.. '•* *» •*£ *m i w ^ Wr.* *er **r.Jj ■: ■ .'ii-, M tin tffc Y:f&«:^ :***M If ^^ »:&»:«/ rf" '"-4J? Surgeon General's Office ■NIP ''ec&cn, W Ha ■\; •«Ei *z5^% UK* 4^fc»^^ SYSTEM DENTAL SURGERY. IN THREE PAR'A. I. Dental Surgery as a Science. II. Operative Dental Surgjsk.y. III. Pharmacy connected with Dental Surgery. BY \ V SAMUEL SHELDON gTCH, M. D. SURGEON-DENTIST. Dentium curam habeto ut bene digeras et diu vivas: laxatis dentibus laxantur et chyloseos omcinae: hinc mille malorum occasiones.—Baglivi. XIII. NEW YORK1: G. & C. & H. CARVILL—108 BROADWAY. 1829. PC4U SOUTHERN DISTRICT OP NEW-YORK, Sis. BE IT REMEMBERED, That on the seventeenth day of February, A. D. 1829, in the fifty-third year of the Independence of the United States of America, G. & C. & H. Carvill, of the said District, have deposited in this office the title of a book, the right whereof they claim as proprietors, in the words following, to wit: " A SYSTEM OF DENTAL SURGERY. In three parts. I. Dental Sur- gery as a Science. II. Operative Dental Surgery. III. Pharmacy con- nected with Dental Surgery. By Samuel Sheldon Fitch, M. D. Sur- geon-Dentist.—Dentium curam habeto ut bene digeras et diu vivas: laxatis dentibus, laxantur, et chyloseos officinae: rune mille malorum occasiones.—Baglivi. xm." In conformity to the Act of Congress of the United States, entitled " Ar Act for the encouragement of learning, by securing the copies of Maps Charts, and Books, to the authors and proprietors of such copies, during tht time therein mentioned." And also to an Act, entitled " An Act supplement- ary to an Act, entitled an Act for the encouragement of learning, by securing the copies of Maps, Charts, and Books, to the authors and proprietors of such copies, during the times therein mentioned, and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints." FREDERICK J. BETTS, Clerk of the Southern District of Neio-York. R. & G. S. WOOD, PRINTERS. Qt/Q/Lt*^ 0&& //%i%^f 4*tm**++** AS A SMALL TESTIMONY #F RESPECT, FOR THAT URBANITT WHICH CHARACTERISES THE ACCOMPLISHED GENTLEMAN IN PRIVATE LIFE; AND FOR THOSE SPLENDID TALENTS AND EXTENSIVE ACQUIREMENTS WHICH HAVE EXALTED HIS PUBLIC CHARACTER TO AN ENVIABLE HEIGHT OF REPUTATION ; THIS WORK IS RESPECTFULLY DEDICATED TO NATHANIEL CHAPMAN, M. D. PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA: BY HIS FRIEJVD MJVD HUMBLE SERVANT, THE AUTHOR. N •►» % *v VIS v vV\\. V ^ * I PREFACE.* In presenting the following "System of Dental Surgery," to the American Medical Public, the Author feels himself called upon to apologize for so bold an undertaking, before his temples were frosted by experienced years, or his dicta had become " law" in his profession. Conscious of the great want of a good work upon this subject, and anxious to fill in some degree a hiatus in English Medical Literature; the production was undertaken, not so much that itself would affect all these objects, but that by uniting a part of what is now known upon it, the defects might attract the notice of some more intelli- gent eye, and arouse a spirit that would approximate the science to some degree of perfection. Pursuing this object, the author has, in nearly all cases, adopted the language and opinions of those writers upon the different parts of this science and art, which are in accordance with his own : he has done this, that the authorities might be known, and his own responsibility diminished : for why should he tempt the bow of Ulysses alone ? If, at any time, he has differed from the opinions of others, he has done it without giving definite reasons, which are still left to the judgment of the reader. Perhaps it may not be amiss in this place to mention a few of the names whose opinions have been noticed, and from whose writings, to a considerable extent, materials for this work have been drawn. Of the French. Martin, Fauchard, Bourdet, Jourdain, Duval, La Forgue, Dellabarre, Le Maire, Baumes, Audibran, Rousseau, &c. &c. &c. Latin. Baglivi, Bartholinus, and others. Of the English. Hunter, Blake, .Fox, Murphy, Parmly, Koecker, Darwin' Rush, Chapman, Horner, Coates, &c. &c. &c. The French translations the reader will indulge; as the limited time the author could devote to the subject, prevented any other than a plain and literal version without attempting ornament of diction. He takes this opportunity to present his most cordial and sincere thanks to the many gentlemen who have most generously co-operated in promoting this publication ; of whom he will only mention Drs. Cliapman and Jackson, distinguished Medical Professors, in the University of Pennsylvania ; who, by their patronage, have imposed upon