or forty. The pulse of females is usually somewhat more fre-
quent than that of men, and owing to the nervous sensibilty of
the gentler sex, is more readily excited by mental emotions, &c.
The healthy pulse is accelerated by exercise, and mental ex-
citement. It is often more frequent in the evening than in the
morning, after a full meal, or the use of exciting drinks, and
in pregnancy. It is also often very much accelerated after
copious evacuations, and under circumstances of great prostra-
* Some writers, as Billard and Valleix, assert that the pulse of young in-
fants is not nearly so frequent as is generally supposed. See Chomel, Ge-
neral Pathology, p. 171.
DIAGNOSIS.
55
tion. It is diminished by the horizontal posture, by rest, by
moderate bleeding, and by the influence of certain drugs, such
as digitalis and the tartrate of antimony.
Indeed, the frequency of the pulse is subject in so great a
degree to the control of idiosyncrasy* and accident, that no posi-
tive inferences can be drawn from this solitary symptom, un-
less the habitual pulse of the patient be known. Chomel says,
" I have seen a lady whose pulse during the paroxysms of in-
termittent fever did not beat above sixty per minute, to the
great astonishment of her physician. This astonishment
would have ceased had he counted the number of pulsations
during the intermission, these being not above forty per mi-
nute."
Quickness and frequency are not synonymous terms. Fre-
quency has reference to the number of pulsations in a given
time, as a minute; quickness to the time required for the com-
pletion of a single pulsation. Slowness is opposed to fre-
quency, not to quickness. Thus we may have a slow quick
pulse; that is, one in which the beats in a minute are fewer
than natural, but each particular beat is rapidly performed.
For an opposite to quick, physicians frequently use sluggish or
labouring.
The natural pulse is soft or compressible: that is, it readily
yields to gentle pressure with the finger. The hard pulse is
the reverse, offering considerable resistance to the obliteration
of its channel by pressure. Tense, wiry, firm, &c, are used
to express modifications of hardness.
Differences are also observed in the volume or size of the
pulse. Sometimes it is full and open, at other times, small
and contracted. It is called regular when the beats succeed
one another in natural order, irregular, or interrupted, when
the regular succession is broken by omissions of pulsations.
Certain conditions, too, are attended with peculiarities of
the pulse. In aneurism of the heart, or large arteries, it im-
parts a peculiar thrilling sensation to the hand, which has more
aptly, than is usual in such illustrations, been compared to the
sensation which would be imparted by the passage of a fluid
* Idiosyncrasy—/JW cuvkj^o-h—peculiar constitution.
56
DIAGNOSIS.
through a shattered quill. Ossification of the coats of the ar-
teries destroys their elasticity, and of course renders the pulse
very hard. The hard pulse is usually attended by a peculiar
condition of the blood, which when drawn and coagulated,
presents a yellowish lymphy surface, which is called the buffy
coat, with but few exceptions, a very important sign of inflam-
matory action.* The following precepts for feeling the pulse,
though very minute, are nevertheless worthy the attention of
those who are inexperienced in it. Long habit imparts to the
fingers an extraordinary accuracy of sensation in this respect,
but until it shall be acquired, it is not easy to form correct
conclusions without all the care demanded by these rules.
The physician should wait until the patient has recovered
from the emotion produced by his presence, requesting him to
preserve absolute silence, and to remain in the sitting or hori-
zontal posture. The pulse may be examined at the temples,
lateral parts of the neck, arm, thigh, wrist, and wherever the
arteries are sufficiently large and superficial; but the radial
artery is generally preferred at the place where it ceases to be
covered by the muscles of the forearm, opposite the radio-car-
pal articulation. If the patient be up, he should be placed in
the sitting posture, if in bed, he should be upon his back, so
that he may neither incline to the right nor left, and thus im-
pede the circulation of blood in the arteries. The arm should
be placed nearly in a state of extension, and sustained in its
whole length, so that the muscles may be relaxed. The fore-
arm should be nearly prone, that it may, upon the cubital edge
and the radial edge, be a little raised. Care should be taken
that no bandage or clothing impede the flow of blood in the
axilla, at the elbow, or at any other point. All bandages
should be removed so that there be the least possible compres-
sion. By means of these various precautions, we may be cer-
tain that there is no foreign obstacle to the flow of blood
through this vessel.
The artery of the left side should be felt by the right hand,
and vice versa: the four fingers placed parallel on the same
* The buffy coat is also seen upon the blood drawn from pregnant females
and persons under mercurial impregnation.
DIAGNOSIS.
57
line, should be applied over the track of this vessel; the index
finger should be nearest the hand of the patient, and the little
finger applied lightly, should be the first to receive the impulse
of the blood; at the same time that the four fingers are placed
over the radial artery, the thumb, or rather the palm of the
hand should rest upon the dorsal face of the forearm, thus af-
fording solid support to the fingers by which the pulse is ex-
amined. The latter should at first receive a slight lateral
movement in order to ascertain the situation of the vessel.
When the fingers are all placed upon the artery, the pressure
should be gradually increased and diminished several times in
succession, so as to appreciate the influence of the pressure
upon it, and thus more easily ascertain its different qualities.
Twenty or thirty successive pulsations should in this manner
be examined. It is not without advantage to examine the
pulse in the two arms alternately, or at once : it should also,
in particular cases, be examined in other places wherever it
may throw light upon the diagnosis. It may be also examined
several times, or at least a second time, before leaving the
patient. However minute these precepts may appear, they
cannot be neglected without inconvenience.—Chomel, Elem.
General Path.
The inferences of pathological conditions to be drawn from
the several above-mentioned differences of the pulse, will be
explained, as far as the purpose of this treatise requires, when
we come to consider particular diseases.
Pain is one of the most common and important symptoms
of disease. It is this which usually gives the first intimation
of disorder, and drives the patient to medicine for relief. It
is very important that the physician and surgeon should know
how to interpret this sign, and in order to this, much general
knowledge of parts and symptoms is necessary.
An uninstructed observer naturally infers that the pain is
always felt in the part diseased, and that its intensity accu-
rately represents the degree of the disorder.
But such prima facie opinions are often very erroneous. We
have already remarked, that a part may sympathise with a
local disease seated in a distant and dissimilar organ. It also
58
DIAGNOSIS.
happens frequently, that diseases of the nervous centres, and
of the nerves themselves, occasion pain at the extremities of
these organs of sensation, instead of at the point actually at-
tacked. Violent pain in the nerves of the face may depend
upon disease located in the brain or intermediate parts; and
similar conditions are noticed in other nerves.
Nor does the degree of pain represent necessarily the degree
of the disease which causes it. Some parts are much more
sensitive than others, the most important organs being least
sensitive. The quality of sensation does not necessarily belong
to living bodies, but is distributed to the several parts, arbi-
trarily, yet with wonderful wisdom and mercy. Pain is in-
tended to warn us of danger and compel us to preserve the in-
tegrity of the body; it is therefore set as a sentinel chiefly
upon the out-posts of life, the external surfaces being much
more sensitive than others; while those most carefully pro-
tected, are least profusely endowed with this watchful property.
Hence it happens that the brain, heart, and lungs may be very
seriously diseased without causing much, or indeed any local
pain, while an unimportant injury to the eye or skin will cre-
ate great distress.
The nature of the disease may often be guessed from the
character of the pain, as it is burning, scalding, fixed, fugi-
tive, darting, throbbing, &c. As pain does not point out with
certainty the seat of the disease, and as its intensity does not
necessarily indicate the degree of the change producing it,
neither does its abatement or disappearance prove the relief or
cure of the disorder. In many instances it certainly does so,
but very often it does not.
Pain may be lulled by the action of causes which lessen the
sensibility, as by narcotic medicines, by the exhaustion inci-
dent to protracted sufferings, by morbid conditions of the
nervous centres, or the nerves themselves, or by absolute loss
of vitality. It sometimes happens that the sudden cessation
of violent pain is a most fatal symptom, as showing that morti-
fication has occurred in the diseased part.
Pain is often intermittent and disappears only in obedience
to a laAv of disease, not of health.
59
CHAPTER V.
TREATMENT OF DISEASE.
The first step towards the cure of disease is to remove the
cause which has produced it. Unless this can be done, we
must be very much embarrassed in our efforts to relieve, inas-
much as the morbid conditions are continually liable to renewal.
The impracticability of doing this effectually, forms the most
serious obstacle to the successful treatment of many disorders.
Children teething during very hot weather are subject to the
action of combined causes, that often induce diseases which are
very serious and very difficult to be controlled, while the causes
continue to act. Dead teeth remaining in the mouth may pro-
voke a series of unpleasant and even dangerous evils, which
cannot be removed while the cause of them remains.
It must not be supposed, however, that the removal of the
primary cause of the disease will necessarily procure the sub-
sidence of the disease itself. If a man pierce his flesh with a
thorn, the wound will remain and may give great pain after
the foreign body has been extracted; the effects of a wound
from a bayonet or musket-ball may manifest themselves in
serious and fatal disease long after the instruments of the in-
jury have been withdrawn. The same truth holds good in all
kinds of injuries by whatever class of agents they may be
produced.
The absolute rest of a diseased part, when the nature of its
function permits, and the least possible exertion of others, is
very conducive to cure.
There are, however, certain exceptions to this rule. Certain
morbid conditions of the articulations are improved by exer-
60
TREATMENT OF DISEASE.
cise; a particular mode of ocular affection requires the light,
&c,—but the exceptions are few and the rule general.
The regimen of the patient, that is his diet, clothing, exer-
cise, employment, &c, require judicious management.
Finally, the most important part of treatment consists in the
skilful application of therapeutical agents, and surgical means;
but of this part of the subject I will treat particularly when
considering special diseases.
61
CHAPTER VI.
NATURE OF DISEASE.
Many of the morbid alterations which seem to constitute
disease, or cause symptoms, have been observed upon the
living and the dead subject: many others have as yet escaped
detection. We are unable, therefore, to compose a full list of
these different conditions of parts, but those which are of com-
mon occurrence, and are well ascertained, may be described as
follows:
1. Redness, swelling, and loss of cohesion of tissues. This
is the most common of all modes of alteration, and is the cause
of a large part of the disorganizations observed in tissues: it
is called inflammation.* The local symptoms of this condition
are heat, redness, swelling, pain, and diminished, altered, or
suspended function. The general symptoms are pyrexia, or
fever, of a particular type, seemingly connected with altered
state of the blood.
2. Stuffing or engorgement of the veins, or congestion. The
symptoms are not so well defined as in the first kind of affec-
tion. The local suffering is generally much less, though when
certain organs, such as the brain and heart are the seat of con-
gestion, the pain and discomfort are often very considerable.
The function of the congested organ is greatly embarrassed or
altogether suspended. The general symptoms are commonly
such as mark diminished action.
3. Red indurations ; vegetations; fungi, polypi.
4. Vesicles, pustules, suppuration, erosion, ulceration, per-
foration, gangrene.
* Inflammation—flamma, aflame. Hup, fire—from the burning sensation
and heated appearance of patients in fever.
6
62
NATURE OF DISEASE.
5. Thickening, granulations, thickness of tissues naturally
transparent, adhesions, effusion of serum, false membranes.
6. Conversion of one tissue into another.
7. Gray induration, gelatinous degeneration, tubercles, en-
cephaloid matter, cancerous matter.
8. Contraction, dilatation and complete obliteration of natu-
ral canals.
9. Accidental canals, fistulas, accidental tissues, cysts.
10. Development of gas in cavities.
11. Living bodies in organs.
12. Effusions of blood, collections of blood.
13. Chalky, stony, hairy, horny, and melanotic* produc-
tion.
14. Changes of form and relation, wounds, ulcers, disten-
sion, lacerations, ruptures, fractures, and dislocations.
15. Foreign bodies.
16. Vices of formation.f
The fluids of the body, especially the blood, are doubtless
capable of undergoing change primarily, and communicating
distress and disease to other parts. But the pathology of the
fluids is but very little understood. The same may be said of
the nervous matter, of the nature of which we know nothing.
The above catalogue is therefore very defective, as it takes no
notice of some of the most common and most important of all
diseases, such as fever; and describes as diseases, conditions,
which are only incidental to other previous and more important
phenomena. Nevertheless, it is as accurate, or nearly so, as
the present state of medical science will permit.
It is my purpose to select from this list such pathological
conditions as are particularly connected with the pursuits of
the dentist, omitting none, which, even in a remote degree,
concern him, and passing by those in which he has no profes-
sional interest.
* Mexac—black. f Roche & Sanson. Path. Med. Chir.
NATURE OF DISEASE.
63
INFLAMMATION.
The most common, and for several reasons the most import-
ant of all morbid conditions, is one which is characterized by
redness, swelling, pain, and increased heat. This is called in-
flammation, and may occur in any parts naturally possessing
sensibility. Alteration or suspension of the natural secretions
is a constant attendant upon inflammation, and when seated in
organs which do not secrete, it arrests, or more or less embar-
rasses, the performance of their functions. The redness of an
inflamed part is caused by the presence of red globules in small
vessels which naturally carry only the serous or white part of
the blood, and frequently, in addition to this, to the escape of
blood from ruptured vessels and its deposit in surrounding tis-
sues. This is called chemosis or ecchemosis.*
The presence of red globules in the serous vessels, or capil-
laries seems to be the essential fact in inflammation; the other
phenomena being apparently consequent upon this error of cir-
culation. It has hence been the anxious desire of pathologists
to ascertain the cause of this irregularity, in hope that such
knowledge might lead to more sure modes of relief. It is not
my purpose to recapitulate the several theories, which have
been constructed by learned and ingenious men, in order to
explain the phenomena of inflammation. The condition thus
named is compatible with very different states of the general
system and also of the tissues immediately concerned, and
therefore no statement of the pathology, and no plan for treat-
ing this form of disease, can be uniformly correct. All patho-
logical conditions attended by heat, redness, swelling, and pain,
are considered inflammatory, whether the parts immediately
concerned be in a sthenicf or asthenic state.
Theorisers upon inflammation have been much perplexed to
reconcile the distension of the capillaries with the apparently
excited state of the parts: for distension or yielding of the
walls of the vessels being connected in their minds with the
Ex., out of. XkjMoc, humour. f 28em, strength.
64
NATURE OF DISEASE.
idea of force overcome, or of relaxation, they suppose, that in
inflammation the capillaries are less active and resistent, or in
other words, comparatively passive; such being the case, it
appears rational to use exciting applications in order to arouse
the capillaries to exertion, so that they may empty themselves
of superfluous blood, and resist the influx of unusual quantities
of that fluid. The fact is, however, that the capillaries expand
when excited, and thus draw to themselves an additional
amount of blood, by a simple hydraulic law. They are not
passive, because distended; but are distended in consequence
of activity. Familiar examples will show the truth of this
opinion. If the cheek be held close to a burning body, the
skin will be reddened; in other words, the effect of the stimu-
lus will be to dilate the capillaries, and attract to them a
large volume of blood, suffering red globules to enter their
canals. On the other hand, if cold water or ice be applied to
the skin, it grows pale and shrinks, showing the contraction of
the capillaries when their activity is diminished. The erectile
tissues furnish us with an example of the operation of a simi-
lar law.
The swelling of an inflamed part depends upon the presence
of an unusual amount of blood in it, and upon the effusion of
serum, blood, lymph, or pus, consequent upon the engorge-
ment.
The cause of the pain in inflamed parts is not very plain.
At first sight it might appear to be due to the mechanical dis-
tension, but a moment's reflection will enable us to perceive
that such cannot be the cause, for we may subject healthy
parts to engorgement and distension, causing redness and
swelling without pain. A string tied around the finger will
cause the extremity of the organ to swell exceedingly, and be-
come lividly red, yet this condition is not attended with pain,
while inflammation of the same part is extremely agonizing.
That the distension of parts is connected under the peculiar
circumstances accompanying inflammation with the pain pro-
duced, is obvious, however, in the disproportionate amount of
NATURE OF DISEASE.
65
suffering experienced between loose tissues, and those which
from nature or situation, admit of little freedom of expansion.
Doubtless the morbid condition of the nerves of the part, is
the primary cause of the pain.
The pain of inflamed parts is so much modified by peculiar-
ity of structure as often to enable the observer to distinguish
the seat of the disease by the character of its sensation. As
a general rule, the external parts are the most sensitive. The
skin when inflamed is affected by a burning or scalding sensa-
tion, often intermingled with itching, even more distressing
than the burning itself. The inflamed mucous membrane par-
takes of this sensation, though generally in less degree, unless
in superficial situations.
The serous membranes when inflamed, "cause a sharp, darting,
lancitive pain. The pain of the cellular membrane under simi-
lar circumstances, differs very much according to its position
and relations. When in connexion with the skin, it partakes
of the pungency which characterizes the inflammation of that
sensitive organ; when the cellular structure of the internal
viscera is inflamed, the pain is usually dull, or obtuse, in con-
sequence of the manner in which these viscera are supplied
with nerves.
When nerves are the seat of inflammation, very acute, dart-
ing pangs are felt, and the surrounding structures are gene-
rally very sore, tender, and more or less inflamed. When the
muscles are inflamed, the sensation is aching, mingled with a
feeling of fatigue. The pain is greatly aggravated by motion.
Inflammation of ligaments and bones, causes sensations not
very different.
Pain is more or less severe in proportion to the degree of
the inflammation, and is also much modified by peculiarities
in the nature of the disease, and the condition of the parts
affected. Certain specific affections, such as cancer, occasion
a peculiarly distressing, darting, and burning pain: slight
inflammation of the pulp of a tooth produces intolerable
agony, &c
Pain does not always proceed from inflammation: it may
6*
66
NATURE OF DISEASE.
attend very opposite conditions. Ice held upon the skin will
cause great suffering.
The secretions of organs are very materially modified by in-
flammation. If it be slight, the natural secretion may be
slightly increased, more often with increased secretion there
will be an obvious alteration of it. Sometimes it is thinner
and acrid, reddening, or excoriating the parts over which it
flows: sometimes it is thicker, and more tenacious, often, es-
pecially if the inflammation be severe, it is much diminished,
or altogether suspended. An abundant discharge of thickened
secretion often precedes, and seems to be the means of relief to
the inflamed parts.
It has become common to designate inflammation of the dif-
ferent parts by attaching the common termination "itis" to
the Greek name of the part affected. Thus, stomatitis indi-
cates inflammation of the *-ra^«, stoma, or mouth—gastritis, of
the yoto-rrie, gaster, or stomach. Sometimes the suffix is added
to a Latin name, as conjunctivitis; in some instances, terms
descriptive of inflammation, have become so firmly fixed in our
nomenclature as yet to be continued, though as exceptions to
the rule. Thus, pneumonia signifies inflammation of the lung;
rheumatism, of the muscles. The term myitis is sometimes
used instead of rheumatism.
Inflammation occurs in two very distinct forms, called
Phlegmon and Erysipelas.
Phlegmon is the common form of healthy inflammation in or-
gans composed largely of cellular tissue. It generally results
from some local cause, as a blow, pinch, or other mechani-
cal injury, or from the irritation of acrid matters, or foreign
substances. Sometimes, however, it depends upon constitu-
tional causes.
When phlegmon is seated in the subcutaneous cellular tis-
sue, it presents a hard, circumscribed red tumour, which is ge-
nerally very painful. At first, the sensation is burning and
darting, subsequently, as the tumour softens, throbbing, or pul-
sating. After a longer or shorter time, according to 'the in-
tensity of the inflammation and nature of the affected parts
NATURE OF DISEASE.
67
fluid is felt to fluctuate in the tumour; in other words, an abscess
filled with pus, has been formed, the skin ulcerates, the matter
is discharged, and the cavity is obliterated.
What is called a boil is the best example of genuine phleg-
mon. It is a possible thing for a phlegmon to terminate by
resolution, but this very rarely happens, unless the incipient
inflammation be actively combatted by the resources of art.
In by far the greatest number of cases the best treatment
fails to prevent suppuration, after the phlegmonous tumour has
been fairly formed.
Circumstances of position may vary the phenomena of phleg-
mon. If it be seated in important viscera, the constitutional
symptoms will predominate very remarkably over the local dis-
tress : if it be formed under aponeuroses or muscles, the ten-
sion occasioned by the resistance of these unyielding tissues
greatly aggravates the pain while it prevents the swelling.
The matter not being able to escape is extravasated among the
adjacent tissues and communicates irritation and inflammation
as far as it reaches. Ultimately an opening may be made at
a distance from the seat of the abscess: the pus may traverse
a tortuous channel, the cavity not being properly emptied, may
first heal, and a sinus, or sinuous ulcer, may be the consequence.
The pathological characteristic of phlegmon is the effusion
of coagulable lymph, by which the inflamed parts are walled
in, and the pus confined within the cavity and made subject to
those obscure and curious processes by which it is ultimately
evacuated. It is this limitation which gives to phlegmon its
hard, resisting character, and which by impeding the circula-
tion, causes the deep red hue which does not disappear upon
pressure. To the same distension of vessels is due the peculiar
pain of these inflammatory tumours.
When phlegmon is deeply seated its presence is often attend-
ed with an ©edematous appearance of the surface,—an observa-
tion worth noting. The period of suppuration, even in super-
ficial abscesses, is often marked by rigors, or chilly sensations.
In deep-seated abscesses these rigors are still more remarkable.
68
NATURE OF DISEASE.
After matter has formed, the pain abates, and assumes a heavy,
throbbing character.
Erysipelas* is peculiar to the skin, and mucous membrane,
and is far more usually met with in the former organ. It dif-
fers from phlegmon particularly in this, that it is not circum-
scribed by lymphy barriers, but is diffused until gradually lost
in healthy parts. The effusion which occurs in erysipelas is
serous. When the skin only is affected, the serum is effused
under the cuticle, and occasions vesications. Sometimes the
cellular tissue beneath the skin becomes inflamed together with
it, and putting on its own phlegmonous condition, though im-
perfectly developed, forms a compound disease, which has been
called phlegmonous erysipelas. The effused serum, and un-
healthy pus, diffused through the loose cells of the cellular tis-
sue, carry destruction to this substance, far and wide, among
the muscles and beneath the skin, while the latter organ ulce-
rating, and sloughing rapidly, gives way before the advancing
inflammation.
This aggravated affection takes place in persons of debili-
tated constitutions, and as the result of wounds, and specific
poisons.
In erysipelas, the circulation of the skin is not impeded, and
therefore the pressure of the finger on the skin temporarily re-
moves the red colour. The pain is burning, or stinging.
Simple erysipelas does not tend to form pus, but ends by
resolution or effusion. The constitutional symptoms attending
it, are generally much more serious than those resulting from
phlegmon.
INFLAMMATORY FEVER.
Fever,f or pyrexia,! is a morbidly increased activity of the
heart and arteries, the proximate cause of which is little under-
* E/i»a), I draw : lit\a.r, near; from the tendency to involve surrounding
parts.
f Ferbeo, I burn. j nw/)> fire
NATURE OF DISEASE.
69
stood, but which is attended with general disturbance of func-
tion.
Merely increased action of the heart and arteries is not fever,
for such excitement may be purely physiological and attended
with no functional distress. Violent exercise and mental emo-
tions will frequently cause the vascular system to work with
vastly greater energy than usual, while the individual who is
the subject of the accelerated circulation will not be at all mor-
bidly affected.
But in fever, the increased vascular action is the effect of
disturbing morbid causes. Often, perhaps always, the blood
itself has undergone change, and the vital fluid thus altered,
being supplied to all the organs, begets universal disorder of
function.
Fever is either idiopathic,* or symptomatic.
By idiopathic fever, we mean that form of it which appears
to us to present the primary, or original disorder, being the
first observable effect of the morbific cause. Such fevers are
not, so far as we know, preceded by a local disease, whose ex-
istence and intensity are represented by the vascular action.
We cannot, in the present state of our knowledge, go behind
the fever to find out its immediate cause, structural change, or
functional error.
Symptomatic, or secondary fevers, or as they are often called,
from the nature of the conditions they most frequently repre-
sent, inflammatory fevers, are merely consequent upon local
disease, having no independent existence, but rising and falling
with the flow and ebb of the disorder they represent.
These two conditions, though called by the common name,
fever, are entirely distinct and different in their cause, nature,
progress, and treatment, and are only allied together, by the
fact, that each of them is attended with morbidly increased
vascular action.
Neither is symptomatic fever a unit; for when it represents
inflammation, it differs essentially from the vascular condition
which is consequent upon another state, which is called irrita-
*], I eat.
80
NATURE OF DISEASE.
removes them, because they are not fit to remain ; and it would
not appear more justifiable to call adhesion and ulceration in-
flammatory processes, than to consider the operations of sur-
geons themselves as particular modes of inflammation.
Inflammation may result in a permanent change of struc-
ture. Parts may become denser and harder, or, indurated;
sometimes certain structures, under the influence of slow in-
flammation, are softened ; sometimes a permeable cellular struc-
ture, as the lungs, becomes changed into a dense impermeable
tissue, like liver, or hepatized :* and sometimes accidental
inflammation begets, in persons and parts inclined thereto,
morbid growths of a specific character.
The most disastrous result of inflammation is the absolute
death of a part, reducing it to the condition of a foreign body,
and subjecting it to the play of chemical affinities.
When this takes place in soft parts, it is called gangrene or
mortification; in bones, necrosis. The dead soft part, when
separated by ulceration from its connexion with living parts,
is called sphacelus,^ or slough; a fragment of dead bone is
called sequestrum.%
Caries is a condition of bone somewhat analogous to ulcera-
tion of soft parts. Caries of the teeth is the result of chemi-
cal agents acting from without, and decomposing their struc-
ture ; they are, however, subject to necrosis, as other bony tis-
sues, and the fact of their being liable to a peculiar erosion,
does not probably exempt them from the kind of caries ob-
served in similar structures. If, however, such idiopathic
caries does occur in the teeth, it must be very rare, and is
always confounded with the erosive caries peculiar to these
organs.
* Eepar, the liver. f 2$*£», I destroy. % Sequestro, I separate.
81
CHAPTER VII.
INFLAMMATION OF THE SEVERAL PARTS COMPOSING THE MOUTH,
AND OF THE PARTS ADJACENT.
The mouth is very complicated and exquisitely organized.
It subserves a variety of very important purposes. Speech,
mastication, insalivation, taste, inhalation, and expiration, are
all performed in this small, but admirably constructed cavity.
Such numerous and complicated functions require the presence
of various and delicate organs closely packed together, and a
large endowment of nerves and blood-vessels. Glands are
hidden in every part of the walls of the cavity; their ducts
perforate its floor, and open on its sides; nerves and blood-
vessels, of extraordinary size, creep along every bony channel,
and spread in expanded network over the whole surface; while
the mucous membrane, with its innumerable crypts and follicles,
covers the whole, and connects every sentient part with the
sympathies of the external and internal surface.
Into the cavity thus constructed, and thus exquisitely en-
dowed, air of different temperature is constantly rushing ; food
and drink of various kinds are received; secretions are poured
out, remains of aliment and of the natural fluids undergo
change, and medicinal agents of various kinds are made to
pass.
Besides all this, the mouth is the seat of the extraordinary
process by which two sets of teeth are matured and evolved,
and one of them removed by a physiological, and the other, to
a greater or less extent, by a morbid disintegration. Under
these circumstances, it is not wonderful that inflammation fre-
quently occurs in the mouth, and that it should be attended
there with severe suffering.
As the cellular tissue enters largely into the composition of
82
INFLAMMATION OF THE MOUTH.
the structures of the mouth, the form of inflammation most
common in that cavity, is what is called phlegmon.
Sometimes this form of disease occurs in the mouth, as the
consequence of wounds, and even as an idiopathic affection.
Sudden death is sometimes produced by the effusion of serum
about the glottis—as the result of erysipelas affecting the la-
rynx. This affection is called oedema of the glottis.
Phlegmonous inflammation frequently occurs in the glands
of the mouth, the tonsils, the gums, the pulps of teeth, the
lining membranes of the alveoli and antrum, and the tongue.
Erysipelous inflammation in these parts is rare, but sometimes
occurs in the mucous membrane lining the gums, cheek, and
palate. The submaxillary glands often take on inflammation
from the effects of cold, and from the irritation produced by
the presence of diseased roots in the alveoli of the lower jaw.
The pain and difficulty of mastication, with the swelling of the
gland, readily indicate the seat and character of the disorder.
Unless the inflammation be speedily subdued, and especially
if it be the consequence of diseased teeth, the gland readily
suppurates, discharging a very fetid pus, either into the cavity
of the mouth, or externally, under the jaw. When the open-
ing takes place internally, the flow of pus into the mouth is
very disagreeable, and the access to, and lodgment of, alimen-
tary matters in the suppurating gland often keep up the in-
flammation until an external issue is secured.
Removal of the diseased teeth generally causes a speedy
cure. Of other remedial means I will discourse hereafter.
Inflammation in these, as in all glandular structures, is apt
to leave permanent indurations.
Inflammation of the tonsils is of very common occurrence.
Its most common exciting cause is cold. The inflammation is
generally very acute, rendering deglutition, and even speech,
very difficult, sometimes impossible. It is generally attended
by severe constitutional symptoms.
Tonsillitis or cynanche* tonsillaris usually terminates by re-
* Cynanche, from kvm, a dog, and h.y%ct, I choke, is a name of a class
of diseases of which obstructed respiration is more or less a symptom.
INFLAMMATION OF THE MOUTH.
83
solution, but very often by suppuration. Permanent enlarge-
ment and induration often ensue upon repeated attacks of the
disease, and the swollen tonsils sometimes offer serious obstruc-
tion to respiration. When this is the case, they may be re-
moved with little difficulty, and without subsequent inconve-
nience. These little organs are also subject to a chronic
inflammation and slow suppuration, which gradually waste them
away. The palate and uvula are often the seats of inflamma-
tion. The latter is liable to erysipelas and oedema.
The parotid gland is rarely inflamed, except when it is the
seat of a peculiar specific disorder, which is called cynanche
parotidea, or mumps.
Inflammation of the lining membrane of the mouth is called
stomatitis.
Simple inflammation of this membrane is characterized by
increased redness, swelling, and heat, but it rarely occurs ex-
cept in connexion with inflammation of the tonsils, larynx, or
pharynx, or as the consequence of the irritation of dentition,
or of acrid, or stimulating matters taken into the mouth for
the purpose of allaying toothache. In such cases it terminates
by resolution.