him a lasting obligation. Mr. Eleazar VI Parmly, Dentist, of New York, himself an easy and intelligent writer, with that urbanity and ingenuousness so peculiar to him, has added to my admiration and respect, the most heartfelt gratitude for his cheerfully-rendered assist- ance to the publication of this volume. In consequence of the work's being published in New York, and the author resident here, a few errors have obtained, which are noticed in an Errata. To conclude: the work, with no small degree of solicitude, is humbly pre- sented to the medical public, hoping that it may be treated with kindness, and prove a small addition to the medical literature of our country. S. S. FITCH. Philadelphia, January 22d, 1829. No. 171, Walnut-street. ' CONTENTS. PART I. Preliminary Discourse - - - - - 9 CHAPTER I. Section i. Anatomy of the maxillary bones - - - - 26 ii. Muscles of the jaw - - - - - 31 hi. Articulation of the lower jaw - ' - - - 40 iv. Of the motion in the joint of the lower jaw - - 42 v. Increase of the jaws - - - - - 44 vi. Synoptical tables—between - - - 48&49 vii. Anatomy of the teeth - - - - - 49 viii. Alveolar processes - - - - - - 59 ix. Of the gums - - - - - - 61 x. Action of the teeth - - - - - 63 xi. Usus dentium - - - - - - 65 CHAPTER II. Natural History of the Teeth - - - - - 67 Section i. Formation of deciduous teeth - - - - 70 n. Commencement and formation of the permanent teeth - 73 hi. Pulp and formation of the bony part of a tooth - - 83 iv. Of the gradual waste of the membrane which surrounds the body of a tooth, and the period at which the temporary teeth, in general, appear - - - - - 89 v. Shedding of the deciduous teeth, &c. - - - 94 vi. Supernumerary teeth, &c. .... 107 vii. Irregularity of the teeth - - - - -111 viii. Analysis of the teeth - - - - - 116 ix. Sensibility of the osseous substance of the teeth - - 120 x. Physiognomy of the teeth. .... 137 CHAPTER III. Diseases of the Teeth - - - - - - 143 Section i. Caries _.----- 144 11. Exostosis of the fangs - - - - - 182 hi. Necrosis affecting the teeth - 188 iv. Of the removal of the enamel, by the denuding process - 191 v. Wearing of the teeth, &c. - - - - - 192 vi. Fractures of the teeth ----- 193 vii. Odontalgia - - - - - - 198 CHAPTER IV. Diseases of the Gums, <$-c. - - - - -213 Section i. Scurvy - - - - - - -213 11. Cancrum oris ------ 233 111. Tumours from the gums ----- 248 CHAPTER V. Diseases of the maxillae ----- 260 Dentition - - - - - - - 279 Gum-boils, abscesses, &c. ----- 283 Effects of mercury upon the teeth. - 292 Tobacco - - - - - 296 VIII CHAPTER VI. Diseases produced by Diseased Teeth - - - - 298 Section i. Phthisis Pulmonalis - 299 n. Dyspepsia ------- 308 m. Pain in the ear and formation of matter in that organ - 317 iv. Inflammation, &c. of the eyes from bad teeth - - 321 v. Nervous affections, epilepsy, hysteria, &c. - - 325 vi. Hypochondriasis - - - - - - 326 vii. Rheumatic affections ----- 327 viii. Tic Douloureux ------ 328 ix. Sympathetic head-ach ----- 337 x. Concluding remarks ----- 341 PART II. , CHAPTER I. Operative Dental Surgery ----- 351 Section i. Extraction of the infant teeth - 353 Extraction of the adult teeth ... - 360 ii. Haemorrhage after the extraction of the teeth - - 370 in. Scaling of the teeth ----- 370 iv. Removal of carious portions from the teeth - - 383 v. Plugging the teeth ------ 398 vi. Order in which dental operations should be performed - 413 vn. Treatment of irregularity of the teeth - - - 411 viii. Manner of preserving the health and beauty of the teeth - 427 CHAPTER II. Artificial Teeth - - - - - - 432 Section i. Materials proper ------ 433 n. Mannner of preparing artificial teeth - - - 451 in. Manner of inserting artificial teeth, &c. ... 452 iv. Manner of taking casts of the mouth ... 460 v. Physiological observations upon stumps of teeth, and man- ner of preparing them for the insertion of artificial teeth upon them ------ 461 vi. Manner of making porcelain teeth - 467 PART III. CHAPTER I. Dental Pharmacy ------ 515 Section i. Acids - - - - - - -516 11. Alkalies and saponaecous substances ... 522 111. Astringents ------- 523 iV. Stimulants, Anodynes, Narcotics, &c. ... 