It is much more common to find this inflammation presenting
the appearance called "aphthae."*
These are grayish or whitish specks, which look like ulcers,
and are described as such by some authors, but which are ex-
udations from the inflamed mucous membrane; when these fall
off, the parts beneath are red and irritable, the cuticle being
peeled off, and the cutis vera exposed.
This disorder is generally supposed to indicate a correspond-
ing disease of the surfaces of the digesting organs. It attends
some forms of constitutional disorder, and constitutes a pecu-
liar infantile disease, called thrush, of which I will have occa-
sion to say more in connexion with dentition.
The gums are very liable to inflammation, which is charac-
terized by redness, swelling, soreness, and often by very severe
aching pain.
* AiTTa>, I burn.
84
INFLAMMATION OF THE MOUTH.
The most common cause of inflammation in these parts, is
the irritation produced by dead teeth. We have already ob-
served that dead parts are subject to the same laws which af-
fect foreign bodies lodged in the flesh, and that nature removes
them, or attempts their removal, by instituting inflammation
and ulceration around them. In other words, it is provided in
the fundamental laws of the animal economy, that dead parts
shall irritate the surrounding parts, and produce in them those
conditions which naturally lead to the expulsion of the offenders.
But dead teeth are firmly set in the jaw, and withal, are of too
dense structure to be readily softened and absorbed. It hap-
pens, therefore, that they remain long after their partial or
complete disorganization, to plague the soft parts with which
they are connected. The gums under these circumstances are
kept in a state of chronic inflammation, and are rendered ex-
ceedingly sensitive to the action of irritants. Cold, or any
local application of an exciting kind, will, under these circum-
stances, occasion aggravation of the chronic affection, and cause
acute inflammation, of a severe character, which is remarkably
liable to end in abscess.
The chronic inflammation is often attended with ulceration
around the decayed tooth; the soft parts being separated
therefrom, in the vain attempt of nature to remove them. In
consequence of the long-continued and unavailing ulceration,
an imperfect attempt is made by the vessels of the gums to
supply the loss of parts by granulations. These are unhealthy,
spongy, loose, and incapable of cicatrizing; in other words,
they are fungous. These fungous growths bleed freely upon
being touched with a brush, or hard body, and being constantly
destroyed and renewed, add much to the fetor of the fluids of
the mouth, which under these circumstances, is often intolera-
ble. Inflammation of the pulp, and the lining membrane of
its cavity is commonly, perhaps always, the consequence of
caries.of the bony structure of the tooth, and exposure of its
sensitive internal parts to the action of external agents. It
gives rise to violent pain, which only subsides to be renewed
again by contact with any hard body, or irritating substance.
This inflammation may continue for a considerable length of
INFLAMMATION OF THE MOUTH.
85
time, passing through successive suppurations, and, ultimately,
completely destroying the vessels and nerves of the pulp, and
with them, the vitality of the tooth.
Sometimes the matter formed within the tooth perforates the
alveolus and the gum, and forms a fistulous* orifice into the
mouth, through which putrid fluids are continually weeping.
This is what is called alveolar abscess, and can only be reme-
died by extraction of the tooth.
The matter of alveolar abscess will sometimes be discovered
at a great distance from its source. The following case, which
occurred in my practice, and which is related in Prof. Harris's
Dental Surgery, as the most singular instance of alveolar ab-
scess which ever fell under his observation, affords a striking
instance of this fact.
The subject was a lady about thirty years old. She con-
sulted me on account of a continual dripping of pus from be-
hind the curtain of the palate, which she attributed to some
disease of those parts, and which had annoyed her for a year
previous.
Upon a close examination of her mouth and throat, I could
discover no tumour or any indication of a deposit of matter
except two protuberances, each nearly as large as a hazelnut,
situated behind the two superior central incisors. Being
strongly inclined to believe that the matter came from these
abscesses, I requested the advice of Prof. Harris, who fully
coincided in my suspicions. Upon our joint advice, the pa-
tient submitted to lose these valuable teeth, and was rewarded
by the cure of the troublesome complaint which had caused her
so much uneasiness.
The maxillary sinus, or antrum, is covered by a membrane
which nearly resembles the mucous covering of the mouth.
This is frequently the seat of inflammation. From the pro-
tected situation of this cavity, locked in on every side by bone,
and covered by thick integuments, it is not apt to be affected
by ordinary agents, acting from without, but the teeth of the
* Fistula—a pipe, a canal whose sides and edges are hard and incapable
of adhesion.
8
86
INFLAMMATION OF THE MOUTH.
upper jaw frequently send their roots into it, and thus affect it
readily, when, happening to become diseased, they are quali-
fied to provoke disorder in neighbouring parts. Even when
they do not penetrate the floor of the antrum, they are often
separated from it by a partition so very thin as to afford no
adequate protection to the antral membrane against the pro-
pagation of inflammation.
When the membrane of the antrum is inflamed, it pours out
a vitiated secretion, which accumulates for some time before it
produces sufficient uneasiness to excite the attention of the
patient. The pain of inflammation depends upon the degree
of pressure to which the parts are subjected, and the peculiar
structure of the antrum prevents much suffering from this
cause until the cavity is completely filled.
Generally, however, some dull pain is felt in this region in
the course of the inflammatory action, but the patient com-
monly refers it to the teeth. After a while, however, the dis-
tension of the walls of the cavity produces more serious suffering:
matter escapes through the nose or mouth, and a hard bony
tumour indicates the projection of the antral walls.
The fluid thus accumulated is usually not pus, but vitiated
mucus. The disease has been very improperly called dropsy*
of the antrum, for the contents are by no means serous.
The discharged matter, having been long retained, is gene-
rally very offensive.
Ulceration may also take place in the membrane of the an-
trum, and pus of a very fetid quality be exuded through the
nose, and when an opening exists, through the mouth. This
condition forms one of those exceedingly distressing, and often
incurable cases of disgustingly fetid breath, which are called
ozwna.\
Sometimes, when the disease is permitted to proceed with-
out proper remedial means being used, the walls continue to
swell, the bones soften, the tumour opens, and a fetid discharge
flows through the aperture over the cheek.
* rJai/)—water. Accumulations of extravasated serum are so called.
■j- o£f/v, to smell.
87
CHAPTER VIII.
TREATMENT OF INFLAMMATION.
In all cases of inflammation it is desirable to bring about
the disappearance of the disease without any disorganization of
structure. In other words, to accomplish cure by resolution.
When this cannot be effected it is important to lessen suppu-
ration, and if possible to prevent, or, at least, limit mortifica-
tion.
The first step towards accomplishing the cure of inflamma-
tion is to remove, if we can, the cause which produces it. This
will often render further treatment very simple and easy, or
altogether unnecessary. Where the gums, or lining membrane
of the antrum are inflamed through the irritation caused by
diseased or dead teeth, no treatment short of their removal
will do any good; and this will generally be a sufficient aid to
nature. Even when the soft parts are suppurating, they will
speedily heal after the irritant has been removed.
The treatment of inflammation proper, consists in general
and local means. With the exception of a few employed to
relieve chronic inflamed conditions, these remedial measures
are comprised under the general name antiphlogistic,* and are
all intended to lessen the vascular action, of the general or
local circulation.
Antiphlogistic treatment is negative or positive. The nega-
tive consists in withholding every local application likely to
excite the vessels, or irritate the morbidly sensitive nerves of
the part; and preventing the taking of such drinks or aliment
as would tend to sustain the morbidly active circulation. In
short, the withdrawing as far as possible of all local and gene-
ral excitants.
*Anti, against; phlogiston, the old name for the cause of heat.
88 TREATMENT OF INFLAMMATION.
The positive treatment consists in the use of means which
lessen vascular action and diminish nervous sensibility. The
general remedies are bloodletting, purgatives, diaphoretics,
and low diet; among the local are bloodletting, from the
affected part, or its immediate vicinity; cooling, emollient,
sedative, and astringent applications, and counter-irritants.
When pus has been formed in a cavity, it is often necessary
to evacuate it by an artificial opening ; sometimes, even after
the tumour has opened spontaneously, a counter-opening is
necessary.
TREATMENT OF INFLAMMATION AND ABSCESS OF THE PARTS
COMPOSING THE MOUTH.
It is rare that inflammation of these structures requires ge-
neral treatment. Sometimes, however, it is sufficiently serious
to occasion inflammatory fever, and call for decided constitu-
tional remedies. When such is the case, the patient should be
bled from the arm until a decided impression be made upon the
circulation, and the operation must be repeated, until the de-
sired effect be accomplished. If the bowels of the patient be
constipated, saline cathartics should be employed. Nauseating
remedies, such as tartar emetic, will also be found useful in
lessening the general inflammatory action and withdrawing the
nervous sensibility from the affected part.
In most cases, however, the dental surgeon will only need to
employ local remedies.
We have already said that when the inflammation is conse-
quent upon the presence of diseased teeth, or parts of teeth,
they must be removed. This being done, the inflammatory
action will commonly subside and speedily disappear.
The teeth are liable to a peculiar calcareous deposit, called
tartar,* or salivary calculus, which adheres with great tenacity
* Tartar, or salivary calculus, is composed, according to Berzelius, of
Phos. lime and magnes, 79 00
Salivary mucus and salivine, 13-50
Animal matter, 7.50
10000
TREATMENT OF INFLAMMATION. 89
to them, and insinuating itself under the edges of the gums,
detaches them from the teeth, and acting as a perpetual irri-
tant, inflames, and often ulcerates them.
This substance is deposited from the saliva under certain
conditions of that fluid, and is most liberally deposited upon
the teeth nearest to the salivary ducts and upon those of the
lower jaw. When it contains a larger proportion of earthy
salts, it is hard, and brittle; when the animal matter is in ex-
cess, it is soft and moist. Under whichever of these forms it
appears, its removal is indispensable to the successful treat-
ment of the disease of the gums which it causes. Sometimes
this can be effected by the brush alone ; often the hard mineral
substance requires to be broken up and elevated by an instru-
ment of steel. When once removed, its subsequent accumu-
lation must be prevented by persevering use of water and the
brush.
It often happens that the gums will be inflamed through the
agency of teeth, the disease of which is not sufficiently serious
to authorize their removal; again, inflammation may occur in
the gums from causes independent of the teeth, as from cold,
irritating applications, bruises, &c.
In order to prevent acute inflammation of the gums from
passing rapidly to suppuration, it is necessary to use free local
depletion. This may be done by scarification, or by leeching.
Scarification is nothing more than slightly incising the gum
and causing its superficial vessels to bleed.
It is a remedy of doubtful utility, and often does more harm
than good.
It is obvious, that any wound inflicted upon an inflamed
part must increase the inflammation to a certain extent, and
unless the quantity of blood taken away be more than sufficient
to counterbalance the additional evil inflicted, the patient will
lose by the operation. Scarification produces copious bleeding
for the instant, but the clean superficial wound is soon closed
by coagulum and lymph, and the oozing of blood continues
but a short time.
8*
90
TREATMENT OF INFLAMMATION.
When the gums present the condition called fungus, scarifi-
cation will cause much freer bleeding, owing to the increased
vascularity of the part. Under such circumstances it is an
important means of cure.
Leeching is a far more effectual process. It is true that
wounds are made by the leeches deeper and more irritating
than those inflicted by the lancet, but the flow of blood con-
tinues very much longer and the quantity discharged is far
greater.
Two or three leeches placed upon a gum will often cause a
bleeding which will continue for several hours, and will cure
severe inflammation in almost as brief a space of time.
In order to be effectual, leeching should be employed in the
early stage of inflammation. If delayed until matter has be-
gun to form, no benefit can be expected, except, perhaps, in
the lessening of the quantity of pus.
Other local applications are of little or no use in the treat-
ment of acute inflammation of the gums. Their position pre-
vents the continuance of any fluid upon their substance. Cold
water, however, may be used by repeatedly filling the mouth
with it. This remedy is serviceable only in slight inflamma-
tions. All stimulating applications used to irritate the sur-
rounding parts and thus alter and divide sensation so as to re-
lieve pain, ultimately aggravate the disease. It is erroneously
supposed that the increased flow of secretions which is occa-
sioned by the irritation, must relieve the vessels and abate the
inflammation, for the very irritation attracts to these parts a
larger supply of blood than usual, and augments secretion only
by increasing arterial activity.*
Where the inflammation is excessive, leeching and blistering
behind the ears or under the jaw may be resorted to.
As great and long-continued suffering frequently attends
this disease, full opiates at night may be given with great ad-
vantage ; securing at once temporary relief and grateful re-
* TJbi irritatio, ibi fluxus—where there is irritation, to that place will be
the flow, is a well-known medical adage. The law applies to the nervous as
well as the vascular system.
TREATMENT OF INFLAMMATION.
91
pose, and aiding materially the efforts of nature to remove the
inflammation.
Inflammation from mechanical violence must be treated upon
the same principles.
The gums are liable to inflammation of a specific character.
When mercurial preparations have been used to a certain ex- \
tent differing much in different individuals, a constitutional im-
pression is obtained, which announces itself by a peculiar
tenderness and inflammation of the gums and an increased
secretion of mucus and glandular fluids into the mouth. This
is called salivation or ptyalism.*
The first symptoms of this mercurialization are observed in
an increased tenderness and some swelling of the gums, which
exhibit a pale rose-colour, except at the edges surrounding the
teeth, where they are of a deep red. The soreness and swell-
ing now rapidly increase, the discharge of mucus and saliva
becomes excessive; and is accompanied by a very peculiar and
disagreeable odour; a metallic or coppery taste is constantly
present in the mouth, and the tongue and salivary glands are
inflamed and swollen.
Such is moderate salivation, but it sometimes happens that
from excessive dosing with mercury, or from peculiar suscepti-
bility of the patient, all the symptoms above enumerated are
greatly aggravated. The gums are very much swollen and
covered with ulcers; irritative fever appears ; the enormous
tumour of the tongue pushes beyond the lips and hangs out of
the mouth, preventing the closure of the jaws; the flow of fluids
is prodigious, the patient wastes excessively; gangrene of the
mucous membrane of the mouth and gums, and extensive
sloughing of the soft parts and bones sometimes occur; the
teeth are loosened and sometimes drop from their sockets and
occasionally the patient expires from exhaustion.
A very frequent consequence of extensive mercurial saliva-
tion and the attendant ulceration and sloughing, is contraction
of the mucous membrane in the neighbourhood of the anterior
* Ptyalism—salivation ; from tttvu, I spit.
92 TREATMENT OF INFLAMMATION.
arches of the palate, whereby the patient is prevented from
opening the mouth, except to a very slight extent. In one
case this condition resulted from salivation produced by a few
grains of blue pill. The patient was unable to open the mouth
wider than half an inch. Surgical aid could give only tempo-
rary relief. In another instance of a child four years old, the
patient when seen several years afterwards, was obliged to suck
food through the spaces left between the jaws by the loss of the
alveolar process.*
It sometimes happens as a consequence of salivation, that
adhesions form between the mucous membrane of the lips and
cheek and that of the gums ; very much deforming the face
and lessening the usefulness of the mouth.
A great variety of remedies have been suggested and em-
ployed for the relief of excessive salivation, but there is no
specific means of relief. No local applications of an irritating
character can be borne, and no astringent but of the mildest
quality can be used. Besides demulcent lotions and some very
mild astringents, such as table tea, we have no topical applica-
tions to recommend.
The only rational treatment is to abate the inflammation by
the use of antiphlogistics, to such extent as the strength of
the patient will permit. Leeches under the jaws procure the
greatest relief, and blisters to the throat and opiates are useful
accessories.f
A form of disease very nearly resembling salivation, occurs
occasionally in children, and sometimes it is said even in adults.
It is ulceration of the inside of the cheek, causing gangrene
and a copious secretion of fetid saliva. It is called Cancrum
oris.
This disease is not properly inflammatory, being rather a
consequence of debility; but lest I should not have an oppor-
tunity to describe it hereafter, I will do so now.
* Pereira's Elements of Materia Medica and Therap.
f It is important to remark that salivation, however severe, does not ne-
cessarily prove the previous administration of mercury. For some curious
observations on this subject, see Pereira's Elements of Mat. Med. and
Therap. 709.
TREATMENT OF INFLAMMATION.
93
Cancrum oris is a foul, fetid ulcer, beginning upon the inside
of the cheek and rapidly sloughing through it until it opens
upon the outside. The gums and alveoli are often seriously
involved; the teeth become carious and loose, and drop out;
abscesses form in different parts of the mouth, and make open-
ings for themselves in different directions. The progress of
the disease is attended by a copious discharge of fetid saliva
and mucus. Exfoliations of the bone are not unfrequent and
extensive sloughing sometimes occurs.
The disease generally occurs in ill-fed children, crowded in
a hospital or living in low, swampy situations. The remedies
must be tonic and invigorating. The principal, are fresh air
and nutritious diet. The best local applications are diluted
mineral acids; burnt alum, sul. zinc, tinct. of myrrh, &c.
The disease is exceedingly rare in our country.
Syphilis, or the venereal disease, often produces ulcerations
of the throat, which are described in the many books upon
that subject, and require no particular notice here.
It is proper, however, for dental surgeons to know that a
peculiar and destructive ulceration of the gums, which will defy
all but specific remedies, sometimes, though very rarely,
attends Syphilis. As it is impossible to describe the peculiar
appearance of this ulceration by words only, so as to enable
the practitioner to detect it upon sight, I refer the reader to
an excellent delineation of it in Messrs. Carey & Hart's edition
of Bayer's Plates, PI. xxiv., Fig. 15.
Chronic inflammation of the gums may depend upon any of
the causes mentioned as productive of acute inflammation. It
tends rather to ulceration than abscess.
If there be no specific cause, after removal of any dead teeth,
&c, the gums require the aid of astringent and somewhat
stimulating lotions, such as port wine and water, weak brandy
and water, myrrh, infusion of Peruvian bark, &c.
There is a common form of disease which is usually called
scurvy or scorbutus of the gums. This designation, however,
is very improper; for scurvy is a constitutional affection, de-
pending upon long privation of fresh and acescent food, aided
94
TREATMENT OF INFLAMMATION.
by the influence of cold, dampness, &c. It is a disease pecu-
liar to ships and prisons, and the affection of the gums which
attends it, is but one among many symptoms of the disorder.
It is well, therefore, to abandon this term, scurvy, as applied
to the local disease of the gums in question, and, following the
example of Professor Harris, I will consider it as an idiopathic
inflammation of the gums, attended by sponginess of structure,
recession of their margins, and frequently, destruction of the
alveolar processes,
When affected by this disease, the gums present a swollen
appearance. Their colour is dark-red or purple; they feel
elastic under the finger, and when pressed, pus oozes out be-
tween the teeth and the margins of the gums, which are thick-
ened and detached. The proper tissue of the gums, having
become to a certain extent fungus, bleeds upon the slightest
touch, and is very sensitive.
The disease progresses with more or less rapidity, according
to the constitutional health of the patient, and the capability of
resistance natural to the organs attacked. Sometimes it is con-
fined to a small portion of the gum, at others, it involves the
periostea of the fangs and the alveoli, and presents a mass of
complicated disorder and devastation. A deposition of bony
matter sometimes takes place in the bottom of the sockets and
the teeth are loosened and drop out.
The treatment of this disease does not differ from that of the
ordinary inflammatory conditions previously described. Indeed
it is not specifically different.
All irritating bodies, such as decayed teeth and roots, must
be removed; irregularities of denture corrected; tartar also
taken away; the gums depleted; and after active inflammation
has subsided, astringent lotions may be used by way of cor-
recting the habitual looseness of texture.*
* For a more extended description of this disease and its treatment, than
is compatible with the scope of this work, see Dr. Harris's Dental Surgery, a
work which I will take for granted is in the hands of every scientific dentist,
and every student of dentistry.
95
CHAPTER IX.
CARIES—MORTIFICATION. *
The term caries has different meanings when applied to the
bones at large and to the teeth. Let us first consider the dis-
ease of the bones thus called.
Caries in the bones is analogous to ulceration of the soft
parts, and is very different from necrosis or mortification of
these parts.
The bones are vital organs, supplied with arteries, nerves,
veins, absorbents, and cellular tissue. Like soft parts, they
grow and waste, undergo disease and accomplish reparation.
The denser the texture of a bone the less liable it is to be
attacked by caries, and for this reason the bones of children
are more susceptible of it than those of adults.
In caries, the bone undergoes a change by which its texture
is softened and broken down; fungous flesh, which bleeds very
readily, grows up in the interstices formed upon the surface of
the diseased bone; fetid, dark-coloured sanies finds its way to
the surface through a sinuous channel, and a communication is
thus formed between the diseased bone and the external parts.
Caries may nevertheless progress for a long time without the
formation of an ulcer and discharge of matter; and these re-
sults depend more often on necrosis than on caries.
The treatment of caries consists in the removal of the dis-
eased part by surgical means, and, as is often necessary, the
application of the actual cautery upon the new surface. The
latter means is not absolutely indispensable ; the former pro-
bably is, unless, as sometimes happens, the separation of the
* Kitguu, to abrade.
96
CARIES—MORTIFICATION.
unsound parts may be accomplished by the unaided efforts of
nature.
Caries of the teeth, is a chemical erosion of those organs by
the action of the fluids of the mouth, and the accidental matters
dissolved in them, upon the salts of which the tooth is mainly
composed.
It is yet a mooted question whether the teeth are ever subject
to true caries, such as affects other bony structures. I have
already remarked that this disease is not apt to occur in the
denser osseous structures, and the close texture of the teeth
renders them particularly unlikely to be thus affected. Yet it
might be too much to say that they are never subject to the
active disorganizing process in question. It is certain, how-
ever, that caries of the teeth, as commonly met with, is a mere
chemical erosion, resulting from the action of acids upon the
earthy salts which principally compose them. A human tooth,
inserted as a substitute in another mouth, will undergo this
change as readily as a natural tooth; showing that in this form
of destruction the organs assailed are passive.
MORTIFICATION OR GANGRENE.
These two words are commonly used synonymously to express
absolute death of a part, but by some writers the term gangrene
is restricted to that condition which immediately precedes death,
and Sphacelus* applied to the latter condition, while mortifica-
tion is a general term covering both conditions.
According to this use of the terms, gangrene represents the
condition in which there is a sudden diminution of pain, if it
has previously existed; a livid discoloration and subsequent
yellowish or greenish hue of the part; a detachment of the
cuticle with effusion of a turbid fluid beneath it, and a soften-
ing and crepitation of the part.
When the part has become cold, insensible, black, motionless,
without circulation and life, the condition is called sphacelus.
The state of bone analogous to this is called necrosis, and the
dead part when detached, a sequestrum.
28va>—I consume—Consumption. There are several
chronic diseases of the lungs, which are vulgarly known as consumption.
Most of these are inflammatory affections and their consequences. Phthisis,
or consumption proper, is an entirely different disorder in its cause and
character. It is, with few exceptions, incurable from the commencement.
The inflammatory affections are all curable if promptly and rightly treated.
ULCERS.
123
Yet men are by no means exempt, but those of the male sex
in whom the lymphatic temperament predominates, are most
liable to it.
It is common to distinguish the scrofulous disposition by
certain external marks which doubtless indicate, with con-
siderable accuracy, the presence of the constitutional vice.
These appearances, from the strong disposition to phthisis
which they manifest, are frequently called "consumptive."
These marks are a fine white skin; light hair; rounded
plump figure; delicate complexion, with rosy cheeks; large
lips; large lower jaw ; yellowish teeth, or teeth, whatever their
colour, which are soft and easily attacked by caries; a large
head; straight and narrow chest; large abdomen, and soft and
flabby flesh. Persons presenting these external appearances
are generally amiable, and often very sprightly and intelligent,
and among them are found the loveliest and most attractive of
the female sex.
The strumous diathesis is exhibited, in another class of per-
sons, very differently. In these the complexion is dark, the
skin harsh, and the habit indolent; the countenance is swollen
and pasty, and all the functions of the body are sluggish and
imperfect; the nervous energy is feeble; the feelings are ob-
tuse, and the moral and intellectual powers occupy a very low
rank. Scrofulous cases of this character are not by any means
uncommon in Britain or the United States, although far more
rare than the other variety, but extreme instances are frequent
in some districts of Switzerland and France; and in these,
human nature appears reduced almost to the level of the brute
creation, assuming forms which awaken feelings of humiliation
and disgust.*
Appearances, such as described as characteristic of either of
the two classes of scrofulous subjects, are not necessary to the
development of scrofula; but when these marks present them-
selves, nothing but the action of circumstances most favourable
to counteract the threatened evil, can prevent its appearance.
* Cumin.
124
ULCERS.
Scrofula is the consequence of damp, cold climates, bad diet,
and want of exercise and fresh air. These circumstances, when
combined, may engender the disease in any child, but in most
cases it is hereditary, being transmitted from the parent; whole
families being frequently destroyed by this fatal legacy. In
one recorded instance, in which the father and mother were
both strumous, eight children out of nine died in childhood, of
scrofulous affections.
The scrofulous disease manifests itself in a variety of ways;
in glandular swellings, sluggish ulcers, distorted bones, cu-
taneous eruptions; but the most common and the most cha-
racteristic attendant upon scrofula, is the production of a soft,
cheesy, unorganized matter, which is found mixed with the pus
of abscesses or deposited in rounded masses of different degrees
of firmness, and of various sizes, called tuberculous matter.
Sometimes this is enclosed in cysts, sometimes diffused through-
out a part, and sometimes it is found in the natural canals or
cavities of the body. To the depositions of this matter and the
irritation and inflammation which it produces, are due the most
serious consequences of scrofula.
Scrofulous ulcers are generally consequent upon tumours of
the same character. These, after having been indolent for a
considerable time, at last ulcerate and discharge their softened
contents. Instead of healing, the orifice enlarges, and an ulcer
is established, discharging a thin glutinous fluid, occasionally
intermixed with the peculiar cheesy or curdy substance already
described.
Commonly, scrofulous sores are not painful; occasionally
they are so. The skin around them is livid and slowly ulce-
rates ; the granulations are flabby and pale, and their margins
are usually overlapped by the thin unhealthy looking skin.
The matter often hardens about the sore, and presents a dis-
gusting appearance. The ulcer heals slowly, and the cicatrix
is irregular, puckered and wrinkled, " with small portions of
projecting skin and even complete bridges, admitting a probe
to pass beneath them ; features by which their origin, long
after a cure, may be readily discovered."
ULCERS.
125
As one ulcer heals, another is often ready to break out, and
the patient is gradually debilitated and worn down by the in-
cessant irritation and drain. Sometimes the disease manifests
itself in a vital organ, and by speedy death curtails the suf-
ferings of the patient.
To scrofula seems properly to belong a very serious ulcera-
tion of the lips, nose, &c, which is called lupus, or nolle me
tangere.
This disease commonly commences by the appearance of a
hard, livid tubercle, which, after being indolent for a longer or
shorter time, ulcerates, and produces ichorous, wasting, ill-con-
ditioned sores, which, in some instances (lupus exedens), rapidly
destroy the adjacent parts ; in other cases, lupus induces a sort
of hypertrophy of the skin. Sometimes the first appearance
of the disease, is a mere violet red colour, tending rapidly to
ulcerate and destroy the surrounding parts.
The tonsils of scrofulous persons are very prone to chronic,
indolent swellings, which, upon slight provocation, take on
acute inflammation. The glands in the neck, and the sublin-
gual and submaxillary glands, are often affected by scrofula,
forming hard, painless, indolent tumours, which sometimes
suppurate, causing intractable ulcers, which, after pouring out
the glutinous and flocculent matter peculiar to this kind of
sores, heal with the irregular, puckered, ugly cicatrix before
described.
Dr. Cumin says that scrofula occasionally attacks the tongue.
It sometimes assumes the form of aphthous ulcerations, and
fissures of the margin, but its most characteristic features are
small knots or nodules, superficially imbedded in the substance
of the organ, varying in size from that of a small shot to that
of a horse bean. They cause no uneasiness, unless when firmly
pressed, and then the pain is slight and pricking. The mucous
membrane covering them, is red and prominent, and soon
breaks in the centre, giving rise to an ulcer, which spreads
and destroys by sloughy erosion, with much pain, profuse sali-
vation, furred tongue, and fetid breath. The ulcers, under
proper treatment, become clean, contract and heal; but the
ll*
126
ULCERS.
hardness remains: fresh nodules form in other parts of the
organ, and the same train of suffering is gone through, after a
longer or shorter interval, according to the state of the pa-
tient's health and the regularity of his mode of life, until a
decided improvement be produced on the constitution by time,
change of climate, or the employment of remedies.
The mucous membranes of scrofulous persons are apt to in-
flame, and generally pour out mucus in large quantity, and
often of an acrid quality; not unfrequently the mucous mem-
brane of the mouth presents aphthous exudations, excoriations
and small ulcers.
I have already mentioned that the texture of the teeth of
scrofulous persons is of that character which makes them an
easy prey to caries. When we remember that teeth thus little
capable of resistance are continually exposed to the action of
unusually abundant and acid mucus, we may readily account
for the ravages of caries upon the mouth of persons of scrofu-
lous taint.
Scrofula sometimes attacks the bones of the face, especially
the nose, causing, when the disease is confined to a very small
portion of the osseous tissue, the intolerably fetid sore called
ozena, and when acting upon a large surface, horrible devasta-
tion and deformity. The bones of scrofulous subjects are
more slender, the outer wall thinner, and the inner softer and
more vascular than the bones of others.
Syphilis, however, is the more common cause, both of ozena
and osseous destruction, but it is in subjects of scrofulous
constitution that it produces its most fearful and irresistible
effects.
The cure of scrofula depends much upon hygienic treatment.
As experience shows that cold, humid climates are most favour-
able to it, one of the best means for preventing and curing its
disorders, is evidently removal to a warm, dry climate. Be-
sides this, which is often impracticable, exercise in the open
air, generous diet, and the use of such medicinal remedies as
are calculated to invigorate the frame, are the best means by
which to combat this obstinate and most serious affection.
ULCERS.
127
Iodine is the best medicine we possess for removing the
superficial glandular obstructions, and healing the ulcers of
scrofula. It often exerts a sanitary influence upon these and
similar external manifestations of scrofula. Unfortunately the
high hopes entertained at one time of the power of this medi-
cine to cure the radical constitutional evil, or even the most
fatal form of its development, tubercular phthisis, have been
totally disappointed. This terrible form of scrofulous malady
yields little to therapeutic agents, and, for the most part, is
checked only by the hygienic means before referred to. Cod-
liver oil is now much used in scrofulous, and especially phthisi-
cal cases, and seems to benefit them, either through some un-
known medicinal principle, or, as is more probable, through
the concentrated and highly nutritious aliment it affords to the
wasting tissues.
128
CHAPTER XL
TUMOURS.
The term tumour,* literally means a swelling, and is often
used in this wide sense, but it is more properly restricted to
such enlargements as depend upon morbid growth, either of
the natural parts, or of organizations not natural, formed in the
tissues of the body. This definition rejects such swellings as
are produced by the presence of free fluids and gases.
Tumours may be divided into malignant, and those which
being comparatively innoxious, may, for want of a better term,
be called benign.
The malignant tumours are such as depend upon some con-
stitutional vice, and, resisting all remedies, tend to convert the
surrounding tissues into their own substance. These spread
rapidly, ulcerate, destroy the blood-vessels of the part, pro-
duce frequent and exhausting hemorrhages, are sometimes very
painful, and if permitted to remain, ultimately fatal.
Cancer, or carcinoma, and fungus hsematodes, or bleeding
fungus, are the general names for these tumours, though distinct
names have been given to varieties of each of these disorders.
FUNGUS H^IMATODES, BLEEDING FUNGUS, SPONGOID INFLAM-
MATION, SOFT CANCER, MEDULLARY SARCOMA.
This disease is almost uniformly, perhaps always, a constitu-
tional one, and therefore beyond the reach of any local means.
Unfortunately we have no antidote to the poison shed through-
out the whole body, and, therefore, there is no disease more
intractable and hopeless.
* Tumeo, I swell.
TUMOURS.
129
It generally makes its appearance in the form of a small
elastic tumour; at first painless, but subsequently very pain-
ful. As it grows, its elasticity becomes more remarkable, a
peculiarity which has originated the term spongoid inflamma-
tion. When ulceration takes place, fungus shoots forward, and
the bleeding which results from these irritable and morbid
granulations, has occasioned the name of the disease.
Patients who suffer from fungus hsematodes, have frequently
a peculiar appearance which indicates their constitutional
pravity. Their skin is sallow, or has a greenish cast, they
are often bedewed with clammy perspiration, and are troubled
with cough and dyspnoea.
Should the tumour be extirpated, the disease soon appears
in some vital organ and proves fatal.
When the tumour is examined after death, it is found full
of a grayish greasy substance, somewhat like that of the brain,
mixed with a thin bloody matter.
Polypus.*—This is the name given to a variety of tumours
which have their seat in certain cavities, particularly the nose
and uterus, and by their growth distend and break up the sur-
rounding parts, and otherwise mechanically impede the per-
formance of function, even to a fatal extent.
Some surgeons distinguish polypi as benign and malignant.
Others deny that any such essential distinction exists. Pro-
bably the disease is never malignant in the proper sense of that
term, unless the constitutional tendency of the patient to some
of the forms of carcinoma engrafts the latter disease upon the
polypoid tumour, in which case it may present the appearance
of cancer or fungus hsematodes.
As a general thing, polypus, however dangerous, has no ma-
lignancy about it. The harm it does is due merely to its bulk
and unfortunate position.
Polypus is very often seated in the nose. According to Mr.
John Bell, every polypus, here seated, is in its early stage a
small movable tumour, attended with sneezing and watering
* Polypus—voxvc, many—ttouc, a foot—from a supposed resemblance to
the radiated animal so called.
130
TUMOURS.
of the eyes; swelling in moist weather; descending with the
breath, but easily pressed back with the finger. It causes no
pain, and generally begets no alarm ; yet this small, innocent
looking tumour may become most distressing and fatal. As it
increases, the pressure it exercises upon the delicate structure
of the cells, &c, where it is seated, begins to cause serious
suffering. It fills the nostrils and obstructs the breathing.
The eyes become watery from the pressure upon the lachrymal
sac; the hearing impaired by the obstruction of the eustachian
tube, and the voice changed by the stoppage of the nostril.
The swallowing begins to be impeded by the depression of the
palate; the bones become carious from the steady and increas-
ing pressure; the tumour projects from the nostril before and
over the arch of the palate behind; the nose is twisted; the
countenance distorted; the patient suffers with terrible head-
aches—a foul and fetid matter is discharged from the nostrils;
alarming hemorrhages ensue ; the floor of the antrum begins
to give way; the teeth fall out and matter issues through their
sockets; the still increasing pressure constantly aggravates
the sufferings of the patient until death closes the scene.
Though all polypi, from their tendency to grow, may in time
produce the terrible train of symptoms above enumerated, yet
I cannot agree with Mr. Bell, that all are essentially similar.
They differ very much in colour, density, and tendency to re-
turn. Some are pale and so loose in texture as to be almost
vesicular; others are red, hard and resisting, &c. But in all
cases they must be removed, and it is of little use to distinguish
between them.
There are four ways of extirpating nasal polypi: extracting
them with forceps; tying them with ligatures; cutting them
out, and destroying them with caustic. The manner of per-
forming these several operations is described in the books on
general surgery. It is not within my province to recapitulate
them.
Benign Tumours.—Are those which have no tendency to
spread by converting adjacent tissues into their own substance ;
which do not depend upon constitutional vice, and may be con-
TUMOURS.
131
sidered as mere local aberrations from healthy growth. Of these
there are several kinds, which may be reduced to two classes,
the Sarcomatous* and Encysted Tumours, and Exostoses.
Sarcomatous or fleshy tumours are known by their firmness,
redness, and fleshy feeling. (Some of the malignant tumours
are arranged by Mr. Abernethy under this class.) There are
several varieties of them, of which the common Vascular and
the Adipose or fatty are, by far, the most common.
These tumours grow to great size ; are not painful, and may
be handled with impunity. Their size and situation, however,
often make it necessary to remove them. If permitted to pur-
sue their natural course, they sometimes suppurate, and then
subside. This mode of cure, however, involves so much incon-
venience, that it is commonly better to extirpate them.
Encysted Tumours, or as they are commonly called, Wens,
have this peculiarity, that their contents are contained in a
cyst or sac, or bag. The contents of the cyst are various.
Sometimes the contained matter is fatty, in which case the
tumour is called a Steatoma.f Sometimes it is a yellowish,
thick substance, somewhat like honey or a mixture of honey and
wax. Tumours of this kind are called Melliceris.% When the
contents are like fluid cheese or pap, the tumour is called Athe-
roma.^
The contents of these tumours, however, are not always of
such a quality as will permit them to be classed under the
names above mentioned. It is not necessary, however, to be
more precise. Perhaps, for all practical purposes, it had been
as well to have permitted them all to wear the popular desig-
nation, Wens.
These encysted tumours are common about the head, and
frequent upon the eyelids. They are generally globular, not
sensitive, and cause no inconvenience beyond what is insepa-
rable from their weight and size; and the trouble from these
causes will, of course, depend upon their location. They
usually grow slowly, but sometimes attain great size. Some-
* 2*§|—flesh. f 2ti*£—fat.
J Mf/,/, honey, and K»g:c, wax. § Afiyg*—pap or pulp.
132
TUMOURS.
times the skin above them ulcerates, and the tumour is thus
evacuated. This does not very frequently occur. These
tumours should always be removed by dissecting them out, be-
ing careful not to leave any portion of the cyst behind—for if
this caution be neglected, the disease is liable to return, and
does not always present, upon its second appearance, the
benign character which characterized it originally. For
obvious reasons, the operation should always be performed
when the tumour is small.
The mode usually adopted in the extirpation of these tumours
is to dissect out the sac with the contents entire. Owing to
the yielding nature of the contents, this is a tedious and trou-
blesome process. Sir Astley Cooper recommended to cut
through the sac at once, and then to dissect it out; and doubt-
less this is the more easy method, inasmuch as the divided
edges of the cyst may then be held by the forceps. Encysted
tumours occurring in the mouth should be attended to as soon as
they are perceived.
"Bony Tumours—Exostosis*—An enlargement of the bone
by the addition of osseous matter within its cavity or upon the
surface. There are several varieties, denominated ivory, lamel-
lated, &c, according to the density of the tumour and the dis-
position of its particles.
The bones are liable to other forms of tumefaction, which
differ from exostosis, although often confounded with it.
When the bones are enlarged by mere distension or separation
of their parts, the disease is not at all similar to the dense
tumour produced by the presence of an unnatural quantity of
bony substance.
Thickening of the periosteum sometimes occasions an appa-
rent enlargement of the bone, when in fact the osseous matter
is not at all increased or distended.
Sir Astley Cooper described exostosis as having two different
seats, viz.: between the external surface of the bone and the
periosteum, constituting periosteal exostosis; and in the me-
dullary membrane and cancellated structure, forming medul-
E%, out of cvtisv—a bone.
TUMOURS.
133
lary exostosis. Sometimes he found the production of bone
preceded by cartilage, in which it was deposited; at other
times connected with a fungus of a malignant character, con-
taining spicula. This latter form of disease seems to have been
a variety of osteo-sarcoma.
Exostosis may occur upon any of the bones, and the cause
of the disease is generally inscrutable; depending upon irregu-
larity of ultimate nutrition, a process which cannot be compre-
hended.
The structure and consistence of exostosis present great dif-
ferences. Sometimes, especially when the tumour is not very
large, and when situated on the surface of a cylindrical bone,
one may trace with the eye the diverging of the osseous fibres,
in the interspaces, of which we might say that there is deposited
a new bony substance, the organization of which is less distinct.
Sometimes the tumour is entirely cellular, and formed of a few
broad, laminal, intercepting, extensive spaces, which are filled
with matter, different from the medulla, and of various quality.
This case is denominated the laminated exostosis. Sometimes
the enlarged portion of bone makes a sort of hollow sphere,
with thick, hard walls, the cavity of which is filled with fungous
granulations, more or less extensive and indolent. According
to Boyer, this variety of the disease differs essentially from
osteo-sarcoma, notwithstanding external appearances. The
case here alluded to, Mr. S. Cooper considers the same as that
which Sir Astley has named cartilaginous exostosis of the me-
dullary membrane.*
In this last-described form of exostosis, Sir Astley Cooper
says that the original shell is absorbed and a new one deposited,
and within the ossified cavity thus produced, a very large mass
of elastic, firm, and fibrous cartilage is formed. This form of
disease is not malignant, but often ends in very extensive dis-
ease.
A true exostosis, consisting of dense bony matter, and of
moderate size, may exist without much inconvenience to the
surrounding parts, provided they be of a kind to endure the
* Cooper, Surg. Diet.
12
134
TUMOURS.
degree of pressure without distress. But where the exostosis
is so situated that its bulk can only be accommodated by press-
ing upon dense and unyielding structures, or upon nerves or
blood-vessels, or where the enlargement impedes muscular mo-
tion, these tumours may occasion very serious consequences.
The action of the flexor muscles of the leg has been seriously
interfered with by an exostosis in the neighbourhood of the
knee. An exostosis of the orbit has displaced the eye. Sir
Astley Cooper narrates a case of this kind, where two exosto-
ses, growing from the antra, pushed out both eyes, and finally
produced death by pressure upon the brain. In another in-
stance an exostosis of the sixth or seventh cervical vertebra,
stopped the circulation in the radial artery by pressing upon
the subclavian, and in another a cartilaginous exostosis of the
medullary membrane of the lower jaw extended so far back,
that it pressed the epiglottis down upon the rima glottidis, and
destroyed the patient.*
The causes of exostosis are various, and, for the most part,
"little understood. The venereal disease is frequently attended
with the formation of bony enlargements, or nodes, but this
cannot by any means be considered the ordinary, or indeed a
frequent cause of other forms of exostosis.
In some individuals there is an unusual tendency to the ir-
regular deposit of bony matter, and provocations, otherwise
trivial, will often determine local osseous enlargements. Some-
times these provocations are perceived, as when they consist in
some form of external force, as blows, pressure, &c.; more fre-
quently the determining cause is as obscure as the constitu-
tional vice.
Exostosis is always very hard, sometimes painful, often in-
sensible. The firm resistance of the tumour, and its adhesion
to a bone, will generally enable us to distinguish it from other
tumours.
Exostosis is commonly gradual and slow in its growth, but
the fungous, or medullary swelling of the bones, is often rapid
in its development. The latter form of disease is attended
* Surgical Essays.
TUMOURS.
135
with very severe pain, and often with much constitutional irri-
tation.
EXOSTOSIS OF THE TEETH.
The fangs of the teeth are more frequently the seat of exos-
tosis than any other part of the osseous structures. This
affection often causes great suffering to the patient, and the
dentist finds in it one of the most common and troublesome im-
pediments to safe and easy extraction of the teeth.
The disease is always developed upon the root; generally at
the extremity, sometimes at the sides; frequently the whole
fang is involved, though not so equally as to present a symme-
trical enlargement.
Mr. Thomas Bell says that the substance thus added, differs
from the natural bone, being harder, yellowish, and slightly
transparent. As the swelling progresses, the pressure on the
alveolus causes the latter to be absorbed, and thus, as the
growth is very slow, room is continually made for the enlarged
fang. The wasting, however, being propagated to the tooth,
soon exposes the cavity to the action of external agents, and
toothache leads to extraction. Mr. Bell says that the con-
tinued irritation sometimes occasions thickening of the peri-
osteum and suppuration, and the case becomes one of simple
alveolar abscess.
Exostosis of the fangs sometimes occasions neuralgic suffering
of a very serious grade and long duration, the cause of which is
rarely discovered by an ordinary observer. Sometimes the
adjacent parts become functionally disturbed, and multiply the
points of suffering. Mr. Fox relates the case of a young lady,
who had suffered long with this affection of the fangs, which
her medical attendants had entirely overlooked. The eyelid
of one eye had not been opened for two months, and the secre-
tion of saliva was so abundant from the irritation that it flowed
out whenever the mouth was opened.
Professor C. A. Harris has recorded the following case :*
Mr. S., of Baltimore, having suffered from pain in the left
superior bicuspis, applied to a dentist in 1843, for the purpose
* Dictionary of Dental Science, article Exostosis.
136
TUMOURS.
of having his tooth removed. In the operation the root was
fractured, about three-sixteenths of an inch from its extremity,
and the upper part left in the socket. The pain continued, and
at the expiration of twelve months the gum over the upper part
of the alveolus became very much swollen, puffing out the up-
per lip to half the size of a hen's egg. The tumour was opened,
and a large quantity of dark-coloured, very fetid matter was
discharged, which for a short time afforded considerable relief.
The tumour, however, soon re-appeared, and was opened four or
five times in as many months.
In the fall of 1845, he called on Dr. Harris for advice. The
gum was swollen, and the lip and cheek protruded in the man-
ner above described. The tumour was opened again, and about
three tablespoonfuls of black matter, resembling thin tar,
were evacuated. Upon farther examination, the outer wall of
the antrum, immediately over the upper part of the alveolus of
the bicuspis, which had been fractured, was destroyed, leaving
an opening large enough to admit the end of the forefinger.
Believing that the extremity of the root left in the socket
was the cause of the mischief, Dr. Harris cut away the outer
wall of the alveolus, and removed the fragment. The root of
the tooth was found exostosed. The patient recovered com-
pletely in a few weeks.
A great number of cases, illustrating the variety and extent
of mischief occasionally resulting from exostosis of the teeth,
are recorded by writers upon the subject. The dentist when
consulted for the relief of pain in the teeth or jaws, especially
if of long continuance and obstinate persistence, should always
seek carefully for evidence of bony enlargement of the fang.
It is a very common disease, and in some individuals affects
many, or even all their teeth simultaneously. Sometimes ex-
ostosis unites several teeth together. In a specimen presented
to the Baltimore College of Dental Surgery, by Dr. G. R.
Hawes, of New York, the three superior molar teeth of one
side, are thus united. In another specimen, presented by Dr.
Blandin, of Columbia, S. C, two upper molars are united; and
in a third, presented by Dr. Ware, of Wilmington, N. C, there
is a deposition of bone on the roots of a first superior mo-
TUMOURS.
137
laris, as large as a hickory nut. Similar specimens are in the
museum of the Institution.
The disease admits of no cure, and the exostosed tooth must
be extracted. In performing the operation, caution is neces-
sary lest in the effort to tear away the enlarged bulb, the alve-
olus, or adjoining teeth, or a fragment of the maxillary, be
brought with it. It is often necessary to cut away the socket
in order to liberate the root.
OSTEO-SARCOMA.
By osteo-sarcoma, is meant a malignant disease of a bone, in
which there takes place within it a growth of fleshy matter, which
distends the bony walls, and gradually converts the structure
into a medullary, cartilaginous, or cancerous-looking substance.
Osteo-sarcoma announces itself by severe, deep-seated pain,
which is often felt for a considerable time before any swelling
of the bone is perceived. Sometimes the pain is so great
and unmitigated as seriously to impair the patient's health,
before there is any perceptible disease.
The tumour is at first deep-seated, general over the part,
hard and tuberculated. It does not yield to pressure, nor is
the pain aggravated by it. The soft parts, for a considerable
time, may manifest no diseased condition; indeed, it is not
necessary to a fatal result that they should be implicated.
Sometimes, however, as the swelling advances and the pain
increases, the skin inflames and ulcerates, and assumes a can-
cerous appearance.
As the disease progresses, hectic fever is set up, and the
patient soon succumbs under accumulated suffering. When the
sarcomatous bone is examined after such a termination, it is
found transformed into a yellowish, cheesy or lardaceous sub-
stance, and all the surrounding parts which have participated
in the disease, are found to be changed into the same homoge-
neous matter.
The prognosis of osteo-sarcoma is decidedly unfavourable.
No medical treatment is of avail in checking it. Extirpation
is the only means which promises relief.
12*
138
TUMOURS.
Spina Ventosa is a swelling of the bones with diminution of
their density. It is most common in the lower jaw, and in the
metatarsal and metacarpal bones and phalanges of the fingers
and toes.
These tumours are the result of inflammation or of scrofulous
degeneration in the cancellated structure of the bones, produc-
ing matter, generally fluid, purulent, and mixed with the dark-
coloured matter of osseous disorganizations. Sometimes, ac-
cording to Dr. Gibson, the contents are cheesy, and Mr. Liston
says, curdy. It is questionable whether these scrofulous swell-
ings of the bones are reducible to the same pathological de-
nomination as the fluid tumours properly known as spina ven-
tosa. They are not malignant, but for the most part require
to be removed by an operation.
ANEURISMAL* TUMOURS.
A tumour caused by the distension of the walls of an artery, or
of the heart, is called a true aneurism ; if the swelling be due
to the rupture of an artery and the extravasation of blood in
the surrounding tissue, it is called a false aneurism. If an
artery be wounded through a vein, so as to permit the arterial
blood to pass into the vein, the condition is called varicose
aneurism.
An aneurismal tumour may generally be detected by the
throbbing or pulsating sensation which it communicates to the
hand upon pressure. Sometimes, however, when an abscess
happens to be seated over an artery, the pulsation of the latter
will be communicated to the former. The pulse often indicates
the existence of an aneurism of the heart, or some large artery,
by a peculiar thrilling sensation, which has been aptly com-
pared to the feeling of a "shattered quill." As fatal acci-
dents have occurred from thoughtlessly opening tumours of this
description, it is always important to examine every tumour
carefully before thrusting a lancet into it.
The pathology and treatment of aneurism does not come
properly within the scope of the present work.
* Anupvveiv, to dilate.
139
CHAPTER XII.
DISEASES OF THE TEETH AND FACE DEPENDENT UPON MORBID
CONDITIONS, EITHER GENERAL OR OF OTHER PARTS.
Neuralgia*—Certain nerves are the organs of sensation,
and like other parts of the body they are liable to disease.
When such is the case, unless the affection be of a kind to
lessen their sensibility, they become the seat of very severe
suffering, which is called neuralgia.
It may be asked whether all painful sensations are not seated
in the nerves? I answer that they are'; yet the distinction
between neuralgic and other pains, is that in the case of the
former the nerves are concerned primarily rather than as in-
struments; or in other words, they transmit intelligence of
their own suffering (for such is pain), not that which is only
shared by them with adjacent parts. We must not expect
philosophical definitions in medicine. The term neuralgia is
not precise, but it is sufficient for practical distinction.
The superficial nerves being by far the most sensitive, and
withal the most exposed to injury, are very much more fre-
quently affected with neuralgia than those which are deeply
seated. It is not certain whether the seat of the disease is in
the neurilemma or the nervous pulp. In fact the ultimate na-
ture of the nerves is too little known to permit us to hazard an
opinion upon this subject.
Neuralgia is a very acute pain, which generally commences
suddenly, and occupies a single spot, from which as the attack
progresses in violence, it radiates by pangs or flashes to the
surrounding nerves. The pain is generally sharp and darting
* Nsygov, a nerve, and &\yoc, pain.
140
NEURALGIA.
or burning, and may be distinguished, among other character-
istics, by this, that in its radiations it follows the threads of
the nerves without extending to the adjacent structures. There
is no heat, redness, or swelling, the absence of which is suffi-
cient to distinguish the disease from inflammation. The pain
after continuing for a longer or shorter time, rarely longer than
a few hours, abates, generally suddenly, and disappears, to re-
turn with equal rapidity if the proper provocation be re-
peated.
The proximate cause of neuralgia is unknown, as indeed is
its pathology.
There are two varieties of it, which may be termed pure and
intermittent.
By pure neuralgia we mean that variety which is not, so far
as we know, connected with or dependent upon any other affec-
tion, general or local.
This disease generally occurs in pale, thin, and feeble per-
sons, and seems to be a disease of debility. The pain for the
most part comes on suddenly, and gradually increases to great
intensity, when either through the efficacy of remedies, or in
obedience to unknown laws, which regulate the ebb and flow of
nervous influence, it abates rapidly and leaves the patient en-
tirely free from suffering. It does not return until some pro-
vocation be applied, when it will suddenly reappear, and will
not be appeased for several hours. Nor is it necessary that
any powerful irritant be applied in order to rouse the nerve to
renewed agony. Often the slightest cause will be sufficient;
the gentle movement or touch of the part, and especially the
slightest breath of cool air, will often be sufficient to renew the
terrible pain.
The intermittent neuralgia is a symptom, and often the only
one, of ague, or intermittent fever, as it is commonly called, but
which in this case must drop the latter word, as there is no
fever present. Of this disease I must speak at length pre-
sently.
Neuralgia of each kind may be located in various nerves.
The scope of this work makes it necessary for me to notice but
one speciality of the disease.
NEURALGIA.
141
NEURALGIA FACIEI OR FACIAL NEURALGIA.
To this subject I would particularly invite my readers, as it
is one which it is most important for all dentists to understand.
The reason will be seen in the sequel.
Neuralgia faciei is sometimes called tic douloureux. The
word tic means a sudden twitching or convulsive movement,
and as this is sometimes noticed in the faces of persons suffer-
ing with neuralgia of that part, the term tic douloureux or pain-
ful tic, was given to the affection.
Neuralgia faciei occurs in some of the branches of the fifth
pair of nerves, and the first and second branches are more com-
monly its seat. The pain is therefore more frequently suffered
over the orbit, in the cheek, mouth, lower jaw, and lower
teeth.
It will be perceived at once that the dentist must often be
called upon to discriminate between this disease and ordinary
toothache, and that, unless he be properly informed upon these
subjects, he may add to the terrible suffering of his too confi-
dent patient, the additional anguish of tooth extraction, and the
injury of losing sound and most valuable organs.
In most cases the neuralgia of the nerves of the jaw is at
first mistaken for toothache, and frequently ignorant dentists
have extracted tooth after tooth, and have at last relinquished
the patient to his aggravated suffering.
The diagnosis of this malady is not difficult. From all acute
inflammatory conditions it may be readily distinguished by the
absence of all the other symptoms of inflammation except pain,
and by the peculiar character and direction of the pain. The
fact that it subsides, disappears, and returns, will also serve to
distinguish it from the continued pain of inflammation.
From toothache depending upon exposed nerves, it may be
diagnosed by the evident centralizing of the pain in a certain
tooth, by the aggravation of it when the tooth in fault is struck,
and by the positive evidence of a cavity in it, with an exqui-
sitely sensitive pulp exposed.
142
NEURALGIA.
The treatment of pure neuralgia faciei is palliative and cura-
tive.
The palliative treatment consists in the use of such means as
are calculated to allay the pain of the paroxysm. The cura-
tive consists in the employment of such remedies as experience
has shown to be most useful in restoring the health of the pa-
tient. Of palliative means, warmth is one of the most impor-
tant. Cold aggravates the pain intensely, and will almost
always excite a paroxysm of pain in a patient subject to neu-
ralgia. Warm or even hot applications to the face are there-
fore important aids in allaying the suffering. Counter irri-
tants, such as mustard plasters, blisters, cupping, &c, are also
occasionally useful.
But our main reliance for the relief of neuralgic pain, is in
the use of narcotics* or anodynes,f and especially of opium,
which is vastly superior to all the rest.
It is necessary to give this medicine in full doses, if we would
benefit the patient under these circumstances. An adult should
take two grains of opium, or sixty drops of laudanum, and in
Borne severe cases, or when the patient has become accustomed
to the effects of the drug, this dose will require increase or
repetition.
Aconite, another powerful narcotic, which has a remarkable
quality of lessening sensibility, is now much used, both exter-
nally and internally, for the relief of neuralgic pain. It must
be used with great caution, as it is eminently a dangerous article.
The curative treatment of pure neuralgia will be modified
by circumstances. If the patient be plethoric, with a red face
and active pulse, even general and local bleeding may be pre-
mised. Such, however, is rarely the case, and when it is, we
have reason to believe that the disease is rather rheumatic than
neuralgic.
If the digestion be bad, which is often the case, correctives
must be directed to the organs involved. But in most cases
the restoration of healthy digestion will not be sufficient to
procure permanent relief.
* Narcotics, from v*gKoa>, I stupify. f Anodyne, from a, primitive, oSuvr<, pain.
NEURALGIA.
143
Generally, neuralgia is a disease of debility, and is found in
the cold, pale, and feeble, and in persons of evidently broken
health. In such cases the tonic medicines offer most advan-
tage, and of these none are found to be so useful as the salts
of iron.
There are several preparations of this medicine. The carbo-
nate, if properly prepared, is a good form of administering
iron, but by far the most valuable preparation is the sulphate.
This has also the advantage of being generally good as found
in the shops, and of being always readily procured. It is, I
think, much more certain and efficient than the other ferrugi-
nous preparations.
It may be given in doses of a grain two or three times a day,
and must be continued for several weeks. Under its use the
patient will generally improve in strength and colour, and with
the invigoration of the general system, the neuralgic affection
will frequently disappear. If this medicine should disagree
with the patient, or it should fail after a fair trial, recourse may
be had to other medicines of the tonic class, of which there are
many, mineral and vegetable.
It is a very common thing for authors and practitioners to
confound the pure and intermittent neuralgias, through want
of discriminating periodicity, from a tendency to return upon
slight provocation. Yet the distinction is plain and very im-
portant, for upon proper diagnosis of the form of the disorder
depends the rational treatment of it.
In pure neuralgia the nerve after the subsidence of a parox-
ysm is left in an exceedingly irritable state, so that it will be
excited to another by causes of irritation in themselves exceed-
ingly slight. But this return is merely accidental and occa-
sional, and of course, obeys no law of regular occurrence. In
some instances the exciting cause may be so trivial as to escape
notice, but after long and painful experience, the patient learns
to perceive potent agents for evil in things which previously
eluded observation altogether.
Periodicity, is the regular return of paroxysms in accord-
ance with a law of the disease and independently of provoca-
tion. It generally observes fixed periods of return and depar-
144
NEURALGIA.
ture, and when irregular as to the common law which governs
the type to which it belongs, it obeys some regulation of its
own, by which some well-defined proportion of paroxysm to
intermission is preserved. It does not follow then, that be-
cause the neuralgic pain abates, either of itself or under narco-
tics, and recurs in a few hours or days, that consequently it is
periodical, and must be treated by quinine.
Intermittent Neuralgia.—In order to understand the charac-
ter and treatment of this disease, it is necessary to have a cor-
rect knowledge of a particular class of fevers, which present
very curious phenomena.
These fevers belong to the class which we have designated as
idiopathic; and to the family of malarious or marsh fevers.
They are commonly known as agues, from the fact that each
paroxysm is preceded by a chill. Hence, also, they are known
popularly as chills and fevers.
The cause of these affections is always malaria; no other
agent or combination of circumstances produces them, and this
is so true that the fact of exposure to malaria is most impor-
tant in deciding upon the character of the disease in mooted
cases.
Malarious neuralgia always assumes the intermittent, never,
as far as I know, the remittent type. It may appear as a quo-
tidian, tertian, or quartan, or it may be irregular in its periods.
Its paroxysms are rarely preceded by chill, accompanied by
fever, or perceptibly finished by a sweating stage. Though
evidently depending upon the same cause as intermittent fever,
it has no phenomena in common with the former, except its
paroxysmal character, periodicity, and curability by certain
specific means.
In endeavouring to ascertain the cause of violent intermitting
pains in the face, it is all-important to learn whether the pa-
tient has previously been exposed to malarious influence. If it
shall appear in any instance that he has not been out of the
central part of a large city, known to be free, at least in such
part of it, from all emanations of a malarious kind, this fact is
abundant evidence that the patient has not intermittent neural-
NEURALGIA. 145
gia, however strong appearances may be to the contrary of this
opinion. On the other hand, if he lives in a marshy or ma-
larious country, or if he has visited such a locality during the
latter part of the preceding summer or early part of the fall,
and especially if the patient has had well-marked ague pre-
viously to the facial suffering, then the presumption will be
very strong in favour of the malarious origin of the disease.
Besides this historical kind of evidence, the attending cir-
cumstances will shed much light on the case. If there be no
apparent cause in the condition of the teeth of the affected jaw
for so much suffering, if no other disease can be detected in the
bones or soft parts, if the pain intermits perfectly and returns
periodically, or even if not with entire regularity, yet obviously
with some obedience to the law of type, and without provoca-
tion, all these circumstances taken together will leave little
doubt as to the nature of the malady.
Cure.—This distressing disease, which," if misunderstood, is
one of the severest and most difficult to alleviate or endure, is
when properly diagnosed a very manageable affection, and often
yields to the very first dose of well-directed medicine.