524 v. Caustics ------- 525 vi. Mechanical substances - 527 CHAPTER II. Formulas, of Dental Medicines - - - - 531 Section i. Dentifrices ------- 531 11. Odontalgic Pills - - - - - - 539 111. Pastes, opiates, electuaries, odontalgic mixtures, antiscorbu- tic tinctures, washes, &c. &c. ... - 540 Catalogue of Books, &c. ----- 561 DENTAL SURGERY. PRELIMINARY DISCOURSE. If the value of any science is to be estimated by its com- parative utility, Dental Surgery will hold a distinguished place in the esteem of mankind. When we consider the extensive influence which the state of the teeth exerts upon the functions of the stomach and the organs of digestion, this subject rises in importance, and assumes a character and consequence, not usually ascribed to it. This science dates its origin from remote antiquity, and is coeval with the first families of the earth. From the mo- ment that the principles of mortality were impressed upon the organs of man, those destined for the comminution of his food, became implicated in the common frailty, and, sympa- thizing with all the other members of his body, were found subject to disease, decay, and dissolution. It is easy for us to conceive, that among the most rude nations, and in the earliest state of society, many important facts connected with this subject, were well understood. The Natural History of the Teeth, as far as regarded their development; and their Anatomy, so far as concerned their form, external appearance, and insertion in the jaws, must necessarily have been known to the earliest races of men. If, prompted by affection, feeling, or the dictates of religion, they had burned their dead, or had inhumated them from 9 10 their sight, still, comparative anatomy would, perhaps, have given them more just notions of the Teeth, than of any other organs of the animal system. Long before a prying curios- ity, or an anxious thirst for knowledge, had induced their sages to dissect the bodies of animals to learn their structure, their bleached bones would have taught them the formation of their osseous frame: and the teeth of most mamiferous animals are inserted, nearly in the same manner as those of man, and must have attracted immediate notice. Again, a pe- culiarity connected with them, not found in any other organs of the body, must have taught the first parents of the human race, that the teeth of their children might be lost and be replaced again, by a larger, firmer, and better set. This taught them their development, and a constant observance of the crowns and nearly all the bodies of the teeth, made them familiar with their external appearance. So that it amounts to almost a certainty, that mankind acquired a gen- eral knowledge of the teeth as soon if not sooner than of any other organs. They must, at a very early period, have appreciated their great utility in masticating their food, and their immense influence in modifying the expression of the human countenance ; either by their regularity and perfec- tion, producing a pleasing appearance ; or, by their irreg- ularity or deformity, giving it an aspect at once displeasing and repulsive to the most casual observer. It would have been seen that they gave the countenance a youthful appear- ance, whilst their loss indicated the approach of age. Con- sequently as soon as the human family began to increase to large societies, and a mutual dependance to be felt, the teeth became an object of attention; as materially adding to the beauty of the countenance, and, thereby, greatly promoting the power of pleasing. Hence in almost every epoch of civilization and refinement, and strikingly in proportion to the 11 degree of their advancement, have the teeth been an object of attention, their regular arrangement and beautiful forma- tion viewed with pleasure, and the means of their preserva- tion considered a desideratum. But as the records of the past, previously to the invention of the art of printing, were made with much difficulty, and at a great expense of time and labour; they are necessarily scanty in number, and very general in their delineations ; whilst the frequent overthrow of the luxurious, refined, and polished nations, by barbarians, who paid no respect to learning, the learned, or their works, contributed to a great, and, in many cases, almost overwhelm- ing extent, to dissipate and nearly extinguish, the few lights of learning, that had shone during the long period ante- cedent to the discovery of the art of printing. And when it is considered that, probably, an account of very few of the great revolutions, which at different and remote periods, have convulsed the natural and moral world, has ever reached us, we need not be surprised at finding no elaborate works upon the teeth amongst the writings of antiquity ; but are left to glean a few observations upon this subject, from the wri- tings of their poets ; and to draw conclusions upon it, from the customs of succeeding generations. The Bramins of India, at this day, make the cleaning of their teeth a matter of religious observance. " As this custom," says Mr. Mur- phy,* " is coeval with the date of their religion and govern- ment, it exhibits a curious proof of the regard which this scientific people had for the purity and beauty of the mouth; when this practice is inculcated as a law, and ren- dered indispensable as a religious duty." I scarcely need remark, that the Bramins are considered as the remnant of one of the oldest polished nations upon the earth; and * See Murphy, page 151. 