We have previously remarked that the pathological cause of
intermittent febrile phenomena is not known ; fortunately for
the world, experience has not waited for pathology, but has
pointed out the means of relief and the mode of applying it.
Certain medicines are known to be positive antidotes to in-
termittent malarious fevers of all kinds. These agents, if ex-
hibited freely during the intermission, rarely fail to prevent
the return of the paroxysm. Owing to the fact that most of
these medicines possess tonic or roborant qualities, it has been
supposed that they check intermittents, through this quality.
Hence, tonics are said to cure ague.
I am convinced, however, that the supposition which attri-
butes the prevention of intermittent paroxysms to the common
roborant quality of tonics is a mistake, and a mistake which
probably has led to unfortunate consequences in practice.
The medicines which possess in the greatest degree the anti-
13
146
NEURALGIA.
dotal power to intermittents, are not those which are the best
tonics; while the best of all roborant medicines have but little?
if any, power to check intermittent paroxysms.
Cinchona, or Peruvian bark, is by far the best anti-intermit-
tent remedy we have, yet as a pure tonic it certainly is vastly
inferior to iron, and hardly equal to some of the vegetable bit-
ters ; while arsenic, which, next to cinchona, is the most pow-
erful anti-paroxysmal medicine of which we have any know-
ledge, has no tonic property at all.
The anti-intermittent quality is therefore obscure, and the
medicines under consideration are prescribed for the cure of
these diseases, simply because experience has clearly proved
their preventing quality, and not because we perceive any ra-
tional relation between the physiological effect of the medicine
and the pathological condition to be removed.
In the treatment of intermittent neuralgia, we must rely upon
the medicines named, or, if these fail, upon others of the same
class. Generally, however, if cinchona and arsenic have failed,
we must look to some other quarter for an efficient remedy.
The best mode of administering cinchona, is in the form of
the sulphate of quinine, because the dose is very much smaller,
and sits better upon the stomach, and because, moreover, the
cinchona in bulk is uncertain in strength. The best form of
administering the quinine, is in solution, although pills of it
are often given.
In order to dissolve it perfectly in water, it is necessary to
add a few drops of sulphuric acid or elix. vit.
The dose varies very much with the circumstances of the
case. Thus if the intermission be long, a considerable time is
afforded between the paroxysms, for the introduction of the
antidote, and small doses, frequently given, are preferable ; if,
however, but little intermission is afforded, the dose of the me-
dicine must be proportionably greater.
The dose, also, must vary with the urgency of the case, and
the condition of the patient. If he has already suffered long,
has been much reduced, and has but little power of resistance
left, the dose should be very decided.
NEURALGIA.
147
There is also considerable difference of opinion among prac-
titioners upon this subject. Some prefer giving large single
doses, or at least rarely repeated; others, small doses, fre-
quently repeated.
Generally speaking, either mode will effect the desired re-
sult ; but as it is plain that we should give the least quantity
of medicine that will be sufficient, I am in the habit of pre-
scribing moderate doses of quinine, and have never found them
to fail except when the stomach refused to bear them ; in which
cases larger doses would have been yet more objectionable.
The prescription of quinine which I generally give, is a so-
lution of ten grains, dissolved in an ounce of water. A tea-
spoonful, containing a grain and a quarter of quinine, being
given as a dose to an adult.
This quantity is given every two hours, if there be an inter-
mission of considerable duration, or every hour if the time for
administering be short.
In very serious cases of intermittent, involving great danger
to the patient, and when the powers of life were low, I have
very much exceeded the quantity above named. Some practi-
tioners always give it in doses of ten or twenty grains; but
this quantity is unnecessary, and hardly safe; for though many
patients would bear it without inconvenience, some would suf-
fer from its action upon the brain.
The dose of quinine to young children, must always be very
small, as their nervous system is more excitable, and their brain
more easily disturbed, than is the case with adults.
Next to quinine, arsenic is our most certain antidote to in-
termittent affections. It is given in the form of arsenias po-
tassse, or Fowler's mineral solution, in which form it is
manageable, and in proper doses entirely safe. The viru-
lently poisonous character of arsenic, renders it improper to
attempt its administration in any but a diluted form.
There are many cases in which the arsenic appears to exer-
cise the anti-intermittent power quite as efficiently as cinchona,
and the small bulk of the dose, and the readiness with which
its flavour may be covered, make it far preferable for admi-
nistration to children.
148
NEURALGIA.
It may be given very advantageously in alternate doses with
quinine. After it has been persevered in for a long time, it is
apt to produce oedema, which readily subsides when the medi-
cine is withdrawn. The dose of Fowler's solution, to an adult,
is eight or ten drops, every one, two, or three hours, or alter-
nating every four hours with quinine. Sometimes it produces
nausea and irritation of the bowels. In such cases the dose
should be lessened. It not unfrequently produces oedematous
swelling of the face and hands, which disappears when the
medicine is suspended.
There are many other remedies, which are more or less effi-
cacious in the prevention of intermittent paroxysms, but it is
not necessary to mention them here.
The quinine and arsenic should be given only during the in-
termission ; though if this be very short, the administration of
remedies, and especially of the arsenic, may be recommenced
before the fever has entirely subsided.
In the treatment of intermittent neuralgias, as in other in-
termittent affections, the prevention of a paroxysm will be
more certain, if a full dose of opium be given an hour before
the expected return.
In cases of intermittent neuralgia, where the patient has
been exposed to malaria for successive years, and has suffered
much from the diseases attributed to this cause, the liver and
other abdominal viscera are generally deranged, and the neu-
ralgia cannot be permanently relieved until these visceral ob-
structions are overcome. The purgative preparations of
mercury are very useful in such cases.
Of course, no permanent cure can be expected, while the
patient shall continue to reside in the unhealthy location, as he
must, of necessity, be exposed to continual renewal of the dis-
ease. Unfortunately, the advice of medical men is rarely of
much avail in directing the choice of residence. This is deter-
mined, for the most part, by considerations entirely indepen-
dent of health; and there is great difficulty in persuading a
man that it is unsafe for him to live where it is most profitable
or pleasant, and that his own property is situated where no-
body ought to dwell.
149
CHAPTER XIII.
MORBID SECRETIONS OF THE MOUTH.
Six glands, the parotid, submaxillary, and sublingual of each
side, pour their secretions into the cavity of the mouth. The
mucous membrane, which lines the organ, also contains upon its
surface a great number of crypts, or follicles, which prepare
and pour mucus into the mouth. The secretions from the
glands and mucous membrane form saliva, which lubricates the
facial cavity, and in mastication is thoroughly mixed with the
food, the subsequent digestion of which it materially aids.
The mucous membrane of the mouth is continuous with that
which lines the pharynx, oesophagus, stomach, and intestines,
and sympathizes greatly with any diseased condition which
affects those organs. Hence the furred tongue in fever, the
red tongue of intestinal irritation, &c.
The fluids of the mouth are readily changed from their nor-
mal condition, when the digestive organs are feeble, and per-
form their functions badly. When such is the case, the secre-
tion of the stomach and its appendages are so changed as to
unfit them for the perfect performance of their work ; they be-
come, to a certain extent, foreign substances, and are capable of
exciting irritation, and also, by mixing with alimentary matters,
of converting them into deleterious agents. Generally the
change produced upon the fluids of the stomach, &c, under
such circumstances, renders them more acid.
Corresponding changes often take place in the fluids of the
mouth. They also become acid, and in such cases corrode the
dental structures, and cause great devastation of the teeth.
They are also liable to be produced in excess, and to be very
abundant in salts, which are collected, mixed with viscid mucus
13*
150 MORBID SECRETIONS OF THE MOUTH.
about the teeth, especially of the lower jaw, forming the seve-
ral varieties of tartar.
The saliva of healthy persons is only sufficient for comfort-
able lubrication of the mouth, and being passed into the sto-
mach as fast as it forms, it does not collect in the mouth, or
require to be frequently excreted. When healthy, it is light,
frothy, and but little viscid, without odour, floats upon, and
mingles readily with water. In this condition it is slightly
alkaline.
The saliva is acid in dyspepsia, and consequently caries is
apt to prey upon the teeth of persons suffering with indigestion.
Nor may the dentist expect to arrest the devastation, unless he
can remove the cause that is continually decomposing the bony
structures of the teeth.
That the saliva is acid in certain diseases, is abundantly
shown by Mr. Donne', of Paris,—who was so struck with the
changes in the chemical character of the fluids of the mouth, as
responding to disordered states of the stomach, that he sug-
gested the use of this fact, as the best means of deciding upon
doubtful cases of such disorders.
MM. Tiedemann and Gmelin had previously found the
saliva to be alkaline in man, and all other animals whose secre-
tions they had examined. Magendie, with his usual careless-
ness of facts, and boldness of theory, taught that the saliva was
sometimes strongly alkaline, sometimes neutral, and sometimes
acid: when the stomach is empty, the fluids of the mouth, ac-
cording to this writer, are acid; during mastication, alkaline;
the acidity disappearing sometimes at the presence of the first
mouthful. The latter part of this opinion, is of course, mere
nonsense.
According to M. Donne', who seems to have investigated this
matter with great carefulness, with the hope to find in it some
semeiological fact, which might lead to great practical results,
the saliva is constantly alkaline when the stomach is in a
healthy condition. This, then, he considers the normal or na-
tural quality of the fluids of the mouth, and all deviations from
it he considers unhealthy, and indicative of gastric disease.
MORBID SECRETIONS OF THE MOUTH. 151
M. Donne* declares that he has never found the saliva acid,
when the stomach has performed its functions well.
The only testing means used by this gentleman in his many
experiments upon the saliva, were slips of litmus paper. The
saliva, if acid, will redden the paper. For test of alkalescence
the paper should first be reddened by an acid and then sub-
jected to the action of the saliva.
M. Donne* narrates a number of cases of various forms of
disease, in all of which the stomach was deranged and the
saliva acid. We will quote a few of them.
A'young woman was admitted into the hospital of La Charite*,
labouring under severe bronchitis, attended with great tender-
ness of the abdomen, excessive irritability of the stomach,
diarrhoea, ardent thirst, &c. The saliva was strongly acid.
The disease assumed in its progress a marked typhoid charac-
ter, the tongue was parched and coated with a brown crust,
the abdomen was always very tender; delirium and coma su-
pervened, and the patient died on the tenth day after admis-
sion. The saliva was acid during the whole course of the
illness. Dissection showed extensive disease of the mucous
membrane of the stomach and intestines.
A young man was received into La Charite*, as a fever pa-
tient. All the symptoms of ataxic* fever soon developed them-
selves. The saliva during the first days was only slightly acid,
but later it became more strongly so; he died comatose. The
saliva remained acid to the end. Dissection showed a fifth
part of the mucous membrane of the stomach diseased.
A young man was admitted into the hospital as a fever pa-
tient. The symptoms were not serious : there was a yellow hue
of the skin; the epigastrium was rather tender on pressure,
there were, however, neither vomiting nor diarrhoea present;
the tongue was white, and the saliva was alkaline. During the
progress of the case the saliva became acid, continued to be so
for three days, then became neutral, and as the patient reco-
vered, gradually resumed its alkalinity.
In the case of a young man who exhibited the symptoms of
gastritis, namely, great tenderness of the epigastrium, thirst,
* Ataxic, nervous or typhoid.
152 MORBID SECRETIONS OF THE MOUTH.
tongue red and parched, &c, the saliva was found to be deci-
dedly acid. By repeated leechings of the abdomen, and the
use of demulcent and refrigerant drinks, the symptoms were
speedily relieved, and in a few days the saliva was quite neu-
tral, having no effect either on the simple litmus paper, or on
that which had been previously reddened by an acid. It soon
regained its alkalinity.
This patient had two relapses of his complaint, and on both
occasions the saliva was acid at first, and became neutral, and
then alkaline, as the symptoms disappeared.
From these and similar facts, M. Donne" inferred that acidity
of the saliva was always attendant upon gastric disorders of a
febrile character.
Professor Harris informs me that repeated experiments have
satisfied him that the acidity is confined to the mucous secre-
tions of the mouth; the secretions from the salivary glands
never reddening the litmus held to the mouth of their ducts.
Schill observes that " carious teeth indicate long-continued
irregularities of digestion. The teeth become very sensible
(sensitive) in many nervous diseases, and in consequence of the
presence of acid in the stomach. They are sometimes covered
with a whitish or gray mucus: this occurs chiefly in catarrhs,
and inflammations of the digestive and respiratory organs."*
When we remember the extreme susceptibility of the teeth
to be decomposed by the action of acids (see page 44), we may
well understand why caries is general, and hard to arrest.
Providence has made the saliva alkaline, in order to protect
the important organs it bathes, from injury by acid matters
taken into the mouth, and also to moderate the acidity of the
gastric fluids.
But under many morbid conditions, especially those most
common to artificial life, the protecting fluid itself becomes the
assailant, and the teeth, exposed at once to the attacks of acid
aliments and drinks, and to the more constant action of acidu-
lent saliva, soon yield to those corrosive agents.
* Schill's Semeiology.
DYSPEPSIA.
153
This acid state of the saliva may accompany a vitiated con-
dition of the fluids of the stomach, when no gastric suffering
has attracted the attention of the patient, and the existence of
any disorder in that organ has not been suspected. In such a
condition of things, however, the dentist can afford only tem-
porary relief, unless, perceiving the evil, he suggests such
remedies as may relieve the patient of the disorder upon which
the disease of the teeth depends.
The practitioner of dentistry should, therefore, be always
prepared to test the quality of a patient's saliva, as regards
acidity or alkalescence; and he should also be ready to
give such advice as may be necessary, in consequence of any
discoveries he may make.
When diseases of an acute character exist there will be no
demand for the services of the Dental Surgeon, unless his me-
chanical assistance be required. It is not necessary, there-
fore, for me to treat of such affections. But it often will hap-
pen, that a patient will apply for operations upon the mouth,
who may be affected with some subacute or chronic disease of
his stomach, for which he is not under medical treatment. If
the disorder be not very trifling, the dentist ought, in such
cases, always to advise application to a judicious physician.
But it will often happen, that the patient cannot conveniently
procure such attention, or that the dentist may not have such
confidence in the skill of the medical practitioner who could be
procured, as to authorize him, as a conscientious man, to de-
volve the case upon another. He must therefore give the ne-
cessary advice himself.
In calling, therefore, the attention of the dental student
to the consideration of dyspepsia,* as a common name for
chronic diseases of the stomach particularly characterized by
indigestion, I do not think I am in any degree leading my
readers away from the studies proper to them.
DYSPEPSIA.
Dyspepsia or indigestion, representing any derangement of
the function by which the aliment, after having been received
Dyspepsia—Ave, with difficulty, and risTT*, I digest.
154
DYSPEPSIA.
into the stomach, is converted into chyle, must necessarily pre-
sent a number of appearances, more or less characteristic of
the particular trouble they represent, and the degree of its
violence. It is therefore impossible to furnish a description
sufficiently accurate and comprehensive to cover all the condi-
tions of defective digestion which are included under the com-
mon name, dyspepsia. Several complicated organs are con-
cerned in the process of digestion. These are connected to-
gether by the natural dependence of reciprocal necessity, and
by powerful sympathies ; and any of them, when diseased, may
interrupt the functions of the others. To understand this sub-
ject well, it will therefore be necessary to have a complete
knowledge of all the morbid conditions of all the organs of di-
gestion, and of all the means likely, under any circumstances,
to be useful in restoring them to healthy action.
Of course, it is not my purpose to discuss this subject in all
its fulness of detail. It will be sufficient to impart such prac-
tical information, as may be easily remembered, and readily
made availing by the dental practitioner.
The symptoms of dyspepsia vary much with the duration
and nature of the affection, the constitution of the patient, his
mode of life, &c.
Generally the appetite is capricious, sometimes very feeble.
Heartburn, a sense of weight or distension in the stomach after
eating, incapacity of digesting certain substances, such as oily
matters, pastry, &c, costiveness, abdominal pains, weakness,
depression of spirits, &c, are most prominent.
From the extensive sympathies existing between the stomach
and brain, headache is a very common attendant upon dys-
pepsia. This is often very violent, and attended by nausea
and vomiting. The patient soon learns by experience that he
cannot take certain articles of food or drink with impunity, and
every deviation from the diet suitable for him, is attended by
renewal of symptoms and aggravated suffering.
Dyspepsia may be variously classified for the purpose of
description and treatment, but the simple, plain, and practical
distinction laid down by Dr. Eberle seems preferable for our
DYSPEPSIA.
355
purpose to any of the more accurate, yet more complicated ar-
rangements presented by other writers upon this subject.
According to Dr. Eberle, dyspepsia may depend upon two
distinct morbid conditions of the digestive organs, viz.: 1. On
functional debility of the stomach from deficient or vitiated se-
cretion of the gastric fluid, and muscular inactivity, indepen-
dent of vascular irritation or inflammation. 2dly. On defi-
cient or vitiated secretion of the gastric fluid with vascular ir-
ritation or chronic inflammation of the mucous membrane of
the stomach and duodenum, and morbidly increased peristaltic
action of these organs.
The characteristic symptoms of the former grade of indiges-
tion, are weak appetite; tongue covered with white fur; absence
of epigastric tenderness, except after a paroxysm of colic from
flatulent distension; costiveness; acid and fetid eructations;
absence of habitual tension and febrile irritations of the pulse;
and the ability of bearing lean and tender animal food better
than vegetable and farinaceous articles of diet.
The phenomena which characterize the second or inflamma-
tory grade of the disease, are tenderness to pressure of the epi-
gastrium, and particularly about the region of the pylorus and
duodenum; a red, chopped, granulated or glossy appearance of
the tongue; a firm, tense, small, and somewhat accelerated
pulse, with slight manifestations of febrile exacerbations to-
wards evening ; emaciation ; irregular action of the bowels, with
frequent attacks of mucous, bilious, or watery diarrhoea; violent
protracted pain in the lower part of the epigastrium during the
process of digestion; fulness about the edge of the false ribs
on the right side; an anxious and discontented expression of
countenance; and inability, without great suffering, to endure
animal food and stimulants. It appears that the irritative or
chronic inflammation of such cases is seated in the mucous
membrane of the pyloric extremity of the stomach, and of the
duodenum, connected usually with a congested state of the liver,
and often with foecal accumulations in the colon.*
* Eberle's Prac. of Medicine.
156
DYSPEPSIA.
The causes of dyspepsia are:
1st. Hereditary predisposition. Some families inherit from
their parents some peculiarities in the intimate organization of
the stomach that inevitably result in dyspepsia of protracted
and aggravated character, which makes its appearance about or
soon after puberty, and continues with more or less intermission
for years. This predisposition, however, is not of very frequent
occurrence.
2d. Mental and moral causes, such as exaggerated passions;
gloomy habits of thought; depression of spirits; over-anxiety
of mind.
The influence of the feelings over the stomach is well known.
Grief destroys the appetite, so do joy and ardent anticipation.
Fasting is a natural exponent of sorrow.
3d. Irregular living, especially the artificial life of the fash-
ionable world, which turns night into day and day into night;
robbing the body of sleep when most disposed to and best pre-
pared for it, and forcing the stomach, at unnatural hours, to eat
heartily of the most indigestible and irritating kinds of food, if
such ingesta can thus be called without impropriety.
4th. Excessive eating, and drinking, both of water and in-
toxicating drinks.
5th. Sedentary living without sufficient exercise.
6th. Unwholesome and insufficient diet. The use of pickles
in excess, especially by delicate females.
7th. Want of healthful and sufficiently laborious occupation.
It is owing to this, together with the adjuvant action of other
causes which we have mentioned, that so many of the young
women of our country are feeble, diseased, useless, and short-
lived.
8th. The abuse of medicines, especially those of a purgative
character. People have a wonderful disposition to be actively
purged. Millions of pills, containing irritating and powerful
cathartics, such as jalap, scammony, aloes, calomel, gamboge,
and croton oil, are annually sold to persons whose only disease
is too frequent purgation. The result often is chronic and in-
curable dyspepsia.
DYSPEPSIA.
157
9th. Eating too fast, so that the gastric juice does not mingle
with the food as rapidly as it is taken. Imperfect mastication,
generally because of carious teeth.
10th. Extensive disease of the teeth, occasioning frequent
and severe toothache, vitiating the secretions of the mouth,
and thus furnishing to the stomach saliva of a bad quality.
We have just seen that imperfect mastication may cause dys-
pepsia. Extensive caries interferes much with mastication.
Moreover, pain disturbs digestion, and frequent toothache
not only produces the common effects of pain, but from the
position of the suffering, interferes with in salivation and regu-
lar eating.
11th. To all these causes may be added everything which
tends to exhaust the vital energies, as every kind of excess
necessarily does.
The treatment of dyspepsia consists first, in removing, as far
as possible, all the causes of it. It will be useless to make an
attempt to cure unless the patient will make persevering and
self-denying efforts.
The patient must be contented to subsist upon such food as
he can readily digest. The diet should be as dry as possible,
for all drinks dilute the gastric juice, and when this is vitiated
or deficient, dilution renders it still less efficient.
As to the character of food, it is exceedingly difficult to lay
down a bill of fare which will suit all cases. The stomach, in
dyspepsia, is very capricious. Some patients will eat with im-
punity what others cannot digest at all. I once had a dys-
peptic female patient whose stomach revolted at the most
simple and digestible substances, yet retained and digested
comfortably, apple-pie and milk. Generally, the patient has
learned, by repeated experiments, what food agrees best with
him, and to this he should be confined.
In general, when the disease is simply one of debility with-
out gastric inflammation, animal food answers better than vege-
table. In selecting the particular kinds of animal food, we
should avoid young meats. Veal, lamb, and young pork are
very indigestible by weak stomachs. The mode of preparation
14
158
DYSPEPSIA.
also is important. Soups of all kinds are pernicious, as they
present the food to the stomach very much diluted and mixed
with oily matters. Oils in all forms must be avoided, hence
fried food, melted butter, gravies, most kinds of fish, &c, are
inadmissible. All acid fruits, and the whole family of nuts,
come under similar condemnation. Sugar is very apt to sour
upon the stomach, especially if it be dissolved in warm water,
as in the form of sweetened tea and coffee.
In these cases of debility of the stomach, a little brandy
taken at dinner is often very serviceable. The remedy, how-
ever, is a dangerous one, and no prospect of advantage from it
should induce us to advise it to one who has at some previous
time been intemperate in its use. It is better for a man to be
a dyspeptic than to be a sot; and reformed inebriates have
seldom a choice between abstinence and excess. Indeed, every
patient who may be advised by his physician to use ardent
spirits, should be faithfully warned against the danger of ac-
quiring an intemperate love of alcoholic excitement.
The medicinal treatment of such cases consists in the em-
ployment of such occasional purgatives as may be necessary to
procure regular alvine evacuations; in the proper use of mild
mercurial means to an extent sufficient to remove torpor of the
liver; in the administration of alkalies, if the patient be trou-
bled with an excess of acid; and finally, in the use of suitable
tonics. All purgative medicines are not by any means equally
well suited for the purpose we have indicated. Those of them
which are very harsh and irritating, and those which produce
watery and exhausting discharges, would be very injurious to
dyspeptics. Indeed, we have enumerated the abuse of these
cathartics among the common causes of the disease.
Rhubarb, from its aromatic and tonic quality, and its mild-
ness, is one of the best medicines for habitual use, under these
circumstances. Aloes is somewhat stimulating to the torpid
intestine, and generally acts very gently upon the lower
bowels. Blue pill mixed with either of the medicines above
named, will often prove very advantageous, and calomel given
occasionally in a decided dose will be very serviceable when
DYSPEPSIA.
159
the liver is indolent, and its secretions deficient either in quan-
tity or quality.
Of the vegetable tonics, the pure bitters, such as quassia
and gentian are the best. But the preparations of iron are
more likely to be decidedly advantageous.
We must not, however, expect a great deal from medicine
in the relief of dyspepsia. At most it is a secondary means
of cure. The removal of the causes and the rigid adherence
to regimen, will, in most cases, ultimately procure relief.
It is very important that the teeth of dyspeptic persons be
carefully examined, for often the cause, or at least a cause of
the disease may be found in the diseased and defective condi-
tion of these organs, and a speedy cure be obtained by their
removal.
As to the form of dyspepsia attended by sub-inflammatory
condition of the lining membrane of the stomach, its cure must
be devised upon the principles which govern in the treatment
of similar conditions elsewhere. Moderate antiphlogistic means
and mild farinaceous diet, will generally be attended with per-
manent relief, nevertheless the gastric surfaces, as the mucous
membranes elsewhere, after having been inflamed, remain sub-
sequently very susceptible to renewal of the disease, and the
patient when relieved must be very careful not to presume
upon the comfortable feeling of his stomach, and introduce into
it stimulating meats, condiments, or liquors.
All dyspeptic persons should be advised to eat slowly and
chew their food well. If the absence or bad condition of the
teeth interfere with mastication, as they will often be found to
do, the skill of the dentist must supply the deficiency, or repair
the injury of those important organs.
Dyspepsia or indigestion expresses only the mal-perform-
ance of an act which is the result of the combined effects of
various organs. Therefore, as failure of function in any one
will interrupt the healthy completion of the great common
purpose, dyspepsia must be a general term comprising several
disorders. Being immediately connected with the digesting
apparatus, and in fact forming an important part of that great
160 SYPHILIS.—RICKETS.—MEASLES.
and complicated system by which aliment is received and pre-
pared for assimilation, the dental apparatus can hardly escape
injury when the other organs of this system are involved in
suffering. Indeed, the mucous membrane, which in the sto-
mach and intestine is the seat of the digesting process, and in
the mouth is continually pouring out important fluids from its
surface and glands, is so intimately connected with the dental
arch as to unite it in close sympathy with the more important
organs of alimentation. A healthy state of the fluids of the
mouth is necessary for the safety of the teeth, and the secre-
tions of the mouth will not be healthy when the functions of
the intestinal canal membrane are disturbed. It is a hopeless
task to save the teeth from caries while the patient suffers
unmitigated dyspepsia.
Syphilis, also, by vitiating the general glandular and secret-
ing systems, may produce a state of the buccal fluids very
inimical to the structure of the teeth. This will only be the
case in those secondary or constitutional forms of lues of which
I have already written sufficiently when treating of ulcers.
Rickets very much delays dentition, and so impairs the struc-
ture of the teeth that when protruded they are very liable to
decay.
The enamel of teeth formed under the influence of this con-
stitutional vice, is often craggy and worm-eaten in appearance,
though sufficiently hard. The fang during the progress of the
disease has been found somewhat softer than natural.
The exanthematous febrile affections, which commonly occur
in childhood, interrupt the regular deposit of bony matter in
the growing teeth, and cause permanent defects, which are
sometimes discernible in the external appearance of the organs.
Measles, for instance, often leaves evidences of its visit upon
the enamel of the teeth, in the pitted appearance which they
present.
As fever of all kinds is always attended with vitiation of the
secretions of the mouth, we may readily perceive how any pro-
tracted disease of this kind may injure the teeth.
All serious diseases of the antrum must involve the dental
MERCURIAL SALIVATION.
161
arch. Inflammation may be propagated, nutrition impeded,
caries communicated, and the arch actually broken up in the
course of those often fatal diseases which have their seat in
this geographically important cavity.
The surgeon dentist should be well acquainted with the va-
rious disorders and morbid growths which maybe developed in
the antrum. Early detection is often necessary to cure, and
none is so likely to have the opportunity of early discovering
the hidden mischief, as the dentist. The first symptoms of the
disorder are often felt in the teeth, and unless the dentist who
may be consulted shall be able to point out the true nature of
the evil, delay may be occasioned, and delay may be fatal.
Mercurial salivation (ptyalism) has often caused extensive
devastation in the dental arch. Mercury, like all other of
heaven's boons, has been shamefully abused, and serious and
even fatal injuries have resulted from the reckless administra-
tion of this most useful medicine. Unhappily, the occurrence
of such calamitous accidents has induced such general and
unreasonable prejudice against the use of mercurial medicines,
that vastly more evil is now suffered by society from the im-
properly withholding, than injudiciously using them. The
feeling against mercury has been the common hobby-horse of
charlatans and unprincipled doctors, and it needs no little
firmness to enable a physician to deal honestly with his patient
in the use of this drug. From the fact that salivation is inju-
rious to the teeth, dentists have been led to comment severely
on the use of calomel, and thus have done much to spread
abroad terrible notions of the evils inseparable from the em-
ployment of this and other mercurial preparations. Some of
these censorious gentlemen have seen evidences of mercurial
devastation in every form of disorder and variety of decay, and
to them calomel is the one thing to be avoided by all who live
to eat, or eat to live.
Doubtless salivation, especially if profuse, must be destruc-
tive to the teeth, and fortunately it is at length understood that
ptyalism is not, by any means, necessary to the attainment of
all the benefit of mercury. Salivation is an accident always
14*
162
SYPHILIS.—SCROFULA.
to be dreaded, and as far as possible to be avoided. Yet even
at the risk of it, mercurial remedies are indispensable, inas-
inuch as life is more important than teeth.
There is no reason to believe that the use of mercury is in-
jurious to the teeth, when salivation is not induced; yet caries
of these organs is very often attributed to it. People are ex-
ceedingly apt to confound the post hoc with the propter hoc,*
and dentists are as liable as other men to fall into the error.
A patient who has escaped a severe attack of fever, finds his
teeth rapidly decaying; in great alarm he applies to the den-
tist. The latter glances at the mouth, and with a look of
boding sagacity, inquires if the patient has not been taking
calomel. The patient replies that he has been taking more or
less of it, and then the man of science, as he is presumed to
be, launches forth for the hundredth time into a bitter diatribe
against mercury as the origin of all the evil.
And why might not the lamented caries be as justly charged
upon the tartar emetic or magnesia, which the patient may
have taken simultaneously with the calomel ? or why does not
the dentist seek for the all-sufficient cause of devastation in the
fact that the teeth in question had been bathed in the acid saliva
of a fevered mouth for weeks consecutively ? Why transfer the
blame to the remedy by which the fever was subdued, and cast
implied and serious censure upon the physician, whose judicious
employment of the vilified drug has, perhaps, saved the pa-
tient's life?
Until I have other information than I now possess, I cannot
believe that the proper employment of mercury is injurious;
and while I reprobate its abuse, and would think the physician
unpardonable who would be careless or reckless in the use of
a medicine capable of doing so much harm, I cannot but regard
that man as the author of greater evil, who by silly declamation
against an important remedy, fetters the practitioner in his con-
test with the most formidable diseases.
Scrofula, to which I have already called attention, interferes
with assimilation, and consequently with the completeness of
* To consider whatever occurs subsequently, to be consequent upon what has
been observed to precede it.
PREGNANCY.
163
nutrition and growth. Being often inherited and developing
its mischievous nature very early in life, it influences the teeth
during the important process of formation, and by preventing
their perfect organization renders them feeble to resist the in-
fluence of morbific causes.
This evil consequence is, however, generally counterbalanced
by the thinness and deficiency of mucous and salivary fluid,
and the difficulty with which the fluids of the mouth of stru-
mous persons become acid.
Pregnancy is supposed to be fraught with danger to the
teeth. Indeed, this opinion has been sufficiently general to
have become condensed into the adage—" for every child a
tooth"—meaning that the mother may expect to lose a tooth
as the result of each pregnancy.
Pregnancy is not disease : it is a physiological condition, and
we cannot believe that it is per se, and naturally, a cause of
disease anywhere, especially in organs distant and not imme-
diately dependent upon the uterus. But in pregnancy, the ner-
vous system is irritable, and the sympathies of the body are in
more lively play. The vascular action is also greater, and the
blood is more highly charged with fibrine. It therefore hap-
pens that there is more liability to pain then than at other
times, and less patience to endure it. Consequently, if the
woman has any diseased teeth, previously neglected, they will
be apt to ache, and when aching, the pain to her irritable
nerves is intolerable. Besides this, there is occasionally a
sympathetic toothache, which, though it cannot be directly
traced to the uterus, appears to depend upon its gravid condition,
and not upon disease of the tooth itself. The dentist should
be aware of this; it is readily alleviated by an anodyne.
It also happens very frequently that the artificial life and the
absurd habits of our young females, induce a constitution but
little capable of sustaining childbearing, although to the wo-
man of good health and vigorous frame, parturition is fraught
with no disadvantage to health or shortening of life. These
pallid, soft, and delicate girls, when become pregnant, begin
rapidly to break down, and the hurried caries which destroys
164
PREGNANCY.
their teeth is but the first manifestation of the premature decay
of the whole body. This is a subject upon which I could and
would willingly write much, but it would be useless.
Fashion, custom, inclination, will bear sway over reason and
moral obligation ; years of comfort will be sacrificed for hours
of mirth ; showy dress and ball-room vigils will continue to
feed the insatiable tomb with the loveliest of our race.
165
CHAPTER XIV.
MORBID EFFECTS OF CONDITIONS OF THE TEETH AND GUMS,
UPON THE GENERAL SYSTEM.
Having considered the several forms of disease in other
parts, or of the general system, which morbidly affect the teeth,
I proceed to inquire what effect these latter organs, in their
varied states, whether physiological or pathological, may in-
duce in other parts, and what changes they may cause in the
more general phenomena of vital action.
As the body is a unit, knit by the closest bonds, pervaded
by one system of blood-vessels and nerves, directed by one in-
telligence, and kept in a continual relation of function and
expression by an all-pervading law of reciprocal reaction and
sympathy; as diseases of other parts, and those which in dis-
tinction to well-defined and limited affections we call general,
are capable of affecting the teeth, it might be apparent, if we
had no particular facts in evidence, that the morbid condition
of the teeth may produce corresponding evils in other parts,
and may even involve the whole system in troubled and morbid
action.
It might also be evident that severe and long-continued pain,
located in the immediate vicinity of the brain, and in parts
little accessible to soothing appliances, cannot be less danger-
ous to health than pain in other organs situated at greater
distance from the nervous centres and more easy of access.
It might also be perceived that sensitive organs, in imme-
diate contact with the great lining membrane of the thoracic
and abdominal cavities, and intimately connected with it by
function, cannot be less capable of propagating disorder to it,
166 MORBID EFFECTS OF THE TEETH, ETC.
than parts located far from it, and having no immediate rela-
tion to it.
Yet natural as these inferences seem to be, they have been,
until lately, almost entirely overlooked, and even now the
medical profession are by no means awake to the facts and the
importance of the morbid relation actually existing between
the teeth and other parts.
It is exceedingly uncommon to hear that a physician, in
searching for obscure causes of protracted ill-health, has paid
any attention to the state of the teeth, though often their ter-
ribly diseased condition cannot escape involuntary recognition
by more of his senses than one. The matter is never alluded
to in lectures delivered to medical classes, and, in fact, is
hardly recognised at all as a subject for pathological or hy-
gienic consideration.
Within a few years, however, several writers upon dentistry
have urged the medical profession to turn their attention to
the diseased conditions of the teeth in connexion with other
disorders, and they have supported their appeals with such an
array of well-observed and clearly narrated cases as must im-
press the mind of all reflecting readers with the fact of the
morbid relations in question.
Unfortunately, these writings are not read by the general
practitioner, and it is to be feared that a long time must elapse
before physicians become properly informed upon this subject.
In the mean time it is the more important that every dentist
be able to perceive these sympathetic conditions, and call the
attention of the patient and physician to them.
The teeth, while in a physiological condition, are capable of
inducing great local distress, and constitutional disorder even
of a fatal kind. During their evolution and passage through
the gum, the pressure even of a sound tooth upon a sound
gum may be attended by irregular phenomena of the most
alarming description : it would be strange indeed if the action
of a diseased tooth upon the diseased gum should be attended
with no evil consequences.
That the process of dentition happens in infancy, causes
MORBID EFFECTS OF THE TEETH, ETC. 167
certainly a modification of effect in accordance with the pecu-
liarities of the infantile constitution ; but, the action of morbid
teeth upon the less mobile nerves of the adult may be as cer-
tain, though less rapid and ostentatious.
The question, however, like other medical questions, is one
of fact, not of inference. And I would leave the truth to be
deduced from a fair examination of subjected cases.
168
CHAPTER XV.
MORBID EFFECTS OF FIRST DENTITION.
Dentition is not, in itself, a morbid process, but a healthy
physiological act. It would be strange, therefore, if it neces-
sarily involved disorder of function and serious consequences
to the subject.
The truth is, that when naturally performed, under the favour-
able circumstances of sound constitution and good health on
the part of the child, the cutting of the teeth is effected with-
out pain or any collateral evil, these organs appearing in their
place without any previous unpleasant sensations to attract at-
tention to their progress through the gum. It is thus that the
domestic animals perform dentition ; and many children com-
plete theirs with no more perceptible inconvenience.
More generally, however, the child experiences, at least with
some of its teeth, more or less suffering of a local kind, and in
many cases the pain is attended by sympathetic irritation of a
grave and not unfrequently of a fatal character.
It is important to know that, however large may be the pro-
portion of painful, in comparison with natural dentitions, the
former are nevertheless to be regarded as accidental modifica-
tions of the regular and healthy process. Starting with this
knowledge, we will, of course, be led to inquire into the causes,
so general and so potent, which effect the changes in question,
and to devise means and management most proper for escaping
or annulling them.
Does painful dentition depend upon the pressure exercised
by the tooth upon the gums ?
If it did, all children would experience suffering and more
or less collateral morbid effects. For, although the difference
MORBID EFFECTS OF FIRST DENTITION. 169
of natural sensibility in different children would occasion dif-
ferences in the degree of trouble arising from this cause, yet
this comparative sensitiveness, being merely natural and
healthy, could not account for the extreme contrasts exhibited
between easy and simple, and complicated and dangerous den-
tition.
Nor is it at all likely that extreme sensibility would escape
morbid manifestation during the rapid evolution of infantile
life, until awakened from its passivity by the evolution of or-
gans themselves not sensitive (in their healthy state), passing
through structures not by any means remarkable for this
quality, and performing their eruption so gradually as to make
no sudden demands upon the nervous and vascular system, so
as to disturb the equilibrium of nervous and vascular distri-
bution.
Nor is it consistent with the facts observed in the history of
dentition that the cause of the suffering is the pressure of the
fangs of the teeth upon the periosteum of the alveoli. Those
who adopt this explanation have not considered that the shoot-
ing of the teeth, characterized by the enlargement of the alve-
olar walls, and the distension of the gums occasioned by the
formation of the body or of the crown of the teeth, is an epoch
often more dangerous than that of the organization of the
roots; which besides would do much more harm in compress-
ing and binding the soft and pulpy part of the tooth than
the serous membrane, which performs the functions of a peri-
osteum and lines the interior of the gum and proper cavity
of the teeth.*
The truth seems to be, that a great number of children are
born into the world so feebly or disproportionably constituted
that they are not capable of maturing. Most of these neces-
sarily perish during childhood, by some of the many forms of
disease common to that period. Many others, though born
with sufficient vigour, are reduced by bad diet and defective
management to a condition which readily yields to irregular or
morbid agents.
* Baumes on First Dentition.
15
170 MORBID EFFECTS OF FIRST DENTITION.
A child may be very feebly organized, and yet may appear
for a time plump and healthy, but when the vital powers come
to be tested either by accidental or physiological demands upon
its energies, the natural feebleness is ascertained by the de-
velopment of various morbid phenomena, indicating the parti-
cular location and kind of disability.
Again, children born healthy are often subjected to privations
or to injudicious diet and regimen which rapidly alter their
fluids and tissues, and lay the foundation for serious accidents.
Dentition demands a certain amount of constitutional energy
to accomplish it. The rapid development of any organ does
this. The changes which take place at puberty, and the evil
consequences, to the feeble, of the developments then com-
pleted, are illustrative of this fact. This demand is the se-
verest test of functional and organic completeness in the child,
and many will not bear it.
The development of the teeth determines an unusual flow of
blood to the head. This happens at a time when the brain is
proportionately large, and undergoing rapid evolution. Inde-
pendently of dentition, this period of life is attended by a
strong tendency to cerebral affections, and to pulmonary and
abdominal complications. The nervous and vascular systems
are, in the child of this age, remarkably active. The several
organs have to perform not only their functions and the pre-
servation of their entireness, but also rapid growth. Animal
life is therefore exalted with all its qualities. Among these
are sensibility and sympathy; the capacity to be impressed
and to propagate impression. Hence a slight cause may pro-
duce great local or constitutional effect, and disease of any
kind may induce sympathetic or constitutional disorder appa-
rently much out of proportion to its own intensity or import-
ance.
In the older child the relation of secondary to primary affec-
tions is more equable, and the second dentition is performed
without the occurrence of those serious constitutional affections
which so frequently attend the first.
Any unnatural obstacle or impediment to the eruption of the
MORBID EFFECTS OF FIRST DENTITION. 171
first teeth, will tend very materially to augment the probability
of morbid consequences. A disproportion between the teeth
and the jaw, or the unusual hardness and impenetrability of
the gum, are of this nature, and sometimes provoke local and
sympathetic disturbance.
The appearance of several teeth at once may make a larger
demand upon the system than it can readily meet, and hence
cause embarrassment, or if- their dentition be painful, the
amount of suffering may be too great for the sensitive and
sympathetic nature of the child, especially if it be constitu-
tionally feeble.
The natural symptoms of healthy dentition, are not remarka-
ble. An increased flow of saliva is usually noticed, though this
perhaps, is not as certainly the consequence of dentition as is
generally supposed. The mouth of infants is generally well
supplied with fluids, which, there being no teeth to prevent it,
will escape more or less from the mouth. The child also car-
ries its fingers to the mouth more frequently, and seems pleased
to press a resisting substance between its gums. Gentle fric-
tion of the gum also seems to be agreeable. The gums are
noticed to be hot, and the child takes the breast frequently.
The bowels are generally looser than usual, and the child ordi-
narily manifests some little restlessness and sleeps less pro-
foundly than previously.
These symptoms precede the eruption of the teeth by several
weeks, and seem to depend upon the rapid ossification and
growth of the teeth. After a few days, they often subside, to
be renewed when the teeth are pressing forward and about to
penetrate the gum.
It is common to alleviate these little inconveniences, by giv-
ing the child a coral, crust of bread, or other hard substance,
to press upon with its gums.
Nature is generally a very correct guide as to her own wants,
and as it is natural thus to allay the sensation of the gums at
this period, it must be right. A priori, however, we might have
feared that the continual pressure would condense and harden
the gum, and make it more impenetrable.
172 MORBID EFFECTS OF FIRST DENTITION.
Inasmuch as nature has not indicated the precise degree of
assistance proper for the purpose, it would be well to use sub-
strnces which do not possess this quality in an unnecessary
degree.
The French use a stick of marsh mallows, or liquorice root
dipped in honey, or a sweetened decoction of barley—the Ger-
mans, a small bag filled with sugar and spices. It is doubtful,
however, whether the success of this invention for quieting the
child may not induce the nurse or mother to neglect it, and
withhold the breast which it would take eagerly and frequently.
Nothing so soothes the infant as the frequent lubrication of
the mouth with the mother's milk, and where nothing in the
state of the mother's health or the condition of her breast for-
bids this indulgence, it is cruel and unnatural to deny it. It
may be, too, that the constant use of sweet and condimental
substances would disorder the stomach of the child ; an accident
to be studiously avoided during teething.
The bowels are generally loose during dentition, and even
when the purging is very frequent we must not consider it ex-
cessive while the child nurses freely, and especially while it
does not emaciate.
Costiveness is much more to be feared under such circum-
stances than purging. It is unnatural, and unless overcome
by proper treatment will result in irritations, local, and per-
haps sympathetic, which may not easily be remedied.
It is always important to restrict a teething child to proper
aliment. The bowels may very readily be irritated, and the
system is so liable to violent excitement at this time that all
irritation should be dreaded, especially irritation of the abdo-
men, for this is the most important part of a child, being the
centre of the very active processes of nutrition and augmenta-
tion everywhere going on. This is no time to try experiments
upon the stomach. Nutritious and easily digested food, and
that which is free from acidity, is to be given, and in such
quantities as the child is willing to take. Unless, indeed, it
has been habitually over-crammed and taught to eat an unna-
tural quantity.
MORBID EFFECTS OF FIRST DENTITION. 173
When the mother has milk, this is, of course, the best food
for the infant, but it will generally happen that the child will
require more nourishment than it can obtain from this source.
In selecting food for it, regard must be had to the condition
of the child. If delicate and thin, animal food will often be
indispensable. Beef, mutton, and occasionally a little salt
meat may be given with advantage. Young meats are gelati-
nous and less digestible, and should be avoided.
If the child, on the contrary, be too fat, if it has been over-
crammed with milk until it presents an appearance similar to
that of the show calves, stuffed and swollen for exhibition at a
fair, it should have diet of a far less nutritious kind. Farina-
ceous articles well diluted with water will be more suitable.
Milk, if fresh and sweet, generally agrees well with children;
but the milk of the cow is more nutritious than that of the mo-
ther, and should be diluted. Cream freely diluted with water
generally agrees better than milk.
It is common among the rich to thicken the child's milk with
arrow-root, tous les mois, or other concentrated farinaceous
food. The consequence generally is that the parents are en-
abled to rejoice over fat babies, and soon to sorrow over sick
ones. Instead of making the milk of the cow more nutritious,
it should be rendered less so than natural. It is rarely that
articles of this kind, even when they are what they are repre-
sented to be, are fit for children. But this is rarely the case.
Most of the arrow-root, &c, of the shops is potato starch.*
Some parents are in the habit of refusing children flesh of
all kinds, and indulging them freely in milk and potatoes. The
result generally is to fatten the children excessively, without
providing them with a proportionate amount of muscular fibre.
The child should have as much exercise in the open air as
the circumstances of the parent will admit. All kinds of ex-
ercise seem to do it good. It is seldom fatigued even by very
long rides, and rarely fails to acknowledge, in its altered ap-
* If the milk require the addition of any farinaceous substance, I prefer
rice flour.
15*
174 MORBID EFFECTS OF FIRST DENTITION.
pearance, the good effect of even an hour's exercise in the
fields.
Frequent bathing is of great use to children of all ages, but
even this means requires to be administered with judgment.
The cold bath is a powerful remedy, and cannot be used with
equal safety and advantage upon all children. Those who are
ruddy and robust will bear it well; while others who are pallid
and of cold skins may suffer serious injury from it. If after
the bath the child shivers for a considerable time, and remains
cool, and if it contracts a dread of the water, the temperature
should be elevated to meet the condition of its sensibilities.
Of course, in cold weather, the water should always be
warmed in proportion to the necessities of the case.
When dentition becomes complicated with morbid conditions,
directly or indirectly connected with it, the management of it
requires far more care and skill. The local symptoms are to
be allayed, serious symptomatic affections are to be relieved,
and the strength of the child to be supported through a tedious
process, in which the powers of the system are taxed to their
utmost capacity. A single mistake here will often prove fatal,
and it is easy under such circumstances to make mistakes.
The diseases of dentition are local, those which affect the
teeth, gums and mouth—or sympathetic, those which manifest
themselves in other organs.
The local diseases of dentition are, first, inflammation of the
gums. These are swollen, hot, redder than common and very
sensitive. The child will not permit them to be touched, and
incessantly craves the breast, or cold liquids. The condition
of the gum is almost always attended with more or less fever
and irritation of the intestinal canal. There is also an evident
determination of blood to the head. The face is flushed, the
head hot, the eyes red and watery, the flow of saliva profuse,
and sometimes the salivary glands are swollen and tender.
Aphthous exudations are often noticed, and it is said, though
this must be very uncommon, that abscesses sometimes occur
at the root of the tongue.
The fever is generally ardent, and increases and subsides
MORBID EFFECTS OF FIRST DENTITION. 175
with remarkable suddenness. The thirst attending it is very
great, and a strong tendency to irregular muscular contrac-
tions or convulsion is generally observed. The sleep of
the child is uneasy and frequently interrupted. It often
starts and screams, and when awake is usually fretful and
stupid by turns.
These symptoms are often very suddenly and effectually
allayed by freely incising the gum and capsule down to the
tooth or teeth, and liberating them from their investments.
This expedient is generally resorted to whenever the gum is
elevated and distended; sometimes, however, it is of no avail,
either because it is not effectually done, or because the symp-
toms to be relieved do not in fact depend upon the mere me-
chanical pressure.
The French writers make a formidable matter of this little
operation; and indeed, as practised by some of them, it is no
trifle, for they make a crucial incision upon the tooth and dis-
sect up the flaps of the gum, or else, with a bistoury, completely
cut off the top of it.
There is no necessity for such painful and protracted opera-
tions ; a free incision, until the lancet grates upon the tooth,
is all that is necessary for the incisors; and when the double
teeth are in question, a cross incision may be added.
The lancet should be carried down to the tooth, or else no
good will be done.
The bleeding which results is trifling and salutary; tending
to relieve the inflamed and swollen gum.
It has been objected to this operation, that unless the tooth
should be very near the surface, the incision would heal and
the cicatrix would offer more resistance than the original struc-
ture of the gum.
The fact is, however, that if such a cicatrix should occur,
and the symptoms return, it would be very easy to divide the
gum again; moreover, a cicatrix is always a feeble tissue,
which is far less resistant than the natural part whose loss it
represents.
Conjointly with the use of the gum-lancet, attention must be
paid to the bowels of the child. If it be costive, the torpor of
176 MORBID EFFECTS OF FIRST DENTITION.
the bowels must be relieved by the administration of proper
purgatives. Of these, calomel is for several reasons by far the
most useful, and is equally safe, for occasional administration,
with the most innocent of the class.
In these conditions the abdominal secretions are always
vicious, and we have no means so powerful as calomel for the
restoration of impeded or altered secerning function. To a
child of a year old, four, and to one of two years, eight grains
should be given at a single dose; and, if necessary, its cathartic
effect insured by the subsequent administration of castor oil or
magnesia.
Small doses of calomel are ineffectual, and, if frequently
repeated, are dangerous.
Should the bowels be too loose, and the passages thin and
white, the same medicine, similarly administered, or joined to a
little rhubarb or chalk, will generally check the diarrhoea.
In these cases, as where constipation exists, the fault seems
to be in the defective or altered secretion of the liver, which
calomel restores.
The fever will generally abate in proportion as the bowels
are put right. Should it continue ardent, however, and
especially if the cerebral plethora should increase or remain
unabated, a few leeches behind the ears will often prove ser-
viceable.
The cold bath, or sponging with cold water, will also allay
the fever and restlessness. The warm bath may sometimes be
preferable, and will be equally serviceable. Above all, country
air, and exercise out of doors, are the best means of combating
the disorders of dentition.
"Very different," says Mr. Jay,* "was the practice of our
forefathers, who, misled by the fanciful doctrine of signatures,
were in the habit of applying to the gums specific ointments
made of the brains of hares, or of the combs of cocks, which
as old Hartman would have us believe, ' cause the production
of teeth without difficulty, and free from accidents.'"
* Cyclop, of Prac. Med., Art. Dentition.
MORBID EFFECTS OF FIRST DENTITION. 177
It is questionable whether we have much right to laugh at
the metaphysical medicine of our ancestors: certainly our
posterity will find abundant occasion to ridicule our own.
We have yet to learn that any ancient theory or practice of
cure was more utterly absurd than Homoeopathy or the cold
water treatment. The doctrine of signatures is quite as philo-
sophical as Mesmerism, and the combs of cocks and brains of
hares are certainly as efficacious as Hahnemann's dilutions.
Among the local diseases of complicated dentition we must
enumerate caries of the tooth and abscess of the gum. When
from any cause, local or constitutional, caries of the tooth takes
place, it engenders inflammation of the periosteum, which soon
extends to the gum. This becomes painful, swollen, and ten-
der ; an effusion of fluid takes place between the fang and its
investing membrane, which thus becomes a sort of cyst or sac ;
finally pus is formed, an abscess appears, and the matter is
voided, either by a spontaneous or artificial opening.
The continuance of the carious tooth as an irritant will, of
course, prevent the proper healing of the ulcer, and the fungus,
so common in carious ulcers, will shoot up.
" In other cases the pressure of the abscess having produced
absorption of a portion of the alveolar process at its lower part,
it effuses its contents through the aperture thus formed, and
the matter insinuates itself along the surface of the lower jaw,
and forms an internal tumour near its base. This tumour is
at first hard and discoloured, but in the course of time it ulti-
mately inflames, and bursting or being opened, leaves a pucker-
ing in the integument, which, adhering to the bone, remains a
permanent blemish. When the diseased tooth, which is the
cause of the mischief, is removed before external redness
takes place, the tumour ultimately retires, and leaves the skin
unblemished."*
A spongy condition of the gums, in which they bleed freely
at the slightest touch, is sometimes observed in dentition.
Ulceration sometimes attends this condition. Weakened
* Coleys' Diseases of Children.
178 MORBID EFFECTS OF FIRST DENTITION.
digestion, and consequent imperfect preparation of chyle and
insufficient nutrition, may be considered the cause of this
affection.
Treatment.—Inflammation of the gum may be very much
abated by the application of a leech to it. In order to do this
with facility, a thread may be passed by a needle through the
extremity of the animal, and it then may be enclosed in a glass
tube. When the inflammation has subsided, the carious tooth
should be extracted.
Should an abscess occur from a similar cause, extraction
must also be resorted to.
Sponginess and ulceration of the gums, depending upon a
depraved digestion, must be met by such means as will restore
the alimentary canal to the regular and complete performance
of its functions.
Mild astringent lotions, such as myrrhine and aluminous
solutions, may be simultaneously employed.
179
CHAPTER XVI.
SYMPATHETIC DISEASES OF DENTITION.
A vast number of diseases have been described by different
authors, as the results of dentition. The recapitulation of
them would show a crowded list of formidable complaints, from
which it would seem that no child could escape. Dentition
appears in this exhibition as the Pandora's box from which all
manner of evils are successively let loose to worry and destroy
the devoted infant. Without pretending to enumerate the
forms of disorder attributed to teething, I offer the following
as a specimen: Vomiting, anorexia, diarrhoea, cholera, costive-
ness, increased or diminished urine, urethral or vaginal dis-
charge, with painful micturition; dry cough, dyspnoea, catarrh,
pneumonia, spasmodic affections of the face, limbs, glottis, &c,
insomnia, agitation, and fright on awaking; epilepsy, somno-
lence, stertor, coma, transient palsy of the arms and legs,
ophthalmia, hydrocephalus, marasmus, eruptions, especially
about the head and face, swelling of the hands and feet, en-
largement of the cervical, femoral, and mesenteric glands, and
other scrofulous affections.
Although any of these disorders may, and all of them do
occasionally occur during dentition, it does not by any means
follow that teething is the cause of them. The mucous mem-
branes of children are very liable to inflammatory affections,
and their brain is very liable to sympathize with these and
other disorders. Moreover, the process of dentition would
certainly afford an awkward complication to any of these forms
of disorder occurring simultaneously with it, or provoked by
accident during the progress of teething. No doubt, also, den-
tition itself, especially if obstructed, or otherwise irregular or
180 SYMPATHETIC DISEASES OF DENTITION.
morbid, may become the exciting cause of any disorder to
which the child may at the time happen to be most prone.
Should inflammatory affections of mucous membranes occur
during dentition, the treatment should be regulated by the na-
ture of the particular case, and the judgment of the physician.
It would always be well, however, to examine the gums care-
fully, and to incise them freely if they be at all swollen. This
can do no harm, and sometimes will result very happily.
Very often, perhaps most frequently, the mucous affections
are not inflammatory, but consist in a kind of morbidly in-
creased sensibility, which we call irritation. The irritability
of the stomach, the vomiting and purging are frequently of
this kind, and would only be aggravated by antiphlogistic
treatment.
Proper purgatives, especially calomel, proper food, and suf-
ficient exercise, will be found to accomplish all or nearly all
that art can do for the relief of such conditions.
The cough which accompanies dentition is also due to the
irritability of the mucous membrane, and needs no special treat-
ment.
The inexperienced practitioner must be careful, however, not
to confound this condition with proper catarrh or pneumonia.
Children are liable to severe pulmonary disorders, which re-
quire the most prompt and vigorous treatment, and which it
would always be serious and often fatal to neglect.
The febrile disturbance, the quick, short respiration, the
distended nostril, and the indescribable, yet intelligible ap-
pearance of the little patient, will render mistake entirely
unnecessary.
The most serious complication of dentition is undoubtedly
a gastro-intestinal disorder, which has acquired the name of
Cholera Infantum.
This disease occurs only in hot weather, and is almost pecu-
liar to cities. Occasional cases of it, however, occurring in
warm, unsheltered places in the country, are sufficient to show
that its urban character is dependent simply upon the heat of
cities, which especially at night is very much greater than is
SYMPATHETIC DISEASES OF DENTITION. 181
experienced in rural situations, unless very unfavourably cir-
cumstanced.
This disease seems closely connected with dentition, for
although very young infants may be attacked by it, they are
by no means so liable as those who have completed their first
year. Hence the familiar danger of the child's "second
summer."
The disorder usually commences by purging; frequently as
the immediate consequence of some indigestible substance taken
into the stomach, but often without any known exciting cause.
The matters passed at first are light green—presenting some-
what the appearance of chopped grass, and gradually becoming
paler until they are of an extremely pale yellow or absolutely
white. Vomiting, especially after swallowing liquids, gene-
rally attends the diarrhoea, and commonly fever of a fickle
fluctuating character also occurs.
The child emaciates very rapidly, and in a few weeks or
days will be reduced to a mere skeleton, and be too feeble to
stand alone. The brain and nervous system become torpid,
the muscles relaxed, the child somnolent and stupid, and death,
from cerebral congestion or convulsions, closes the scene.
The disease is sometimes acute and rapid in its development
and progress, at other times chronic. The only medicinal
agent which is uniformly beneficial in this disease is calomel.
The nature of the alvine discharges evinces a deficiency or
entire absence of bilious matter. A full purgative dose of
calomel rarely fails to restore this secretion, and all the symp-
toms are alleviated by it.
From the fact that this medicine can be given in small bulk,
that it is almost tasteless, and that it will remain in the sto-
mach which rejects all other drugs, it is peculiarly adapted to
the condition in question. As this adaptation makes it the
most available, it is exceedingly fortunate that its medical
qualities make it by far the most efficient of remedies in this
disease.
Some writers recommend it to be given in small doses, fre-
quently repeated, but while there is no advantage to be gained
16
182 SYMPATHETIC DISEASES OF DENTITION.
by this procedure, there is risk incurred of mercurializing the
child; which would generally be fatal to it. It is true that
this rarely occurs; but some children have a peculiar constitu-
tional susceptibility to mercurial action, and it is better to risk
nothing unnecessarily in this respect.
The dose which experience leads me to employ, is from five
to ten grains, according to the age of the child and the condi-
tion of its sensibility. It may be repeated several times within
a week or less, if necessary.
Alkaline medicines, soda, potassa, magnesia, and chalk, are
also useful in neutralizing acid, and, perhaps, also in correcting
the disordered condition of the mucous membranes.
A cautious yet bold use of opium, will often render service
which no other treatment will afford. It quiets the stomach,
soothes irritation, checks the diarrhoea, and gives refreshing
sleep.
The great difficulty in the treatment of this disease arises
from the fact that it is the result of causes which continue to
act; so that the disorder is constantly reproduced.
These causes are heat and dentition; and it is often impos-
sible to cure the child while the causes continue to act.
In large, well-ventilated rooms, it is often possible, even in
cities, to procure for the child a temperature which is salutary;
but even under these circumstances it is not always possible to
do so. When, therefore, the little patient is the child of
poverty, imprisoned in the small room of a small house, shut
up in a court or alley, it is almost impossible to rescue it from
death.
The most certain of all remedies is to take the child to the
country. There proper medical treatment will rarely, or never,
fail to cure the disease. Children in apparently the last de-
gree of prostration are sometimes revived as by miracle, by
the cool air of the country.
3ut when we say country, we do not mean a hot room near
the roof of an unshaded tavern fronting on a turnpike road,
where numbers of sick children are shut up together, in a tem-
perature perhaps higher than that of the spacious city man-
SYMPATHETIC DISEASES OF DENTITION. 183
sions from which they have been hastily removed. Shade and
green grass are essential. There must be no bare surface to
reflect the heat, and there must be shade where the child may
be exercised, and where it may be conveyed in the middle of
the day, when country houses are as warm, and often, from
their size and construction, warmer than city dwellings.