12 whose origin and history are lost in the lapse of ages. Dur- ing the brighter periods of Egyptian greatness, we are as- sured that they regarded the teeth with peculiar attention ; and that our art was carried to a considerable extent in Mem- phis, their ancient capital; and was thence diffused to the surrounding nations. The written records of the customs, habits, history, and learning of the Egyptians, were nearly all lost when their grand library was burned at Alexandria, A. D. 860, by which about 700,000 volumes of ancient wri- tings were lost to the learned world ; and, with them, near- ly all traces of the learning and ancient history of the Egyp- tians : save what is to be found in detached fragments of authors, inferred from their public works, or gathered in the ex- planation of obscure hieroglyphics. Among the Hebrews many phenomena connected with the teeth were well understood ; and their regularity and healthy state considered as peculiarly necessary in the perfection of beauty. Solomon in compli- menting an illustrious woman, and in admiration of those charms, conferred by a beautiful set of teeth, says : " Your teeth are like a flock of sheep, that are even shorn, which come up from the washing; whereof every one bear *' twins, and none are barren among them."* At once con- veying to us an idea of a full and perfect set of regular, even, and clean teeth, by a figure as delicate, chaste, and lovely, as any that the customs or peculiarities of that pasto- ral people, could afford. He likewise seemed well aware that the loss of the teeth often occurred in old age ; for, in remarking the characteristics of the decline of life, among others he says; " The grinders cease because they are few." The Hebrew writers appear to have clearly understood, that, in some animals, their teeth gave to them a hideous and * See Canticles of Solomon, Chap. iv. verse 2. 13 frightful appearance ; and were terrible instruments either for defence or attack; for says Daniel,* " after this I saw in the night visions, and behold, a fourth beast, dreadful and terrible, and strong exceedingly; and it had great iron " teeth; it devoured and brake in pieces, &c." Their loss was punished by the law of retaliation, an eye for an eye, and a tooth for a tooth. The Poets of India occasionally delight to refer to the beauty and cleanliness of the teeth, in most pleasing images, as;f " The Cunda blossom yields to the whiteness of the Teeth : speak but one mild word, and the rays of thy sparkling teeth will dispel the gloom ol my fears !" The Ancient Greeks and Romans acknowledged the im- portance of the teeth; and, so far had the principles and practice of Dental Surgery advanced amongst them, that their natural history was considerably understood, and almost every part of this science and art was known and practised by their physicians, and persons with whom it was a par- ticular profession. Galen speaks of this last class of prac- titioners, and calls them a't^c- 'o Jo-vrtx-ea-, (Medicins Den- taires) Physicians, or Surgeon Dentists. Hippocrates, who has justly been styled the " Father of Medicine," has trans- mitted to us an account of many operations upon the teeth, or, as the French with great propriety term them, " Ope- rations Odontotecniques." But we have never received from the Greeks or Romans, any works especially devoted to this branch of Surgery or Medicine. The Greek and Latin poets have refered to the teeth at almost every period of their growth and age. They have spoken of artificial teeth * Chap. 7. verse 7. t Gitazovinda. Murphy, page 152. 