Convulsions very frequently occur during dentition. They
are of an epileptic character. The symptoms are a fixed stare
and often distortion of the eyes, insensibility and frequent
irregular contraction and expansion of the muscles, generally
of the limbs and face. The jaws are firmly clenched, and the
saliva is ejected in froth from the lips.
This is a very frightful and generally very alarming affection,
though not very often fatal.
Convulsions during dentition may be excited by several
causes. The first and the most common is the eating of crude
and indigestible matters; secondly, fever; and thirdly, the
irritation of the teeth themselves: often two, and sometimes
all three of these causes act together.
The convulsion generally passes off in a few minutes, but
another will occur unless the cause be removed. Sometimes it
will continue with little or no mitigation for hours, and some-
times it continues until the death of the patient. In order to
relieve the spasms, it is generally sufficient to put the extremi-
ties in warm water and pour cold water on the head: if this do
not speedily accomplish the end, more active means must be
used, and such as look to the removal of the cause.
If spontaneously, or by use of the bath, the convulsion sub-
sides, we should carefully inquire into the cause of it. If the
child has recently eaten anything, it should be immediately
vomited, and indeed this can rarely be amiss, for it is often
impossible to elicit the necessary information, until the pre-
sence of the ejected matters exhibits the cause of irritation.
If the child have fever, it should be bled, in order to relieve
the brain, which is suffering from the rapid circulation of blood
through it. This may be done either by the lancet or by
leeches.
If the gum be swollen and ,tense, and the child seems to be
184 SYMPATHETIC DISEASES OF DENTITION.
suffering from this cause, a free incision will often relieve the
tendency to spasm, by allaying the local, and with it the cere-
bral irritation.
Finally, if the child be costive, its bowels should be imme-
diately opened by injection, and subsequently by a purgative
dose of calomel.
Dr. Underwood describes a peculiar swelling of the hands
and feet as a casual attendant upon dentition. He considered
it, however, as rather beneficial than otherwise, as it ceased
spontaneously with the appearance of the teeth.
Cutaneous eruptions frequently occur during dentition, but
they are of little consequence, as they spontaneously disappear,
and, in some instances, may be considered as a salutary diver-
sion made by nature for the relief of the brain. Sometimes,
however, they are so disagreeable, that some efforts are de-
manded for their relief. Most, or perhaps all of them, occur
independently of dentition, and as a description of them would
be tedious, and without plates, unsatisfactory, and as they are
all fully described in works specially upon this subject, it will
only be necessary to do little more than name them here.
The curious student may seek further information from writers
upon cutaneous disease.
The principal varieties are, an erythematous efflorescence
behind the ears, called, in medical language, intertrigo; crusta
lactea; the several varieties of strophulus; small phlyctense,
or blisters, and evanescent red spots.
Although these eruptions occur frequently during dentition,
they are by no means peculiar to this period, and it is difficult
to show that they are necessarily connected with the cutting
of the teeth.
INTERTRIGO.
This is a kind of erythemic or superficial inflammation of
the skin, generally attended with some exudation of a semi-
purulent matter, occurring behind the ears. When the two
excoriated surfaces rub upon each other, the result is fre-
ouently a very ugly superficial ulcer. The disease can be
readily cured by the use of absorbent or "drying" powders.
SYMPATHETIC DISEASES OF DENTITION. 185
All moist applications do harm. A most valuable prescription
for this and similar conditions of the skin is a powder composed
of two parts of lapis calaminaris, and one part of calomel,
rubbed together in a mortar. This is to be freely dusted upon
the sore by means of a little raw cotton, several times a day.
It will rarely fail of success.
There is an opinion very prevalent that it is hazardous to
dry up these eruptions, but, according to my observation, there
is no ground for this supposition.
CRUSTA LACTEA, OR MILK CRUST (PORRIGO LARVALIs).
This eruption appears with white vesicles, speedily passing
into dark-coloured scabs, itching and ichorous, and frequently
covering a large part of the face, head, and sometimes other
parts.
The eruption is very ugly and unpleasant, but is rarely in-
jurious to the child. The little patient is generally plump and
hearty. Indeed, the disease seems rather to depend upon a
plethoric state, than upon any morbid condition of an impor-
tant nature. The teething is not impeded by it.
Crusta Lactea is often obstinate and of some months' dura-
tion.. The only serious attendant upon the disease is the itch-
ing, which is sometimes so annoying to the child as to cause it
to fall away, and become sallow, &c.
No treatment is required, or, rather, none does it much good.
The bowels should be kept free, and the itching allayed by
warm bathing, lotions of weak spirit and water, and solutions
of Sul. Zinc.
Where there is much discharge from beneath the scabs, the
drying powder already mentioned is a good application. As a
general rule, the less we do to cure this affection the better.
Time will certainly restore to the child its natural skin; medicine
might, and if persevered in, would destroy its appetite, tease
its stomach, enfeeble its health, and, after all, produce no
effect upon the eruption, except, perhaps, to make it worse.
STROPHULUS, TOOTH RASH, RED GUM.
This is an eruption very common to nursing children. It
16*
186 SYMPATHETIC DISEASES OF DENTITION.
consists of red or white and itchy papulse evolved upon the
face and lower limbs, disappearing and returning, and ending
generally in the throwing off of a kind of powdery desquama-
tion.
The papulse present differences in size and appearance, which
have given origin to different designations. When vividly red,
prominent, scattered over the cheeks, face, arms, and dorsal
aspect of the hands, and intermingled with erythematous
patches of varying extent, it is called Strophulus Intertinctus
(Rayer.)
When the papulse are white, large, and without surrounding
redness of the base, the affection is called Strophulus Candidus
(Willan.)
When the papulse are very thick, smaller, and confluent,
Willan calls it Strophulus Confertus ; and finally, S. Volati-
cus, when it occurs in circular patches, or clusters, here and
there, on the surface. All those forms of strophulus may affect
the child at the same time.
It is not by any means a serious affection, though it some-
times torments the child by the itching it causes. To allay
this, we may use the cold or warm bath, purgatives, and cool
dressing ; for the sufferings of the child may be very unneces-
sarily aggravated by warm clothing, especially at night,
The disease spontaneously declines, in a few days or weeks,
leaving behind it no traces of its previous existence.
Phlycteno3, are vesications or blisters of different sizes, re-
sembling sealds or burns. They soon disappear, and require
no special treatment.
There are a number of rashes seen during dentition, which
it is not necessary for us to describe particularly. Scrofulous
children are subject, during dentition, to the lymphatic disor-
ders peculiar to their constitution, such as is manifested by the
swelling of the cervical, inguinal, and mesenteric glands.
The treatment of these, and kindred affections, must turn
upon the means of invigoration previously referred to when
considering the constitutional vice upon which tliey depend.
Proper nutriment, exercise, clothing, &c, will do all that can
be expected from external agents.
SYMPATHETIC DISEASES OF DENTITION. 187
SECOND DENTITION.
The cutting of the second set of teeth is commonly accom-
plished without inconvenience, either of a local or constitutional
character, with the exception of the wisdom teeth, which being
often crowded, not unfrequently occasion a great deal of suffer-
ing, such as acute local pain, inflammation of the gums and
adjacent tissues, fever, violent headache, ophthalmia, &c. This
suffering has often been mistaken for that accompanying other
affections, such as neuralgia, intermittent fever, and rheuma-
tism. Abscesses near the angle of the jaw may occur under
these circumstances.
Of course the treatment would be to liberate the impeded
tooth by a free incision, or even, under certain conditions,
to extract it. The inflammation of the soft parts must be
combated, if necessary, by antiphlogistic means.
THIRD DENTITION.
A number of well-authenticated cases of partial and even
complete dentition, occurring in very old persons, are recorded
in the books. In one instance recorded in the Edinburgh
Medical Com., vol. iii., the subject of this late teething suffered
very severely.
The patient, in this instance, was sixty years old, and en-
tirely toothless. At this time he experienced very severe pain
in his gums and jaws, which at length amounted to excruciat-
ing torture; but at the end of twenty-one days from the be-
ginning of his sufferings, he was compensated by the appear-
ance of a complete new set of teeth.
With regard to the constitutional effects of this abnormal
dentition, Prof. Harris, who relates two cases of this kind as
having occurred under his own observation, remarks: '*It
would seem that the efforts made by nature for the production
of a third complete set of teeth, are usually so great, that they
exhaust the remaining energies of the system; for occurrences
of this kind are generally soon followed by death."
188
CHAPTER XVII.
EFFECTS OF DISEASED TEETH AND GUMS UPON ADJACENT PARTS
AND THE GENERAL SYSTEM.
That diseased conditions of the teeth and the structures
adjacent to them, do exert a most pernicious influence upon
the general health, is a fact as well established as any other
medical observation; yet the medical profession are, apparently
with very few exceptions, entirely unaware of it.
I am not apprised that the subject is ever alluded to by lec-
turers on the practice of physic, when recapitulating to their
classes the causes of functional disturbance and constitutional
suffering; it is not noticed in the many text-books on practice ;
and, certainly, however frequently the physician may look into
the mouths of his patients, it is very rarely that his compre-
hensive glance perceives anything worthy of note in the de-
caying organs of mastication.
It is full time that practitioners of medicine should perceive
the importance of the teeth and of their diseases; but, until
they do so, it is the more important that the dentist should be
able to point out the causes of obscure disease, which the phy-
sician has in vain endeavoured to discover, simply because he
has sought for it everywhere but in the right place.
It might be granted, a priori, that if physiological conditions
of the teeth, owing to their peculiar position, association, and
history, may exercise powerful influence upon the health of
other organs, pathological conditions of these same teeth can-
not be entirely harmless.
Again, if we would examine the structure of a tooth, and
perceive how completely its sensitive part is enclosed in an
unyielding bony case, we might readily infer from the conse-
EFFECTS OF DISEASED TEETH AND GUMS. 189
quences of compression in other parts, that the swollen and
inflamed pulp, &c, would be exceedingly painful. If, too, we
would regard the close connexion existing between the teeth,
the rapidity with which the flash of sympathetic pain darts
along the nervous cords that vitalize them, and the intolerable
and protracted suffering which ensues, upon even trifling irrita-
tion of these sensitive filaments, and remember that pain itself
is fully capable of deranging the whole economy, and inducing
serious and fatal disorder, we might, without the aid of much
reflection, adopt the very rational conclusion that the diseases
of the teeth must be of considerable consequence to the entire
organization. We might, also, with similar propriety, conclude
that the teeth were not made merely for ornament, and that
mastication and insalivation are something more than mere
forms of introduction to the stomach; that they are important
to digestion, which is important to the entireness of organs and
the performance of function, and that if mastication, and the
insalivation accompanying it, be imperfectly performed, some
corresponding imperfection of digestion must result. We
might also infer, from the known consequences of long-con-
tinued morbid influences, however unimportant in their imme-
diate action, that disturbance of digestion, constantly repeated,
must, in time, develope evils of a serious character.
The old pathological maxim, " ubi irritatio ibi fluxus,"* is
fraught with a valuable lesson to the medical practitioner. It
is true that the nervous, and to a certain degree, even the vas-
cular forces hurry to the part which throws out the signal of
distress, and all the floating energies of the system are directed
to the relief of the suffering. If it can be readily accomplished,
the equilibrium of the body is soon restored, and no perceptible
inconvenience results. But if from the impracticable nature
of the tissue or organ affected, but little relief can be given,
and if the efforts of nature to accomplish cure or removal of
the part, end only in accumulating about it an uncommon
amount of sensibility, increasing the irritation and demanding
* " Where there is irritation, to that part will be the flow."
190 EFFECTS OF DISEASED TEETH AND GUMS.
yet more of constitutional effort to combat it, the consequence
must be such a diversion of nervous influences from other parts
as to weaken their force of action, and to embarrass their
functions.
In short, it is easy to understand that when the first move-
ment towards constitutional derangement has been made, if the
cause continue to act, each accession of morbid condition must
aggravate and extend the evil, and hence it is that causes in
themselves very slight may, if long continued, from the influ-
ence of sympathy and the accident of relations, induce morbid
conditions of the most serious character.
The remarks of Mr. Koeeker upon this point are so sensible
and so well expressed, that no apology will be necessary for
introducing them here at some length.
Mr. Koeeker observes that, " to form a more distinct con-
ception of the very powerful morbific influence which the dis-
eases of the teeth and their contiguous parts must unavoidably
produce upon the general constitution, it is necessary to con-
sider the peculiarity of the structure and functions of these
parts.
" The extremely hard and dense structure of the bony parts
of the teeth, and the great arterial activity and nervous irrita-
bility of their lining membranes, which can so powerfully, and
for so long a time, defend the teeth against general local and
morbid influences, are also causes of their producing very ex-
tensive morbid effects upon the whole system. The functions
of the teeth as well as of the gums, when in a healthy state,
act as powerful stimuli towards their preservation, but when
these parts are diseased or affected with disorder of any kind,
they become constant causes of irritation upon them as well as
upon the general health. The bony structure of the teeth,
however, having in itself but little self-restoring power, and
their peculiar functions being much less favourable to this na-
tural process than those of any other part of the body, and the
teeth and their gums, periostea and sockets, being altogether
dependent upon each other, this power is much more constantly
and in a much higher degree required, and seems to be much
EFFECTS OF DISEASED TEETH AND GUMS. 191
more exerted by these than by any other structures; and the
more these powerful efforts are incapable of curing the dental
diseases, and resisted in their efforts to remove their causes,
the more active is the constitution in its attempts to resist the
progress of such diseases, whilst at the same time a conside-
rable portion of general health and strength is consumed in
the struggle.
" Diseases in the bony structure, and indeed of the teeth and
gums generally, when yet in their incipient stage and without
being influenced by any other causes than the local disorder
itself, produce no greater constitutional effects than other local
maladies; but with this difference, that their self-curative ac-
tion is exerted in a proportion corresponding to the peculiar
structure, functions, and relations of these parts, and therefore
comparatively much greater and longer continued than that
produced by diseases of other parts or bones. In this state
they proceed very slowly, and their morbid effects can only be
detected by the most minute attention.
" The general system, however, in the mean time being often
disturbed, the caries will be found to proceed much faster to-
wards the cavity of the teeth, and the inflammation of the
gums to increase. In that event, any constitutional disorder
is competent to aggravate the local one, whilst the latter, also,
in its turn, greatly excites and augments the former. At this
period it may be still taken as a general rule, that the morbid
influences of general disease upon the dental maladies are more
powerful than those of the teeth upon the general system.
" The teeth having been deprived of their vitality by the
destruction of their lining membranes, are not only rendered
useless, but are converted into lifeless incumbrances upon the
system, which produce, by their mechanical and chemical irri-
tation, an action similar to that effected by gangrene or morti-
fication in other bones, by means of which, nature attempts to
throw off the dead part.
" The parts surrounding such dead teeth, viz.: gums, perios-
tea, sockets and maxillary bones, are thus involved in serious
disease, inflammation gradually extends over the whole of these
192 EFFECTS OF DISEASED TEETH AND GUMS.
parts, and a strong effort appears to be made to effect the ex-
pulsion of the decayed teeth, now become dead and offending
bodies. But although nature might succeed in thus removing
almost any other soft or hard part of the body of equal dimen-
sions, in a few weeks or months, a space of from five to ten
years, and sometimes a much longer period is required for the
removal, by the same natural power, of a dead tooth.
" As long as the primary diseases are principally confined to
the teeth themselves, and in these instances where they are the
proximate local causes of diseases of the mouth without sup-
posing the existence of many dead stumps of teeth, so long
may we look for those acute symptoms and effects which have
been stated, and see them change alternately from one form of
disease into another, but after that period, or when the local
maladies having originally commenced in the gums, periostea,
alveoli, and maxillary bones, shall have extended to a certain
degree, a total transition into a permanent chronic state of the
disease takes place.
"In such a state of disease nature seems exclusively and
actively engaged by producing inflammation and suppuration
in extricating the mouth from all the morbid causes affecting
the diseased parts, such as dead roots and stumps, tartar, and
teeth which are loose or irregularly situated. The sanative
power of nature being, however, very rarely competent to
effect such a cure, the various diseases of the gums, periostea,
alveoli, and maxillary bones are exasperated, and for the most
part terminate in a state of suppuration and mortification."*
When the chronic condition here described has been fairly
reached in the progress of disease, the sensibility of the parts
is much diminished; the gums and periostea are thickened and
callous, and the continual discharge sufficiently depletes the
vessels, to relieve them of the suffering incident to inflamma-
tory engorgement. All resistance to devastation of the dental
arch seems to cease, and the parts are abandoned to rapid de-
struction. In the mean time the patient congratulates himself
* Koeeker, Princ. Dental Surgery.
EFFECTS OF DISEASED TEETH AND GUMS. 193
that his teeth have ceased to ache, and consequently gives
himself no trouble about them. Inflammation, suppuration
and caries now spread along the dental arch until every tooth
is broken down and every root has become a permanent irri-
tant, provoking a constant purulent discharge from the soft
parts about it.
The food is no longer chewed, and everything which passes
through the mouth is mixed with a vitiated compound of saliva,
mucus, pus, and blood, which descends to the stomach to mingle
with the gastric juice, and deteriorate the quality of that most
important fluid.
The absorbents, too, are constantly at work, and the dis-
solved fragments of carious bone, &c, are continually thrown
into the current of the blood.
The alveoli cannot escape the general ruin. Involved in the
all-pervading inflammation, they also suppurate and break
down, and not unfrequently the maxillary bones and the an-
trum are also involved in disease.
Dyspeptic symptoms, marasmus, cough and other pectoral
symptoms, violent neuralgic affections of the face, great
nervous depression, hysterics and hypochondriasis, may be
expected to attend such conditions of the teeth.
The dyspepsia is easily accounted for. In the first place,
the food is badly prepared for the stomach; 2d, the fluids of
the mouth, constantly trickling into the stomach, impair its
tone and vitiate its solvent secretion; and 3d, the continual
demand made upon the system by the vain efforts which nature
makes to cure the diseases of the teeth, and also by the fre-
quent and severe pain, diminishes the nervous influence which
the stomach receives, and impairs its powers.
Every one is aware that when the stomach is full, there
takes place in that organ such a concentration of nervous
energy as is sensibly felt by its loss in other parts of the
body. Hence the drowsiness and the indisposition to mental
and physical effort experienced after a hearty meal.
It is also well known that anything which attracts from the
17
194 EFFECTS OF DISEASED TEETH AND GUMS.
stomach this accumulated nervous power, impairs appetite and
digestion.
Extraordinary emotions, powerful intellectual efforts, vene-
real excesses, &c, all act in this way upon the digestive appa-
ratus. Pain, also, wherever located, produces a similar effect,
and the impairment from this cause will be important in pro-
portion to the frequency and continuance of the suffering.
In these several facts we have sufficient reasons for the indi-
gestion which so frequently attends extensive diseases of the
teeth.
Marasmus, or gradual emaciation, is but a consequence of
the insufficient nutrition attending dyspepsia.
Cough and other pectoral symptoms, may result as the con-
sequence of any prolonged irritation, especially if digestion be
impaired. The mucous membrane of the larynx, trachea, and
lungs sympathizing with similar structures, and participating in
the common defect of nutrition.
Neuralgic affections of the face, head, and neck, are occa-
sioned by the continual irritation of the extremities of the
dental nerve, and the propagation of it to the trunk and
branches of the great fifth pair, or trifacial nerve.
Depression of spirits, hysterics, and hypochondriasis, result
from continual nervous irritation, and the debility of nerve
which results from long-continued over-action. Indigestion
also is a powerful cause of the melancholy or hysterical condi-
tion so often observed in these cases.
Epilepsy, and other affections not enumerated above, some-
times occur as the result of dental irritation, as will be shown
by the following cases narrated by Dr. Rush [31ed. Repos.
vol. vi. 285.)
Case 1. "Some time in the month of October, 1801," says
Dr. Rush, "I attended Miss 0. C. with a rheumatism in her
hip joint, which yielded for a while to the several remedies for
that disease. In the month of November it returned with
great violence, accompanied with a severe toothache. Sus-
pecting the rheumatic affection was excited by the pain in her
tooth, I directed it to be extracted. The rheumatism imme-
EFFECTS OF DISEASED TEETH AND GUMS. 195
diately left her hip, and she recovered in a few days. She has
continued ever since to be free from it.
" Soon after this I was consulted by Mrs. T. R., who had
been affected for several weeks vrith dyspepsia and toothache.
Her tooth, though no mark of decay appeared in it, was drawn,
by my advice. The next day she was relieved from her dis-
tressing stomach complaints, and has continued ever since to
enjoy good health. From the soundness of the external part
of the tooth, and the adjoining gums, there was no reason to
suspect a discharge of matter from it had produced the disease
in the stomach." (Doubtless it was due to the irritation, and
the consequent deviation of nervous influence to the suffering
parts.)
Case 2. (Dr. Rush.) " Some time in the year 1801, I was
consulted by the father of a young gentleman in Baltimore,
who had been affected with epilepsy. I inquired into the state
of his teeth [an inquiry which is even yet very unusual in such
cases, but which serves to show the superiority of Dr. R. in
judgment and comprehensiveness of thought], and was informed
that several of them in his upper jaw were very much decayed.
I directed them to be extracted, and advised him afterwards
to lose a few ounces of blood at any time when he felt the pre-
monitory symptoms of a recurrence of his fits. He followed
my advice; in consequence of which I had lately the pleasure
of hearing from his brother that he was perfectly cured."
In commenting upon these cases, Dr. Rush remarks:
"I have been made happy by discovering that I have only
added to the observations of other physicians in pointing out a
connexion between the extraction of decayed and diseased
teeth, and the cure of general disease. Several cases of the
efficiency of that remedy in relieving headache and vertigo, are
mentioned by Dr. Darwin. Dr. Gater relates that M. Petit, a
celebrated French surgeon, had often cured intermittent fevers,
which had resisted the bark for months and even years, by this
prescription." (These cases must have been merely irritative
fever, appearing, as it generally does, with exacerbations de-
pending upon constantly recurring circumstances, such as the
stimulus of light, food, exercise, &c. They were not true in-
196 EFFECTS OF DISEASED TEETH AND GUMS.
termittents.) He also quotes from the work of Petit, two
cases; the one of consumption (apparently), the other of ver-
tigo, both of long continuance, which were suddenly cured by
the extraction of two decayed teeth in the former, and of two
supernumerary teeth in the latter case.
"In the second number of a late work, entitled 'Bibliotheque
Germanique Medico-Chirurgicale,' there is an account, by Dr.
Seibold, of a young woman who had been affected for several
months with great inflammation, pain, and ulcers in her right
upper and lower jaws, at the usual time of the appearance of the
catamenia, which were always deficient in quantity. Upon in-
specting the seats of these morbid affections, the doctor dis-
covered several of the molars in both jaws to be decayed. He
directed them to be drawn, in consequence of which the woman
was relieved of the monthly disease in her mouth, and after-
wards had a regular discharge of her catamenia.
"These facts," continues Dr. Rush, "though but little at-
tended to, should not surprise us, when we recollect how often
the most distressing general diseases are brought on by very
inconsiderable inlets of morbid excitement into the system. A
small tumour concealed in the fleshy part of the leg, has been
known to bring on epilepsy. A trifling wound with a splinter,
or a nail, even after it has healed, has often induced a fatal teta-
nus. Worms in the bowels have produced internal dropsy of
the brain, and a stone in the kidney has excited the most vio-
lent commotions in every part of the system. Many hundred
facts of a similar nature are to be met with in the records of
medicine.*
* I met with a remarkable case of this kind a year ago. A wagoner, be-
tween 40 and 50 years of age, a very athletic man, had been engaged on
the day previous in lifting some logs of wood, and perceived a little blood
upon his finger, though no wound could be seen. Early the next morning he
drove his team to the city, nine miles distant. On the road he suffered
with intense pain in the finger, and when he reached the city, he was chilly,
pale, and evidently labouring under great constitutional irritation. The
finger showed no wound. The pain increasing, he with considerable difficulty
reached home. Erysipelas appeared, and he died in a few days.
The season of the year, being winter, precludes the possibility of his
having been bitten by a serpent. He was not intemperate in his habits!
EFFECTS OF DISEASED TEETH AND GUMS. 197
" When we consider how often the teeth, when decayed, are
exposed to irritation from hot and cold drinks and aliments,
from pressure, by mortification, and from the cold air, and how
intimate the connexion of the mouth is with the whole system,
I am disposed to believe they are often unsuspected causes of
general, and particularly of nervous, diseases. When we add
to the list of these diseases the morbid effects of the acrid and
putrid matters which are sometimes discharged from carious
teeth, or from ulcers in the gums, created by them; also the
influence which both have in preventing perfect mastication,
and the connexion of that animal function with good health, I
cannot help thinking that our success in the treatment of all
chronic diseases would be very much promoted by directing our
inquiries into the state of the teeth in sick people, and by ad-
vising their extraction in every case in which they are decayed.
It is not necessary that they should be attended with pain, in
order to produce disease; for splinters, tumours, and other irri-
tants before mentioned, often bring on disease and death, when
they give no pain, and are unsuspected as causes of them.
This translation of sensation and motion to parts remote from
the place where impressions are made, appears in many in-
stances, and seems to depend upon an original law of the ani-
mal economy."
Tissot, who wrote nearly a century ago, had become aware,
from observation, of the great importance of diseases of the
teeth to the general health. He describes toothache as result-
ing from gout and rheumatism, as connected with disordered
stomach, and as the result of the presence of noxious matters
in the blood, which, according to the pathology of his day, was
the mode of expressing what we mean by constitutional vices
or disorders. He also mentions intermittent toothache, which
he cured with Peruvian bark; and neuralgic toothache, which
was arrested by generous diet and wine.
Modern medicine, or rather, medical writers, have retrogra-
ded in some respects, however much they may congratulate
themselves upon their progress in others. Microscopic soma-
tology but poorly compensates for that close observation of
17*
198 EFFECTS OF DISEASED TEETH AND GUMS.
living disease, upon which our fathers deservedly laid so much
stress.
In the Dublin Medical Free Press, I find the following case
recorded:—
Case 3. Painful affection of the eye cured by extracting a
tooth.—Dr. Emmeuch relates a case of this kind. A man con-
sulted him on account of a painful affection of one of his eyes,
which had lasted fourteen years, and occasioned great suffer-
ing. There was considerable vascularity of the conjunctiva
and sclerotica, especially around the cornea, which structure
itself was somewhat opaque and spotted. There was a con-
tinual flow of tears, with pain, and intolerance of light. All
these symptoms were greatly aggravated by any indiscretion
in diet and the use of the slightest stimulus, such as a single
glass of wine. All kinds of remedies had been tried in vain,
at different times, and the affection seemed incurable. On
examination of the upper jaw, Dr. E. found a carious tooth
in the side corresponding to that of the affected eye. The
portion of the jaw around the tooth was painful, and very sen-
sitive to the touch. The patient thought the affection of the
tooth had begun simultaneously with that of the eye. The
tooth was drawn, and almost immediately afterwards the symp-
toms relating to the eye began to subside, and soon entirely
disappeared. The affection of the eye was evidently the result
of sympathy between the second and third branches of the
fifth pair of nerves.
Dr. Rush (Med. Inq. and Observations on the Diseases of the
Mind, p. 33,) observes that "Irritation, from certain foreign
matters retained in irritable parts of the body, is among the
causes of insanity." He adds, " I once knew some small shot
which were lodged in the foot of a schoolboy, induce madness,
several years after he became a man. It (insanity) has been
brought on, in one instance, by decayed teeth, which were not
accompanied with pain."
Mr. Koeeker has published a number of cases, forcibly illus-
trating the effect of diseases of the teeth upon the general
health. From these I select the following:—
EFFECTS OF DISEASED TEETH AND GUMS. 199
Case 4. "Mrs. P., a lady of great respectability, under the
medical care of Dr. Jule Rucco, of Leicester Square, had, some
years since, continually suffered from dyspepsia, as well as
from various kinds of nervous attacks of a very annoying and
alarming nature. This judicious physician had for a long time
suspected the cause, and frequently proposed to consult me.
By the wish of the lady, however, the dentist of the family
was at last sent for, and three or four teeth and roots were
removed, which, according to the assertion of the dental at-
tendant, were all that could be extracted. The disease, how-
ever, was only aggravated by this interference, and the suf-
ferings of the patient increased more and more.
" About six months after, the doctor again urged a meeting
with me on the subject, and at last I was sent for. I found
the lady labouring under a complete salivation, from an extraor-
dinary sympathy of all the glands in any way connected with
the teeth. On the previous night, and, indeed, for many nights
preceding, she had been suffering such violent fits of convul-
sion as to alarm the whole family. The face was affected with
an acute erysipelatous inflammation, accompanied with head-
ache, as also with considerable derangement of the digestive
functions, such as sickness, vomiting, loss of appetite, &c. By
examining the mouth, I found that the previous dental treatment
had been very partial, and I proposed the removal of every
tooth and root which produced irritation.
" The lady consented imjnediately to my proposal, and the
necessary operations were performed on the 8th of October,
1824, when nine decayed teeth, some of them mere roots,
were extracted. The patient was requested to rinse her mouth
frequently with a diluted astringent lotion. By this simple
local treatment, and by the further medical care of Dr. Rucco,
she was perfectly cured in about a week after the operation.
" Very soon after her recovery, the lady was enabled to
fulfil a promise of marriage which for some time had been pre-
vented by her protracted and distressing disease. Since that
period, she has enjoyed perfectly good health.
" The farther treatment of the case has, however, been de-
200 EFFECTS OF DISEASED TEETH AND GUMS.
layed, on the accomplishment of which, of course, the perma-
nency of the cure will depend."
Case 5. A literary gentleman in the neighbourhood of Lon-
don had been for some years under the medical care of Mr. J.
Derbyshire, of Greek Street, Soho, on account of a constant
state of derangement of his digestion.
Much sedentary occupation, and some excessive grief, had of
late greatly augmented the distressing symptoms generally
accompanying this cruel disorder. His disease had assumed
the character of hypochondriasis. His spirits were so dejected,
and the state of his bodily health was so low, that he was no
longer capable of attending to his ordinary business.