14 as a common occurrence, and likewise have noticed the effects of the teeth upon the countenance, and upon the ad- dress and appearance of the individual, (a) Thus Ovid re- commends as a remedy " against love, to make her smile who has bad teeth. We find Palladius (b) joking a super- annuated coquette, in saying to her, that, " for the price of her hair, with that of her paint, her wax, her honey, and her teeth, she might have bought an entire mask." Martial, the Greek Poet, addressing himself to Lelius, says, (c) " you are not ashamed to purchase teeth and hair but what will you do for an eye ; as there are none to sell." The toothless mouth of Egle was repaired by bone and ivory; (d) and Galla more refined, removed her artificial teeth, dur- ing the night, (e) Horace cites the case of the sorceresses Canidia and Sagana, running through the city and losing, the one her teeth, and the other her false hair, (f) Macedonius said to an old lady ; " What medical art can ever be able to fasten your teeth ?" Martial answered, " Cascellius is in the habit of fastening as well as extracting the teeth." I need not extend the subject any farther; enough has been said, and much more might be, if necessary, to prove clearly and conclusively that the odontotechny of the Greeks and Romans was advanced to a considerable degree of perfection: and that the toilet of the politer part of these people, was not considered as in any degree perfected, when their teeth were dirty, or their mouths in an unpleasant state. Catulus delights to say, that, " when Julia presented herself to Manlius, she shone by a flowery mouth, (g) She doubt- less possessed those teeth of snow, so sung by the favorite of the muses ; (h) or that row of pearls so extolled by Lu- (a) See Dentiste Jeunesse, page 63, (b) 22, (c) 23, (d) 24, (e) 25, (f) 34, (S) , 60(A) 62, 15 cian; (i) the lustre of which was esteemed by Theocritus as above that of the finest marble of Paros. i As we have noticed that traces of our science and art are to be found in every epoch of civilization and refinement, so on the contrary, when the institutes of polished society be- gan to fail, virtuous and enlightened communities to sink into ignorance and debauchery, or were overwhelmed by barbarians, it declined with them; not to revive again, un- til raised by the hands of more enlightened men, to fulfil the wants and complete the attractions of polite society. Although nursed in the lap of Grecian and Roman refine- ment, this happy condition was not always to remain; Grecian strength was broken by Roman power; and her states became Roman provinces. The Roman Empire, enervated by luxury and weakened by intestine broils, grad- ually sunk under its own weight, until the northern barba- rians, flushed with success, and lured by the spoils of con- quest, carried their arms to the heart of Rome itself; and at length wasted by repeated ravages, nothing remained of this once proud mistress of the world, save the grandeur of her splendid ruins. A night of ignorance and barbarism succeeded, and con- tinued, during the lapse of some centuries, which have been appropriately termed, " saecula atrocea, The Dark Ages." It was as the sun eclipsed, between a bright morning and a subsequently beautiful day. Our science and art, during the greater part of these ages, found a resting place only in those records, which detailed the customs, and portrayed the refinement of ancient days. " Hie currus fuit hie ilius arma." (i) See Dentiste Jeunesse. page 63. 16 With the revival of learning and letters in the xivth, xvth, and xvith centuries, this subject became an object of attention with the learned, and obtained the notice of Fal- opius, Eustachius, and Ambrose Pare. The latter described the manner of replacing the teeth, and the use of obturateurs. Eustachius published the first edition of his Opusculum de Dentibus in the year 1563 ;* which appears to be the first work of consequence upon this subject, of which any ac- count has ever reached us.f Urbain Hemard4 published a work entitled, Researches upon the true Anatomy of the Teeth, their nature, and prop- erties, with an account of those diseases to which they are subject, at Lyons, by Benoit Rigaud, in 1582. " These Researches," says Fauchard, " which are very good and useful, plainly evince that this surgeon had read the Greek and Latin Authors, whose writings he has judicious- ly incorporated into his own work." Mr. Blake calls Urbain Hemard an ingenuous surgeon and a great man.|| Mr. Audebran observes that, " he was the first to unite in " a body those precepts upon the teeth, which before had not been well considered." He was surgeon to the Cardi- nal Georges of Armignac. The next work upon tins subject was published by Benjamin Martin; printed in Paris by Thiery, in the year 1679, entitled, " A dissertation upon the teeth," forming a small volume, in 12mo. of 136 pages. In which he treats of the nature of the teeth, their sensibility, their development, diseases, &c. &c.; but does not de- scribe those methods by which they are preserved and ren- dered healthy. He was apothecary to one of the French princes. * RufF a German. Wurtzburgh, 1548. t Blake, pa°;e 4. t Fauchard, Preface, page 10. |] Page 6—32. 