Having had some conversations with Mr. Derbyshire on the
influence of disease of the teeth upon the general health, that
gentleman was induced, at his next visit, to inquire into the
state of his patient's teeth, and learning that they were in a
very deplorable condition, he proposed a consultation with me
on the subject. After a particular examination, I found every
tooth in the patient's mouth more or less carious, or dead, and
all the gums and sockets in a very diseased state.
On the 27th of May, 1824, twenty-one teeth and roots were
extracted, all of which were more or less in a state of putrefac-
tion—three large grinders only excepted, which were either
suffering from complicated caries, or producing morbid irrita-
tion upon the other parts, from some other causes.
The mouth was restored to perfect health in the course of
about six weeks. During the progress of treatment of the dis-
eases of the mouth, the general health improved very surpris-
ingly; and after the restoration of perfect health to all the re-
maining teeth, and their relative parts, the patient enjoyed
uninterrupted good health, and returned to his ordinary pro-
fessional avocations.
Case 6. The following is a letter which was handed to me
(Mr. Koeeker) by Miss B., Manchester Street, London, in the
beginning of the month of May, 1825. The history it gives is,
perhaps, one of the most distressing cases of its kind, concern-
ing a lady of great respectability and rank in Scotland, of
EFFECTS OF DISEASED TEETH AND GUMS. 201
about thirty-eight years of age. Its contents, indeed, are not
less remarkable for the manner in which they display the un-
common fortitude of the unhappy sufferer, than for the strik-
ing confirmation which they give of the facts which I have de-
tailed, as well as the description I have given, respecting the
present state of dental surgery. Considering this evidence as
most useful and important, I beg to submit to the reader the
whole of the fair sufferer's most interesting and affecting com-
munication.
"My Dear----, I have been so ill since I wrote you last,
that I have not been able to answer your kind letter. As I
can express myself to you easier than to a stranger, I shall
endeavour to give you some idea of my present state, and you
can give my letter to Mr. Koeeker. Constant faint gnawing
pains in my gums, membrane of my mouth and cheeks, ac-
companied with considerable swelling of the latter, which are
always blotched, inflamed, and irritated, just in the way some
people's faces are affected when suffering toothache; my very
nose is swelled and inflamed, and the muscles of the under part
of my face so contracted and drawn upwards, that I cannot
swallow anything but liquids. My mouth is contracted and
full of slimy saliva. In bed I have constant twitches in my
gums, like what I could figure electricity. Sometimes my
gums and face burn like fire, and sometimes feel as if every
nerve and blood-vessel were filled with ice, and the sheets near
my mouth are wet with saliva. All these sensations often run
down behind my ears, to my neck and arms; and at these
times I have a great hurry and agitation of spirits, and aching
across the breast and heart. To me, one of my greatest tor-
tures is the extraordinary inflation of gums, particularly to-
wards the roof of my mouth. They feel as if they absolutely
tore from the bone, hove up, as it were, with the wind, and my
jaws feel twice too large for my mouth, the pressure against
my face is such. The same sensation often proceeds to my
cheek bones, which increases the swelling of the muscles and
the dragging up of the under jaw.
202 EFFECTS OF DISEASED TEETH AND GUMS.
" I must now go back in my history, that Mr. Koeeker may
know the progress of the last five years of my continued misery.
But, unluckily, I fear it is impossible to make any one under-
stand my sufferings, they are so various and complicated. You
know I always blamed my teeth as the cause of all my suffer-
ings ; but I am now convinced that the disease is in my gums
and remains of the alveolar processes; and as I was told that
was a part of his profession Mr. Koeeker was supposed to be
very skilful in, it makes me very anxious to have his opinion.
You will remember how long (many months) the sockets of my
large molar teeth stood open, and even when they did heal up,
the gums were full of morbid sensibility. When I last saw
you, I had only about five front teeth remaining, and eight
below. About 1818 they began to ache a little, and, as usual,
to irritate and inflame my cheeks. The five upper ones began
to spoil; but I fought on with them until the winter of 1819,
when the inflammation, and the various sensations I have men-
tioned before as now suffering, increasing, and the teeth them-
selves aching, I had them pulled. The gums swelled and
inflamed most dreadfully, the horrid sensations in the roof of
my mouth increased, and my face was as bad as ever. In about
a month the wounds healed, but the gums remained swelled
and became a hard white gristle. After suffering for many
months, I had the gums opened. They were so hard and
thick, the dentist said they were like bone. The sockets were
not the least absorbed; of course, rough, and in some parts
exfoliated.
" The gums were kept open near a month, and caustic ap-
plied to excite absorption. In the course of this process the
point of a tooth was discovered in one of the sockets, and ex-
tracted. It was a full-grown eye-tooth, which, for want of
room, had never made its way down. I was easier as long as
the gums were open; but just where I was, when they healed
up and resumed their state.
" Some month's after this, my under jaw became affected;
the teeth were not spoiled, but became so painful to the touch,
that I could bear nothing in my mouth to touch them. My
EFFECTS OF DISEASED TEETH AND GUMS. 203
lips became very tremulous, and my hands trembled so that I
could neither feed nor dress myself. When warm in bed they
ceased; but from the moment I rose and began to speak, or
let the air into my mouth, I never ceased trembling, and the dry
retchings (which you remember how tortured I used to be
with) increased so as to bring on vomiting. I suffered in this
way for eleven weeks, when, in despair, I had all my remaining
teeth pulled. The tremblings and retchings quickly abated,
and in a few weeks completely left me, and I have never had
them since. My under gums, even before the teeth were pulled,
were a hard gristle, and almost as white as the teeth. My
gums have been often opened to give me relief, but as nothing
will induce them to suppurate, I get no advantage, the wound-
ing only increasing the hardness.
"These gums seem to me to act as levers, pressing on the
nerves and blood-vessels, and keeping up a constant irritation
and inflammation in my mouth and face.
" Under an idea that my complaint proceeded from neural-
gia, I was advised to have the mental nerves divided at the
chin, which did no good, and has created such hard tumours
on these places, that I think their pressure on the side of the
jaw is the cause of the twitching pain of my under lip, and
the contraction of the muscles.
"I would take it as a great favour if Mr. Koeeker would
say whether he thinks he could be of any use to me here, until
I am able (which, alas ! I fear I am not) to come to London;
or if he could give me any advice which I might desire to be
done here; and if he will be so very good as to mention what
are the different kinds of diseases he has ever met with in the
gums or alveolar processes, and his mode of treatment. There
seems to be an idea here that if the sockets are not carious,
there can be no disease there; but I think Fox mentions other-
wise.
"My upper gums had not been touched for four years,until
a week ago, when a part was opened that was very trouble-
some, and much swelled. The bone was full of points and
inequalities, and rough; sounding gritty, like sand. There
204 EFFECTS OF DISEASED TEETH AND GUMS.
was a great deal of thick slime, like the white of egg, mixed
with blood. Some nitrous acid was put upon the wound, to
try to keep it open a little, but in vain. It is already covered
with a new gum, and the old thick parts gaping open. I am
sure if these old swelled gums could be got away, I should
suffer less.
" I should think there is about the eighth of an inch of the
socket remaining. The ridge of the under jaw is as sharp as
a knife, and so painful to the touch, when I press it, that it
makes my face, ears, and neck burn. My lips are painful, and
are drawn in. I was advised to try false teeth, but they in-
creased my sufferings ten-fold, which is very hard, as the
clinching of my jaws adds much to my sufferings. My eyes
are beginning to be much affected, which must plead my
apology to Mr. Koeeker for this sad scrawl, which I think you
will need to help him to decipher.
"There are various opinions about my complaint. One says
it is a nervous complaint at the origin of the nerves, affecting
the extremities of these nerves; others say it is a nervous
affection of the dental nerves and their ramifications on the
face; and others are of opinion it is an affection of the cover-
ing of the bone. I am satisfied it is some disease of the an-
trum. Could it injure me to have the antrum opened to ease
my mind ? There is one place where I think there is part of
a fang of a tooth, which I am certain was broken, as the den-
tist burnt the tooth without letting me see it; perhaps that
may torment me."
Mr. Koeeker gives no opinion upon this case; but the lady
seems to me to have had more discernment than her profes-
sional advisers. The disease was probably seated in the an-
trum, and very likely the fragment of fang was the irritating
cause.
The following cases are reported by Dr. C. A. Harris:—
Case 7. " In September, 1830, I was consulted by Mr.
----, at that time a resident of New York. Before I examined
his teeth, he informed me that his general health had been
EFFECTS OF DISEASED TEETH AND GUMS. 205
very bad for four or five years past, and that he had applied
to some of the most eminent physicians of New York, Troy,
and Albany, but had not obtained any permanent relief from
his sufferings.
"The character of the symptoms that prevailed at this time
was very peculiar. His digestive organs were so much de-
ranged, that he was obliged to observe the strictest regimen,
and confine himself to the simplest kind of vegetable food.
Besides the dyspeptic affection with which he was troubled, he
had severe paroxysms of headache and vomiting, that recurred
at regular intervals of from four to five weeks. These were
always preceded by numbness, which commenced in his tongue
and extended thence throughout the whole system. This sen-
sation continued usually for about two hours, when it was suc-
ceeded by a violent pain in the head and partial vertigo,
from which, in about ten hours, he was relieved by vomiting.
The effects of these paroxysms lasted about ten days, and the
other symptoms had continued, without much mitigation, for
three years.
" On examining his mouth, I gave it as my opinion that the
diseased state of his teeth was the cause of his affliction. This
idea, though entirely novel to him, he was disposed to believe
correct, and therefore readily consented to the treatment I
prescribed. Many of his teeth were much decayed, and nearly
all of them covered with tartar. The roots of some were de-
nuded of the gums, the alveolar processes more or less absorbed,
the gums turgescent, fungoid, bleeding on the slightest touch,
and of a dark red colour. The secretions of the mouth were
viscid, and their exhalations exceedingly offensive.
" Such of his teeth as could not be perfectly restored were
extracted, and as much tartar was taken away as could be con-
veniently removed at one time, and the rest at subsequent sit-
tings. His gums were freely scarified, and a tonic astringent
and detergent wash was directed to be used three or four times
every day. Under this treatment the local affection of the
mouth rapidly disappeared, and in about four or five weeks his
teeth and gums became perfectly healthy. His general health
18
206 EFFECTS OF DISEASED TEETH AND GUMS.
also began to improve, and in about two months it was perfectly
restored, and has so continued."
Case 8, communicated by Dr. Harris. " In February, 1851,
W. S., of Virginia, aged about 45, called on me for advice in
relation to a tumour in the roof of his mouth, which had been
first perceived fifteen months previously, during which time
there had been an occasional dripping of purulent matter be-
hind the velum palati. On inquiring into the history of the
case, I learned, that about two or three weeks previous to the
occurrence of the tumour, he had an attack of toothache. The
pain was felt in the first right superior molar, but had subsided
before the formation of the tumour, leaving the tooth somewhat
sensitive and sore to the touch and slightly elongated. As it
caused him but little inconvenience, having some years before
lost the tooth in the lower jaw with which the diseased upper
molar antagonized, it was not suspected to have any connexion
with the disease of the palate, although the swelling had fre-
quently extended down the side of the alveolar border opposite
the palatine root.
" Having ascertained these facts, I had but little difficulty in
tracing the origin of the disease to the alveolus of the palatine
root of the tooth in question : the tooth being necrosed.
" The extraction of the tooth confirmed the correctness of my
suspicions. In three days the tumour of the palate disappeared,
and the trickling of pus ceased."
It might be curious to inquire, what would have been the opinion
given of this case, and the treatment pursued, by some able sur-
geons to whom the effects of diseased teeth upon the adjacent
structures had never been a subject of inquiry or observation.
As the tooth did not ache, and had not ached for some time
before the appearance of the tumour, it probably would have
never been suspected of any agency in the matter. Had its
necrosed and elongated condition been observed, it would natu-
rally have been attributed to the pressure of the tumour upon
the alveolus. The probabilities are very small, that any but
a dentist or a surgeon more than commonly attentive to the
teeth, would have perceived the patient's condition, or relieved
EFFECTS OF DISEASED TEETH AND GUMS. 207
it. Very probably he would have been subjected to painful
and worse than useless attempts at cure, until the disease, so
simple and so manageable, might have become far more serious
and intractable. As a general rule, in all local inflammations,
tumours, &c, of the parts adjacent to the teeth, the latter are to
be suspected as the cause; and, until thorough observation
and careful consideration have determined the contrary, we
should not look elsewhere for the origin of the evil. Proba-
bly, in nine cases out of ten, our first suspicions will prove to
be correct.
Dr. S----, a distinguished surgeon and physician of Virginia,
reports the two cases following :
Case 9. " Mrs. S----, a lady of thirty or thirty-five years
of age, with several children, in easy circumstances, rather
delicate and of sedentary habits, complained of derangement
in the functions of the digestive organs, with much nervous
disorder, and a painful sensation about the head, as if there
were a pound weight on the top of it, with an occasional tight-
ening of the scalp. This last sensation, she compared to that
which might be expected from having the scalp forcibly drawn
together on the vertex by the clawing of some animal with
talons, as a hawk. Her friends, at first, thought but little of
her complaints, and from their eccentricity were inclined to
believe them, for the most part, imaginary. The affection of
the head, however, and the sensitiveness of the nervous system,
evidently increased, until they became so harassing and acute,
that they deprived her of rest, and made manifest inroads upon
her healthful appearance.
" Medical advice having been now obtained, a regular and
carefully-directed course of purgatives was prescribed, but with
little or no advantage. The cathartics having been discon-
tinued, the Rub. Ferri, Bark, Valerian, Mineral Acids, Zinc,
Assafoetida, &c, were next tried, to which were added frictions
and tepid salt baths, but still without any material amendment.
" She now began to have evident exacerbations of fever
towards evening, which passed off with copious and debilitating
sweats, that much reduced her, and caused her countenance to
208 EFFECTS of diseased teeth and gums.
assume a sickly aspect. She visited the watering-places in
Virginia, but though her strength was somewhat recruited, the
distressing symptoms, with some slight modifications, still con-
tinued. She was occasionally confined to the house, but gene-
rally was able to take some slight exercise in the open air.
" This state of things had continued for eighteen months,
when the attention of her physician was called to an abscess
formed near the root of one of her incisor teeth. This brought
about an inquiry into the general state of the teeth, of which
the following is the result:
" Mrs. S----, at an early period had bad teeth, which, since
her marriage, had been gradually growing worse. A few years
before the time of which I speak, two of the incisors of the
upper jaw were clipped off close to the sockets, and artificial
teeth were inserted on the fangs. Much pain, irritation, and
swelling of the gums and lips followed the operation, and similar
symptoms occasionally occurred for a year or two afterwards,
and were frequently attended with alveolar abscesses. The
remaining incisors of the upper jaw, and several of the inferior
and superior molar teeth, were found to be in a dilapidated
state. The alveolar processes of several of the inferior molars
were partially destroyed, and one or two of their roots were
turned on one side, and clung to the alveoli by the remaining
integuments.
" The situation of the mouth rendered it quite probable that
the ill health of the patient arose from the irritation produced
by the bad state of her teeth; the more so, as her nervous
system was exceedingly sensitive. She was persuaded to have
the carious incisors and the worst of the molars removed ; and,
a short time after this was done, her health began to improve.
The affection of the head and scalp soon ceased, the nervous
symptoms vanished, and she is now in good health, and has a
set of teeth decidedly more ornamental than those given her
by nature ever were. The speedy restoration of her health
after the removal of her diseased teeth, justifies the conclusion
that her bad health depended on the bad state in which these
organs were found."
EFFECTS OF DISEASED TEETH AND GUMS. 209
The following case, related by the same gentleman, is parti-
cularly worthy of attention, as showing the terrible conse-
quences which may result from ignorance of the effects which
disease of the teeth, or even of a single tooth, is capable of
producing in subjects of certain constitutions:
Case 10. " Miss W----, a maiden lady of about fifty years
of age, in comfortable circumstances, and for the most part
sedentary of habit, had suffered much from pain in the right
cheek. For some time it was not considered of much moment,
but, on its continuance, a physician was consulted.
" He found but a single tooth, one of the second molars, in
the superior maxillary of the affected side, and that was in a
semi-decayed state. The gums above the teeth, and for half
an inch on each side of it, were much swollen and of a livid
redness. The tumour seemed spongoid and puffy to the touch,
but there was neither fluctuation nor abscess. The patient's
health had not sensibly deteriorated. She said the tumour on
the gums had existed for many weeks, but had not been at-
tended with any remarkable pain, until the occurrence of that
of which she complained. She described it as being deep in
the cheek, and generally dull, but now and then, for an instant,
sharp and lancinating. She said the tooth, for several years
past, had been accustomed to ache occasionally, but that, not-
withstanding its decayed state, it was very useful, and she had
therefore declined having it extracted.
" The immediate extraction of the tooth was, however,
thought advisable, and with her consent, it was effected. A
week afterwards the spongy tumour of the gum continued, with-
out any abatement of the pain in the cheek. The tumour was
now laid open with a lancet. It contained no matter, but was
filled with those shaggy or shreddy fungi, which are often seen
to occupy tumours or diseased bones. An abscess, or some other
affection of the antrum, was suspected. A perforation was
therefore made in its cavity, and about a table-spoonful of very
dark brown matter discharged, which gave the silver spoon
into which it was received a thin coat of the blackest pigment,
and, on account of its offensive smell, was almost insupportable.
18*
210 EFFECTS OF DISEASED TEETH AND GUMS.
There was a difficulty in reaching the disease with remedies,
and it was thought advisable to enlarge the communication
with the antrum. The crown of a small trephine was accord-
ingly applied to the alveolar portion of the superior maxillary,
the soft parts having been first dissected up, and a correspond-
ing portion of the bone was removed. The end of the little
finger could now be introduced into the antrum, the inner sur-
face of which, it was easy to perceive, had, at several points,
been denuded of the pituitary membrane and of the periosteum.
" The disease was now fairly exposed, and nothing could ex-
ceed the offensiveness of its fetor when not corrected by suitable
dressings. The usual antiseptics and detergents were locally
applied, while tonics and a generous diet were prescribed to
sustain the patient's general health, and every effort was made
to substitute a healthy purulent secretion for the ill-conditioned
and offensive discharge from the antrum, but without any effect.
"An irremediable necrosis seemed to have taken possession
of the superior maxillary of the affected side, which soon began
to come away by piecemeal. In the mean time the soft parts
about it were laid waste by the phagedenic character of the
ulceration, and the eye of the same side became seriously af-
fected. The disease now progressed rapidly. The perforation
of the antrum was made on the 11th of March, 1821, and on
the 26th of May following, the patient was found in a perfect
state of apoplexy, the disease having penetrated the basis of
the cranium and seized upon the brain itself. On the 30th of
the same month she expired, and was thus released, by death,
from the most horrible disease that can be conceived, but which
had its origin in nothing more extraordinary than a neglected
carious tooth."
PHTHISIS PULMONALIS INDUCED BY DENTAL IRRITATION.
Dr. M----, an eminent practitioner of this State, reports
the following extraordinary case :
Case 11. "Inthe summer of 1834,1 was called to visit Mr.
D. M----, who had come into this neighbourhood to obtain
EFFECTS OF DISEASED TEETH AND GUMS. 211
the benefit of the country air, having resided in Baltimore from
his earliest youth. When I saw him he was in the last stage
of phthisis pulmonalis. He gave me the following history of
his case:
"About eight years previous he felt a soreness and tumefac-
tion in his gum at the posterior part of his mouth, and as he
had never cut the dentes sapientise, he thought the disquietude
was occasioned by the progress of one of these teeth, and in
consequence gave it no attention until the soreness and inflam-
mation had extended themselves over the whole surface of his
mouth and fauces. The tooth not having protruded through
the gum, he consulted his family physician, who advised imme-
diate extraction.
" In conformity with this advice, he called on an eminent
dentist of Baltimore, but the tooth not having presented itself
and the cause of his suffering being doubted, the operation
was deferred. His sufferings, however, having become intole-
rable, and the irritation having extended itself to the lungs,
producing considerable uneasiness, he determined, if it were at
all possible, to have the tooth removed. A few days after, he
stated his determination to the dentist. The gum was freely
split, and after considerable pain and difficulty, the tooth ex-
tracted. The inflammation in his mouth and fauces immedi-
ately subsided, his appetite returned, and his general health
soon became as good as formerly.
"About three years subsequent to this, his mouth and fau-
ces, under similar circumstances, and from the same cause,
became very sore and painful. The inflammation soon reached
the lungs, and established a confirmed phthisis pulmonalis. He
died a few weeks after my first visit."
The subject of this case was doubtless the victim of tubercu-
lar disease of the lungs. The tubercles were latent until the
dental irritation was propagated to them, when inflammation
and softening rapidly ensued. The teeth, though they did not,
strictly speaking, cause the consumption, evidently precipitated
it, and perhaps anticipated the fatal development by many
years. The same physician, to whom we are indebted for the
212 EFFECTS OF DISEASED TEETH AND GUMS.
preceding case, has recorded another, in which the fatal result
was more directly attributable to dental suffering. He says :
Case 12. "My friend, Dr. L----, of Frederick, Md., was
called to visit a young gentleman who laboured under violent
pain of the face and inferior maxillary, with very great tume-
faction of the gums. His sufferings were traced to the roots of
one of his molar teeth, which had been broken in an attempt
to extract it. His gums and the glands of his throat became
so much enlarged, that it was impossible to remove the offend-
ing portion of the tooth. The inflammation, notwithstanding
the skilful exertions of the physician, rapidly increased, high
and intractable fever supervened, deglutition became totally
obstructed, and, in a few days, he died."
Case 13. A case very similar to the last, though more for-
tunate in its results, came within my knowledge lately. A
dentist was applied to to extract a molar tooth, which he did.
He told the patient that the tooth had come out entire; and
dismissed him. Violent inflammation ensued, a large abscess
formed, and the life of the man was brought into imminent
jeopardy. His physician called in a surgeon, and both being
baffled, an eminent dentist was consulted. He suspected that
a fragment of the root had been left, and after great difficulty,
owing to the swelling of the parts, he succeeded in extracting
it, and saving the life of the patient.
Dr. Fitch, in his "System of Dental Surgery," narrates a
number of cases of constitutional disease, evidently caused by
the protracted irritation incident to diseased conditions of the
tqeth and gums, from which I select the following:—
Case 14. "In February, 1827, Dr. Samuel Jackson called
and requested me to see Mrs. R----, living in Tenth above
Walnut Street, who, he said, was labouring under every symp-
tom of confirmed phthisis pulmonalis, and also appeared to
suffer greatly from a diseased state of her mouth. I, accord-
ingly, called on Mrs. R----. The following were her symp-
toms : great emaciation, hectic fever, almost constant cough,
nearly a total loss of voice, articulation being extremely diffi-
cult, the voice as if speaking through a trumpet. Dr. Jackson
EFFECTS OF DISEASED TEETH AND GUMS. 213
said that in the practice of seven years in the hospital, alms-
house, and private practice, he had never seen a person re-
cover from the symptoms under which Mrs. R----laboured.
" The following was the condition of Mrs. R----'s mouth.
About two years before she had the upper wisdom-tooth of the
left side plugged, and the plug was pounded in by a mallet and
punch. The fangs of the tooth converged together so as to
form a fang of a conical shape. In hammering in the plug
the socket was much injured. A chronic inflammation took
place, which passed back over the palate, half arches, and
some distance down the oesophagus, also over the glottis, epi-
glottis, and larynx. It then travelled forwards on the right
side of the under jaw, and caused to inflame and slough away
all the sockets and teeth of the lower jaw but one, which was
the left dens sapientise. When I first saw Mrs. R----, the
process of inflammation, sloughing, and gangrene was at its
height. Extensive exfoliations of the jaw were taking place.
Dr. Jackson and myself concluded that the patient could not
live more than four weeks.
" Treatment. I at once removed all the teeth that were
loose, and whose sockets were in a state of gangrene and ex-
foliation. I likewise, as fast as possible, removed all the dead
bone, and directed the patient to wash her mouth constantly
with a strong infusion of powdered galls. In about eighteen
days her mouth was perfectly well. The amendment of her
general health was surprisingly rapid. In five weeks she was
able to take long walks in the street, and in six months she
was restored to perfect health. Nearly six years have passed
away, and she still continues perfectly well."
As a corollary to this case, Dr. Fitch very properly ob-
serves: "I think we may safely infer, although diseased teeth
do not, in every instance, excite general diseases of the sys-
tem and of the lungs, yet, like an insidious enemy, they are
ever ready to unite with or exasperate other causes, so as
finally to undermine the powers of the system. I would ear-
nestly solicit the attention of the medical faculty in general to
a critical inquiry into the state of the teeth in all cases of pul-
214 EFFECTS OF DISEASED TEETH AND GUMS.
monary affection; and there is hardly a doubt that their in-
quiries would result in the general conclusion that a diseased
state of the teeth and gums does very frequently excite pulmo-
nary affections, especially in persons predisposed to them, and
always aggravates these complaints, let them be excited by
whatever cause they may."
Professor Chapman, of the University of Pennsylvania, in
his lectures related the following case:—
Case 15. " Some years since a lady came from a distant
part of the country to this city, in pursuit of medical aid, and
placed herself under the care of Dr, Chapman. He found her
labouring under every symptom of obstinate dyspepsia, by which
her health and strength were greatly impaired. His correct
and well-known acumen in the pathology of disease immedi-
ately led him to inquire into the state of her gums and teeth.
He found her gums in a high state of inflammation, and many
of her teeth loose and diseased. By the direction of Dr.
Chapman she applied to one of our most respectable dentists,
and had her mouth and teeth placed in a healthy condition,
and with the return of health in her teeth, gums, &c, every
dyspeptic symptom left her, and she became quite well.
" After some time had elapsed, and the lady's health seemed
confirmed, she had a few artificial teeth placed in her mouth to
supply some which she had lost, which, either from not being
well adapted and properly inserted in her mouth, or from some
peculiarity in the lady's constitution, proved a source of irrita-
tion, and brought on a return of the distressing dyspeptic symp-
toms, which compelled her to dispense entirely with the artifi-
cial teeth, when her health was again completely restored."
The celebrated Baglivi observes, that "Persons whose teeth
are in an unclean and viscid state, though daily washed, have
universally a weak stomach, bad digestion, and offensive breath,
headache after meals, generally bad health and low spirits. If
engaged in business or study they are irritable and impatient,
and are often seized with dizziness. From weakness of the
stomach they are naturally somnolent, scarcely wakeful in the
morning, and never satisfied with sleep."
EFFECTS OF DISEASED TEETH AND GUMS. 215
Hufeland enumerates sound teeth among the signs of long
life. "For good digestion," he says, "good teeth are ex-
tremely necessary, and one, therefore, may consider them
among the essential properties requisite for long life : and in
two points of view—First, good and strong teeth are always a
sign of a sound, strong constitution, and good juices. Those
who lose their teeth early, have, in a certain measure, taken
possession of the other world, with a part of their bodies.
Secondly, the teeth are a great help to digestion, and, conse-
quently, to restoration."
Mr. Liston observes:* "From the presence of carious
teeth, or decayed portions of teeth, many evils, both local and
general, ensue, besides inflammation and abscess. They are
frequently the cause, and the sole cause, of violent and con-
tinued headaches; of glandular swellings in the neck, terminat-
ing in, or combined with, abscess ; of enlargement and inflam-
mation of the tonsils, either chronic or acute; of ulcerations
of the tongue and lips, often assuming a malignant action from
continued irritation; of painful feelings in the face, tic-doulou-
reux, pains in the tongue, jaws, &c; of disordered stomach
from affection of the nerves, or from imperfect mastication; of
continued constitutional irritation, which may give rise to seri-
ous diseases."
Case 16. (Dr. Fitch.) "Mrs. S----, aged about 38 years,
was sent to me, by one of our most eminent physicians, with a
request that I would examine her teeth, and perform such ope-
rations upon them as I judged proper, to render them and the
gums healthy. The state of this lady's health was miserable;
she was harrassed by the most distressing symptoms of dys-
pepsia. Her digestion was very imperfect, the stomach irri-
tated, loss of appetite, and a most melancholy depression of
spirits. When she first called it was necessary for her to re-
pose herself for some time, before she could have her mouth
examined.
" Upon examining her teeth and gums, I found nearly all the
former in a state of disease, and the latter were in a state of
* Liston's Surgery.
216 EFFECTS OF DISEASED TEETH AND GUMS.
suppuration, much inflamed and swollen. A considerable de-
posit of tartar was formed around the necks of the teeth; in
several instances their fangs were denuded of the gum by the
deposit of tartar, and, in fine, her mouth was in a general state
of disease. I need not detail the several operations by which
her mouth and teeth were rendered healthy. Suffice it to say,
that in about four weeks her mouth was perfectly Avell. The
amendment of the general health, after the first operations
were performed on her teeth, was also surprising, and would
have been entirely so to any person not acquainted with the
immense sympathy between the mouth, gums, &c, and the
stomach.
" Within five weeks after I saw her, every vestige of disease
in her digestive organs left her, and she was apparently in per-
fect health."
Case 17. Neuralgia from diseased teeth.—(Prof. Harris.)
" The following is one of the many cases of tic-douloureux or
neuralgia faciei, produced by disordered teeth, that have come
under my own observation.
" The subject of it was a lady about forty years, of sedentary
habits, and naturally of rather a nervous temperament. For
several years she had been afflicted at times with a most dis-
tressing and painful affection of her face, which was pronounced
by her physician to be tic-douloureux. The pain was some-
times so acute and lancinating that it almost deprived her of
reason. It generally commenced near or a little anterior to
the angle of the superior maxillary bone, thence it darted
across the face to the alse of the nose, and then to the temple,
forehead, and angle of the eye, accompanied with frequent and
sudden transitions from one side to the other, twitching and
tremors of the muscles of4the affected parts, and with a preter-
natural flow of saliva. Her face, and sometimes the whole of
her head, were rendered so sore by these paroxysms, that the
slightest touch would produce pain.
"These paroxysms, although they were generally of short
duration, frequently recurred as often as ten or fifteen times in
twenty-four hours, and sometimes lasted ten, sixteen, and even
EFFECTS OF DISEASED TEETH AND GUMS. 217
twenty days, after which they would gradually subside, having
subjected her during their continuance to the greatest misery,
and leaving after their subsidence a dull, heavy pain in one or
both jaws. A sensation similar to this was always (especially
in the right side of the upper jaw) experienced several days
before one of these attacks, which often enabled her physician
to ward them off, and finally led to the detection of their
cause. These spasms were more severe and occurred more
frequently in cold, damp, and wet than in warm and dry wea-
ther.
"Bark, quinine, carb. ferri, stramonium, belladonna, and
various other tonics and antispasmodics were prescribed, but
without any apparent beneficial effect. Leeching, sinapisms,
and epispastics were also of no avail. As a last resort, it was
determined to divide the affected nerve; but before the opera-
tion the physician was induced by the pain in the jaws, always
preceding these paroxysms, to examine the condition of the
patient's teeth. The examination showed them to be in a very
unhealthy state. The molares generally, and especially those
on the right side, were involved in complicated caries. The
gums were much tumefied and inflamed, and very sensitive.
" Her teeth and gums, from the diseased condition in which
they were found, were immediately supposed to have some
agency in producing the affection of the face. A consultation
with me was therefore proposed, and I was requested to visit
her.
" On examining her teeth, I found that eleven were so much
decayed as to render their restoration impracticable. It was
therefore determined to remove them immediately, but it was
not thought proper, owing to her extreme debility and the state
of her nervous system, that more than two or three should be
extracted at one time.
" So great was her agitation at the mere thought of the ope-
ration, that notwithstanding the agony she suffered, she could
not, on my first visit, be persuaded to have even a single tooth
extracted, but requested me to call on the next day, when she
19
218 EFFECTS OF DISEASED TEETH AND GUMS.
promised she would submit to the removal of as many as she
possibly could.
" I accordingly called on the following day, and to the as-
tonishment of her friends, she allowed all her jaw teeth that
were carious, eleven in number, to be at once extracted. The
operation at once revealed the cause of her disease. The roots
of three of these teeth were very much enlarged by bony depo-
sitions. One of the fangs, was, at its extremity, about the size
of a pea. Those of the other two were not quite so large, but
a disposition to exostosis was manifested by all. With the re-
moval of these teeth, all symptoms of pain entirely vanished,
nor have they, to my knowledge, returned since."
Case 18. Death caused by the extraction of a tooth.—(Jour-
dain.) "A citizen having submitted to the extraction of a
tooth, the gums became gangrenous; the gangrene reached the
brain and caused death." The same author reports a case of
Case 19. " Convulsions and death caused by the shortening
of a tooth longer than the others. A nun of Padua having had
a tooth shortened in order to get rid of the deformity, died im-
mediately in an epileptic convulsion. A small fragment of
nerve was discovered in the section of the tooth."
This case and others, which fortunately have not terminated
so seriously, should be a warning to all operators upon the
teeth, not to inflict sudden and violent pangs. Experience
shows us that a great amount of pain can be endured, if slowly
and gradually inflicted, while instinct teaches us all to dread
sudden pangs, even of more moderate intensity. Even in ex-
tracting a tooth, it is better to operate gradually rather than
wrench it out with a sudden and violent effort. If pain be
gradually inflicted, the nervous system, conscious of the coming
trial, summons up all its powers of endurance; but when taken
by surprise, the shock is severely felt and the consequences
may even be fatal, as in the case just quoted.
Pain is a great evil. It should never be inflicted unneces-
sarily, and when necessity occurs, the inflictor should use all
possible means to render the suffering as tolerable as possible.
Moreover, there is great difference in individuals as to the
EFFECTS OF DISEASED TEETH AND GUMS. 219
tolerance of pain; even as to the perception of it. Many per-
sons will suffer terribly from operations which would not cause
serious pain to others. The same persons will suffer much
more at one time than another. All these considerations are
well worthy the attention of the dentist.
Very severe headache of the neuralgic kind, is frequently
caused by diseases of the teeth and the irritation produced by
the pressure of dead roots in the jaw. In illustration of this,
I will quote a few from many cases:
Case 20. " Inveterate headache cured by the extraction of
many roots of carious teeth.—(Fabricius Hildanus.) A lady was
afflicted with a very severe continued pain in the left side of her
head. The violence of the pain was chiefly experienced in cold,
damp weather. By the advice of her physicians, she had tried
a great many remedies, internal and external, but without suc-
cess. Finally, I was called to see her. I carefully examined
all the causes of her malady. I learned from her that for six
months she was afflicted with an agonizing pain in the teeth of
the left jaw. After this, the pain somewhat abated, but left a
similar one in the corresponding side of the head. I conjec-
tured from that the headache was caused by the roots of dead
teeth. Upon examining the upper jaw, I found four carious
teeth whose roots were deeply planted. I advised her to have
them extracted, to which she cheerfully consented. I then
purged her freely and applied cups to her neck and shoulders,
and directed an aposeme to be taken during four days in the
morning. On the fifth, while fasting, I extirpated the roots."
After other treatment of a kind then in vogue, but of no
utility, the lady recovered.
Case 21. Headache dependent upon the teeth.—(M. Petit.)
"The late Princess of Conde" recommended to her physicians
one of her protegees, to be cured of a headache of five years'
duration. She had been bled twenty times, and finally M.
Petit was requested to bleed her in the throat. This surgeon
having examined the patient, was led from her complaint of a
pain and weight in the lower jaw, to look into her mouth. He
found some irregularity in the teeth, and upon close inspection
220 EFFECTS OF DISEASED TEETH AND GUMS.
ascertained that the patient had an unnatural number of them,
there being eighteen in the lower jaw. The second molar on
each side appearing to be most crowded, he took them out, and
in twenty-four hours the lady was cured of a headache of five
years' continuance."
Case 22. Ophthalmia and loss of an eye by abscess upon the
teeth.—(Fab. Hil.) "A lady of Cologne was for a long time
tormented with inflammation upon the last molar of the left
side, which was carious. By the advice of physicians, she was
frequently purged, and cupped between the shoulders, but as
she refused to have the tooth extracted, the continued irrita-
tion of the gums occasioned inflammation of the eye on the
same side, which finally destroyed the sight."
Case 23. Ear-ache cured by extracting a tooth.—(Jour-
dain.) "A lady had long suffered with severe pain in the
right ear. All the ordinary remedies were used without effect
At length she was asked if she had any carious teeth. She
replied that she had not: that all her teeth were good and
never gave her any inconvenience. Nevertheless, her mouth
was carefully examined. At first sight all seemed right, but a
close inspection showed external caries of the dens sapientise.
As the pain of the ear extended to the angle of the jaw, and
even a little along its base, I persuaded the lady to permit me
to extract this tooth, which I suspected to be the real cause of
the mischief. Three days afterwards, the lady was perfectly
and permanently relieved."
A similar case is reported by Mr. Koeeker.
Dr. Darwin relates several cases of serious disorder produced
in adjacent parts and in the general system by diseased teeth.
The following are very remarkable :
Case 24. "Mrs. ----, about thirty years of age, was
seized with great pain about the middle of the right parietal
bone, which had continued a whole day before I saw her, and
was so violent as to threaten convulsions. Not being able to
detect a decaying tooth or tender one, by examination with my
eye or by striking them with a teaspoon, and fearing bad con-
sequences from her tendency to convulsions, I advised her to
EFFECTS OF DISEASED TEETH AND GUMS. 221
permit the extraction of the last tooth of the under jaw on the
affected side, which was done without any good effect. She
was then directed to lose blood and to take a brisk cathartic,
and after that had operated, about sixty drops of laudanum
were given her, with large doses of bark, by which the pain
was removed.
"In about a fortnight she took a cathartic by ill advice, and
the pain returned with greater violence in the same place, and
before I could arrive, she suffered a paralytic stroke, which
affected her limbs and her face on one side, and relieved the
pain of her head.
" About a year afterwards I was again called to see her on
account of a pain as violent as before, exactly on the same
part of the other parietal bone. On examining the mouth, I
found the second molaris of the under jaw, on the side before
affected, was now decayed, and concluded that this tooth had
occasioned the stroke of the palsy, by the pain and consequent
irritation it had caused. On this account I earnestly entreated
her to allow the sound molaris of the same jaw, opposite to
the decayed one, to be extracted ; which was forthwith done,
and the pain of her head immediately ceased."
Case 25. (Darwin.) Since the above was first published,
I have seen two case which were very similar, and seemed
much to confirm the above theory of sympathetic hemicrania,
being, perhaps, always owing to the sympathy of the mem-
branes about the cranium with those about diseased teeth.
" Lord M. and Mr. B., of Edinburgh, both of them about
the middle of life, were afflicted with violent hemicrania for
about two years; in the beginning of which time, they both
assured me that their teeth were perfectly sound, but on in-
specting their mouths I found all the molares were now so de-
cayed as to have lost their crowns. After having suffered pain
for sixteen or eighteen months, almost incessantly, in different
parts of their heads, they had each a hemiplegia, from which
they gradually recovered as much as paralytic affections gene-
rally do recover. All the stumps of their teeth, which were
useless, were directed to be extracted, as the swallowing so
19*
222 effects of diseased teeth and gums.
much putrid matter from decaying bones, seemed to injure
their digestion."
Sir Henry Halford, in a paper on tic-douloureux, read before
the College of Physicians, related the following cases which
came under his own observation:—
Case 26. "A lady, forty years of age, suffered under the
violent form of tic-douloureux, at Brighton, notwithstanding the
careful attention and skill of a very judicious physician there.
On returning to town, it was observed that the rending spasms,
by which the disease is marked, were frequently preceded by
an uneasiness in one particular tooth, which exhibited, how-
ever, no signs of unsoundness ; but the constancy of this symp-
tom was enough to justify the extraction of the tooth in this
instance; and on its being drawn, a large exostosis was ob-
served at the root of the tooth, and the lady never suffered
more than very slight attacks, and these very seldom, after-
wards."
Case 27. (Sir Henry Halford.) " The late Earl of C. un-
derwent martyrdom by this disease, and excited the warmest
sympathy of his friends by the agonies he sustained for many
years. He submitted to the operation for the division of seve-
ral branches of the fifth pair of nerves repeatedly, by Sir
Everard Home and Mr. Charles Bell, without obtaining more
than temporary relief. At length he was seized with apoplexy,
and lay insensible for some days, and in great peril, from the
attack, but finally recovered. After the apoplexy the parox-
ysms of tic-douloureux became less frequent and less severe,
and were administered to satisfactorily by an ingenious physi-
cian, who wrote his inaugural exercise on the disease. For
the last year or two of his life, his lordship ceased to suffer from
the tic-douloureux, and died at an advanced age, without any
marked malady. While I attended him he underivent repeated
exfoliations of the alveolar process of the teeth, which I thought
occasioned his torment."
Doubtless, the exfoliations being completed, and the disease
of those parts removed, the irritation ceased, and the patient
recovered. It is melancholy to think of the protracted suffer-
effects of diseased teeth and gums. 223
ing which rendered the life of this unfortunate nobleman
wretched and comparatively useless, and which might probably
have been cured with little difficulty, if such men as Sir Eve-
rard Home and Mr. Charles Bell had been aware of the sym-
pathetic disorder which may be, and often is, produced by
diseased teeth. These eminent gentlemen not only did no
good, but they inflicted great additional pain on their unhappy
patient; but, doubtless, he would have fared little better in
other hands, for the profession, while searching with powerful
microscopes for causes of disease, entirely overlook the teeth,
though reason and experience, the demonstrations of the ana-
tomist, and the voices of the most discerning of the masters
in medicine, are continually pointing them to the important
sympathies of these organs.
From its relation to the teeth of the upper jaw, the fangs of
which frequently perforate its floor, the antrum is often the
seat of disease of a serious and sometimes fatal character.
resulting from irritation produced by diseased conditions of
these highly sensitive organs. Indeed, the teeth are directly
or indirectly concerned in most of the diseases of the antrum.
Boyer, Deschamps, Harris, and most others who have written
upon this subject, give united testimony to this fact.
Dr. Harris, in the second edition of his valuable work on
Dental Surgery, records several cases in evidence of the
facility with which diseased teeth may propagate disorder to
the antrum, and the formidable diseases which may result
therefrom. I select the following:—
Case 28. (Dr. Harris.) "Mrs. L., at twenty-seven or
twenty-eight years, of a scrofulous habit, had been at times
affected, for more than two years, with a deep-seated pain in
the right side of her face, midway between the orbit and the
alveolar ridge, and on closing the left nostril, and making a
violent expiration through the right, discharged a slightly, yet
perceptibly fetid mucous matter, which occasionally excoriated
the mucous membrane lining this cavity of the nose. The
pain, from the fact that it was most severe in cold and damp
weather, was thought to be rheumatic. General and local
224 effects of diseased teeth and gums.
bleeding, fomentations, mustard plasters, purgatives, anodynes,
tonics, and many other remedies, had been employed in vain.
"A severe paroxysm of toothache, about this time, more
than two years since she first felt the deep-seated pain in her
cheek, induced her to apply to me.
"On examining her mouth, the crowns of the second molar,
dens sapientise, and first bicuspis of the affected side, were
found to be destroyed by caries; the gums, covering the sockets
of their roots, were inflamed and very sensitive. It was the
roots of the wisdom or third molar tooth that ached. Extrac-
tion being the only remedy that held out the least prospect of
relief, I at once proposed the operation, and, at the same time,
urged upon her the importance of having the roots of the
second molar and first bicuspid removed. A great deal of per-
suasion was necessary to obtain her consent, she being of an
exceedingly nervous and timid disposition; but, having made
up her mind to submit, she determined to have the operation
performed immediately. She had no cause to regret it; for
not only was she freed from the annoyance which the roots
had occasioned to her tongue, gums, &c, but the operation was
also followed by a speedy subsidence of the pain in the cheek,
and a cessation of the fetid discharge from the nose."
Case 29. (Dr. Harris.) "In December, 1841, I was con-
sulted by Mr. S. M. J----, twenty-three years of age. He had
been affected for several months with a dull heavy pain, which,
as he said, seemed to be seated deep in his right cheek; and
as in the case last described, a fetid mucous matter was dis-
charged from the nostril of the affected side, on making a
violent expiration, though it, with the other nasal cavity,
closed. His teeth, to all appearance, were perfectly sound;
but his gums, around the first and second bicuspides and first
molar, were inflamed, spongy, and slightly ulcerated between
their edges and the necks of the teeth, from which they had
separated, to the edge of the alveoli. This condition he at-
tributed to a blow which he had received by a fall, upon these
teeth, about two years before. It was immediately followed
by pain, inflammation, and, in about two months, the exfolia-
effects of diseased teeth and gums. 225
tion of several small portions of the alveolar processes, which
came out through the gum. . These were the only unpleasant
effects which he experienced at the time, but afterwards there
was always a slight soreness in the teeth that had received the
injury. This gradually extended higher and higher into the
substance of the jaw, until about four months previously to his
calling upon me, when its place seemed to be taken by the
kind of pain first described, and soon after, the fetid discharge
from the nostril was discovered.
" That the deep-seated pain in the right superior maxillary
was occasioned by inflammation of the mucous membrane which
lined the sinus, I could not doubt; and that this had resulted
from the alveolar irritation caused by the violence that had
been inflicted upon the bicuspides and first molaris, to me, was
equally evident. I therefore proposed the extraction of the
teeth, to which he consented. Three weeks afterwards the
pain in his jaw had entirely disappeared."
Case 30. (Dr. Shepherd.) Neuralgia vs. Toothache.—
" Neuralgia has become a very fashionable disease now-a-days,
and many persons suffer long and severely, and ransack the
whole materia medica in search of remedies; and finally an
examination of the teeth is thought of, the very first thing that
should have been done. In nine cases out of ten of supposed
neuralgia, the extraction of some badly-decayed tooth, which
the suffering individual knows ought to have been out more
than a year ago, perhaps, would cause a subsidence of all
symptoms of neuralgia.
" As a prominent example of the above, I am induced to re-
port the following case :—Miss C. W., a resident of this town,
of delicate constitution, was attacked with severe pain in the
right side of the head, neck and shoulder, about twelve months
ago; and from the severity of the pain, and other circum-
stances attending it, she came to the conclusion that it was ueu-
ralgia; and by concurrence with her medical adviser, her opinion
was confirmed. She used, therefore, all possible remedies for
that disease, without success. In the mean time her attacks
were growing more frequent and more severe; and for the last
226 EFFECTS OF DISEASED TEETH AND GUMS.
two or three months, they occurred daily at precisely five
o'clock in the afternoon, and continued with the most intense
severity until midnight; when the pain would begin gradually
to subside, growing less and less until she was perfectly easy.
These daily attacks came on with such perfect regularity that,
to use her own words, 'five o'clock was a terror to her before
it came.' At this stage of the disease she was in Baltimore,
whether in search of medical advice or not, I do not know;
but while there she consulted Dr. B., an eminent physician of
that city; and he advised her to have her teeth examined, in-
timating that they might be involved; he gave her, at the same
time, a prescription for neuralgia, to be used in case the teeth
were not at fault. With this advice she returned home, and
sent for me, and related to me substantially what I have stated
above. I examined her teeth, and found the inferior wisdom-
tooth of the right side decayed to the nerve, and I gave it as
my opinion that all her 'neuralgia' originated there; I there-
fore advised its immediate extraction, to which she assented.
The first day after the tooth was extracted she had very little
pain, the next still less, and the third none at all.
" Thus a perfect cure was effected, of what perhaps nine-
teen out of twenty of our very best physicians would have pro-
nounced neuralgia, without once thinking of the teeth, by the
simple extraction of a bad tooth.
"I do not offer the above as a case of rare occurrence; I
have often met with such in the course of my dental practice,
as doubtless dentists in general have; and I cannot account
for the fact, that physicians so generally prescribe for neural-
gia, without once thinking of the teeth, when there is so strik-
ing a similarity to true neuralgia in many cases of toothache.
In the case above, there were some striking peculiarities, which
would have been, perhaps, sufficient to screen the most vigilant
from the charge of superficiality in the examination of his
patients, though he might have forgotten the teeth. The dura-
tion, the regular increase of pain, the extent to which the sys-
tem was affected, and when the attacks became daily, the per-
fect uniformity as to the time of commencement, together with
EFFECTS OF DISEASED TEETH AND GUMS. 227
the nervous temperament of the subject, were all circumstances
well calculated to mislead the judgment; and yet this proved
to be a case of toothache, a fact which might have been proved
just as easily in its very commencement, if an examination
of the teeth had been once thought of as a matter of any
consequence."
The cases above mentioned are but a few of a great number
that might be collected, showing the importance of the teeth,
in their healthy and unhealthy conditions, to the well-being of
the whole economy. Surely those here presented will be suf-
ficient to arouse the physician to the necessity of regarding
the agency of these organs in the production and continuance
of diseases, and to impress the dentist with the importance of
pursuing his vocation, not as a mere mechanical craft to be ex-
ercised upon isolated excrescences of the body, but as a part
of curative science, embracing in its relations, the knowledge of
diseased life as manifested by many organs, or by them all.
The general surgeon must be more than a mere cutter of flesh
or setter of bones; the obstetrician more than a man midwife;
and the dentist is unworthy of the confidence'or respect of the
community who is not well-informed upon the nature and his-
tory of disease, and the part which the organs upon which he
operates perform in its causation, or modification.
It is strange that physicians have paid so little attention to
this subject. It would be less so, if so many of the ablest
writers among them had not so earnestly and repeatedly pro-
claimed the importance of giving to the teeth their due con-
sideration in the diagnosis of disease. But when Hunter, Rush,
Darwin, Halford, Chapman, and other such men, have taken
special pains to direct the attention of the profession to the
subject, it is unaccountable that their voices have been alto-
gether unheeded.
Unfortunately, it has now become the fashion to study patho-
logy in the corpse-house, rather than by the bed-side; to make
microscopical inquisitions of disease upon the dead, rather than
to observe its phenomena in the living. From the very neces-
sity of the case this necrological research falls into the hands
228 EFFECTS OF DISEASED TEETH AND GUMS.
of the young and inexperienced, and these become writers and
teachers before they have been to the only sure school of medi-
cine, the chamber of the sick. As the teeth may be seen by
the naked eye, they are not likely to be considered of much
importance. Had they been discernible only by the micro-
scope, they doubtless would have received due consideration.
It is said that the celebrated Pennant, by use of the micro-
scope, lost the use of his eyes. I fear that this is too com-
monly the fate of his successors.
I fully coincide with Dr. Fitch, who well remarks: "We
are not to contemn the diseases of the teeth because they seem
insignificant. Many persons are formed of. a fibre so fragile,
as to be broken by the slightest shock; of a stamina so deli-
cate, as to be affected by the slightest impression. Disease in
its steps at first is, as it were, soft and hesitating, weak in its
powers, and slow in its progress. But every instance of in-
dulgence, and each succeeding advantage gained, confirms its
step, increases its powers, and hastens its progress, and what
but a moment ago seemed a thing too insignificant to mention,
now rises a monster that derides human effort, and whose sting
is the arrow of death.
"Almost inappreciable are the beginnings of many fatal dis-
eases ; and could the grave reveal its secrets, I have not a doubt,
when I consider the number of diseases produced by diseased
teeth, that it would be found that thousands are there, in whom
the first fatal impulse was given by a diseased state of these
organs; and could I raise my voice so as to be heard by every
medical man in America, I would say to them, attend to your
patients' teeth, and if they are diseased, direct such remedies as
shall restore them to health; and if in health, such means as
will keep them so."
229
CHAPTER XVIII.
WOUNDS OF THE MOUTH AND FACE.
The face, with all the organs which enter into its structure, is
exposed to the several forms of injury which are known by the
common name of wound.
Surrounded as the human body is by a great number of sub-
stances denser and more resistant than itself, it is liable to have
its tissues separated, penetrated, torn, violently compressed,
or broken asunder. Consisting, also, of a number of ele-
ments constituting organized parts, and held in union by the
mysterious force of vitality, it is also liable to have this union
dissolved by the action of forces more powerful than life, and
to be chemically disintegrated.
As the face from the necessity of the case must be uncovered,
and as from its position it is most liable to be injured by falls
or reached by malicious blows, it is more frequently wounded
than any other part of the body; and owing to the deformity
which attends scarring of the countenance as well as the im-
portance of the organs connected with it, facial wounds require
more nicety in their management than any others.
The mouth is very frequently involved in these injuries, and
the teeth are often displaced or fractured by them. The mani-
pulations required for the reparation of these wounds require
a dexterity only to be acquired by daily observation of the
teeth in their natural positions, and the habit of handling and
operating upon them. The dentist, if believed skilful, is there-
fore often called upon, even by the general surgeon, to aid in
the management of such cases.
In medical language, a wound is a recent lesion or interrup-
20
230 WOUNDS OF THE MOUTH AND FACE.
tion of the continuity of parts from an external cause; but the
term is made to include all hurts received from agents acting
mechanically or chemically upon the surface of the body.
Wounds differ materially from one another, in kind, extent,
position, and character of the parts wounded.
When the parts are merely divided by a clean, sharp instru-
ment, with as little injury to the separated tissues as possible,
the wound is called a Simple Incision—(simple incised wound).
If the parts be rudely torn asunder, the injury is called a
Laceration—(lacerated wound). If the part be violently and
suddenly compressed, so as to rupture some of the small ves-
sels and break or otherwise injure the muscular fibre, skin, &c,
the injury is called a Contusion, or Bruise—(contused wound).
If a pointed instrument be forced into the body, penetrating
tissues, it causes a Puncture—(punctured wound). If a bone
be broken, the wound is called a Fracture. Injuries from
bodies propelled by gunpowder are called (xun-shot wounds,
and from fire, Burns. To these may be added Poisoned wounds,
or those in which a slight puncture or trivial laceration becomes
the means of introducing venomous matter into the system;
such wounds are inflicted by certain insects, serpents, and rabid
animals.
Simple Incised wounds are, per se, the least serious of all
injuries, though from the flow of blood which attends them,
they are generally the most alarming.
In these cases the parts are simply separated, of course not
without injury at the immediate line of division, but without
any which suspends the vital action of the separated surfaces,
or breaks up their relation, so as to render readaptation diffi-
cult.
Of course these wounds may be of the most serious nature,
or immediately fatal, if large vessels be divided or vital func-
tions interrupted by them. In these cases the danger is not
from the nature of the wound, but from the accident of its
seat.
Commonly the most alarming and most dangerous complica-
tion of incised wounds, is the bleeding or hemorrhage which
WOUNDS OF THE MOUTH AND FACE. 231
attends them. This will be greater or less, according to the
size and character of blood-vessels divided, the form of the in-
cision, and the vascular activity, &c, of the patient.
A wound of this character may be attended by venous or
arterial hemorrhage.
A slight incision will commonly be attended by a gush of dark-
coloured blood from the superficial veins. This flows freely for
some minutes, but if the wounded part be not officiously bathed,
and especially if it be bound up, the hemorrhage soon ceases,
and does not again return.
Sometimes the gush is so considerable as to cause the pa-
tient to faint, or, in medical language, to induce syncope.* In
this condition the patient has temporarily lost his conscious-
ness, his skin has become cold, and his pulse ceased to be per-
ceptible.
This state, though apparently very dangerous, is by no means
so, unless the patient has previously been much exhausted. On
the contrary, it is salutary; for it checks the hemorrhage, and
affords time for the permanent closure of the wound in the way
to be described presently.
As the syncope depends upon the want of circulation through
the brain, the patient should be placed in a recumbent position
with his head low. If fainting be feared in any case, this is
the best position and the best means to prevent it.
The arrest of venous hemorrhage depends upon the singular
and most important quality possessed by the blood to solidify
or coagulate when exposed to the air. Without such a provi-
sion, the slightest wounds would be very troublesome, and often
fatal.
As soon as a coagulum forms about the orifice of the wounded
vessel, the bleeding ceases, and the current of blood, finding no
longer an artificial egress, pursues its natural course.
It is evident that if the flow of blood be very great, or if the
wound be very large, the coagulum will be longer in forming a
sufficient barrier to the hemorrhage. For the blood must be
* Syncope, 2vyno7rTu—I fall down.
232 WOUNDS OF THE MOUTH AND FACE.
at rest before it can coagulate, and the amount which, under
these circumstances, will be arrested by the edges of the
wound, etc., and detained until coagulation, will bear but a
small proportion to the current, and will be constantly washed
away by it.
It is in such cases that fainting is sure to occur, and by this
means the flow being stopped, the blood at the moment filling
the wound is arrested and coagulates before the action of the
heart is recovered.
Sometimes, however, it happens that small veins will bleed
obstinately and profusely; owing to the peculiar irritation of
the wounded part or the indisposition of the blood to coagulate.
It is evident that compression of the lips of a wounded vessel
so as to obstruct its channel, is the readiest way to stop the
hemorrhage, and that as the flow of blood in the veins is to-
wards the heart, the pressure should, when these vessels are
wounded, be especially upon the distal extremity of the
wound. Inasmuch, however, as the veins anastomose* freely,
pressure must be exerted upon both sides of the wound.
As soon as the flow of blood through the vessel is arrested,
the blood begins to coagulate at the point where it is impeded,
and in a little while a plug of coagulum effectually stops each
end of the divided vein.
It is never necessary to tie a vein, unless it be of the largest
size, and the operation is always very dangerous. Arteries
may be tied with impunity; but the veins, when thus treated,
are very apt to develope an inflammation of their lining mem-
brane (phlebitisf) which is rapidly propagated to the heart, and
is generally fatal.
Styptics,J of many kinds, have been employed more or less
for ages, for the stay of hemorrhage.
These are astringent substances which corrugate the animal
fibre, thus contracting the orifice of the wound, or articles of a
* Anastomose—communicate by a number of mouths; from Ava, and
^tc/ua., a mouth.
f Phlebitis, from Mail SubsckS will be & per annum, or $1 per number, the postage being paid phe-
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The contents of the last number, as below, will give some idea of the great value of the work:
CONTENTS OF NUMBER XIII.
Part I. Practical Medicine, Pathology, and Therapeutics.
Section 1. General Pathology, -------
2. Diseases of the Nervous System, - - - - -
3. Diseases of the Respiratory Organs, - - - - -
4. Diseases of the Circulatory System, - - - - -
5. Diseases of the Chylopoietic System, -
6. Diseases of the Genito-Urinary System, - - - -
7. Diseases of the Skin, &c, ------
8. Materia Medica and Therapeutics, -----
Part II. Surgery.
Section 1. Symptomatology and Diagnosis of Surgical Diseases,
2. Nature and Causes of Surgical Diseases, - - - -
3. Treatment of Surgical Diseases, - - - - -
4. Rare Surgical Cases, -------
Part III. Midwifery and Diseases of Women and Children.
Section 1. Midwifery and Diseases of Women, - - - - -
2. Diseases of Children, -------
Reports.
1. On the Progress of Practical Medicine, Pathology, and Therapeutics.
2. On the Progress of Surgery.
3. On the Progress of Midwifery, and Diseases of Women and Children.
4. On the Recent Progress of Toxicology and Forensic Medicine.
5. List of Books Received.
6. Bibliographical Record.
7. Index.
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v porous style. We would advise members of the profession to purchase it. It embrace, in a brief space
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16
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Receipts, $1.
Cooley's Cyclopedia of Practical Receipts, $1 50.
Mackenzie's 5000 Receipts, $1 25.
Arnott's Elements of Physics, $2 50.
Berzelius on the Blowpipe, $1 25.
Mohr & Redwood's Pharmacy, $3 50.
Solly's Syllabus of Chemistry, $1 25.
Griffith's Chemistry of the Seasons, $1.
Knapp's Chemical Technology, 2 vols. $7.
Bird's Natural Philosophy, $1 50.
Overman's Practical Mineralogy, Assaying, and
Mining, 75 cents..
De la Beche's Geological Manual.
Kirby & Spence's Entomology, $2.
Knox on the Races of Men, $1.
Lardner's Handbook of Natural Philosophy.
Muller's Physics and Meteorology, $4.
FAMILY MEDICAL WORKS.
The Family Medicine Chest Companion, $1 50.
Reese's Family Medical Guide, $3.
Bull on the Maternal Management of Children,
75 cents.
Gunn's Domestic Medicine, $3.
The Family Medical Library, S3.
VETERINARY MEDICINE.
Clater and Skinner's Farrier, 1 vol. 12mo., 75 cis.
Youatt on the Horse, by Skinner, $1 50.
Youatt and Clater's Cattle Doctor, 1 vol. 75 cts.
Youatt on the Dog, by Lewis, $1 50.
Youatt on the Pig, 75 cents.
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