17 Fauchard,* in speaking of the state of dental surgery, in his time, remarks, that in France, " the most celebrated sur- geons, having abandoned this branch of surgery, or hav- ing but little cultivated it, their negligence gave rise to a class of persons who without theoretic knowledge or ex- perience, and without being qualified, practised it at haz- ard, having neither principles nor system. It was only since the year 1700, that the intelligent in Paris opened their eyes to these abuses: When it was provided, that those who intended practising dental surgery, should sub- mit to an examination by men, learned in all the branches of medical science ; who should decide upon their merits." Mr. Blake concurs in these remarks, and observes,-]- that about the year 1700, the necessity of some artificial mode of preserving the teeth attracted particular attention in Paris, and a few surgeons there began to confine their at- tention to diseases of the mouth and teeth alone ; from which period may be dated the commencement of useful knowledge in that branch, founded on experience." It appears that at this time dental surgery was at a very low ebb in England, being little understood either in theory or practice ; and as bad, or even worse, amongst the other European nations. Our science and art obtained a gradual amelioration in Paris, and, in the year 1728, Fauchard pub- lished his justly celebrated work: a work which has only to be read to be admired ; and has justly obtained for him the title of " the Father of Modern Dentists." He lived in the reign of Louis XVth, and was one of the most distinguished dentists of his time. His work proves him to have been learned in the medical sciences. Mr. Andibran, says, " it * Preface, page si—xii. t Page 5 3 18 is in effect impossible to expose with more clearness, and to demonstrate with more evidence, the precepts of an art which partakes at the same time of medicine and sur- gery."* It is entitled, " Le Chirugien Dentiste ou Traite des Dents, ou L'onEnseigne lesmoyens deles entretenir propre et saines, de les embellir, d'en reparer la perte et de remedier a leur maladies, a celles des gencives et aux accidens qui peuvent survenir aux autres parties voisines des dents. Avec des observations et des Reflexions sur plusiers cas singuliers." It is enriched with 42 engraved plates. This work is far from being faultless, but allowances be- ing made for the infancy of the science, and few works upon this subject will be found to surpass it. From this time, the knowledge and precepts of dental surgery, assumed the form of a regular body of science, destined to be enriched by the researches and contributions of future practitioners, and to be of immense benefit to mankind. A second edition of this work was published in 1746. I will continue this subject a little farther, and mention a few of the many wri- ters, that have appeared among the French and English, without, however, presuming to trespass so much upon the time of the reader, as to fatigue him with the names of all those who have contributed, directly and indirectly, to the advancement of our science. The French, who have ever been celebrated for their attention to the graces and elegance of their persons, have contributed more to the advance- ment of this science, especially in the " la pratique," than any other nation. * Audibran, page 8—9. 19 Bunon, published a work, entitled, " Essai sur les mala- dies des Dents. Paris, 1743." Mouton, wrote a small work upon this subject, entitled, " Essai d' odontotechnie, ou Dissertation sur les dents artificielles, 1746." Written in an elegant but not in a meth- odical manner. Bourdet, published his work upon this subject, in Paris, 1757, entitled, " Recherches et Observations sur toutes les Parties de L' Art du Dentiste." It is enriched with some valuable plates and contains many correct observations. Jourdain published two works upon this subject: the first was printed in Paris, 1761, and is entitled, " Traite des depots dans les sinus Maxillaires des fractures et des caries suivi des reflexions sur toutes les operations de L' Art du Dentiste." The second is entitled, " Traite des maladies et des ope- rations reellement chirurgicales de la bouche et des autres parties qui y correspondent." Paris, 1778. In 8vo. 2 Volumes. These works have enjoyed a considerable reputation. Gariot, published a work entitled, " Traite des Maladies de la bouche d'apres l'etat actuel des connaissances en med- ecine et en chirurgie qui comprend la structure et les fonc- tions de la Bouche, l'histoire des maladies des dents les moyens d'en conserver la sante et la beautie et les opera- tions particulieres a 1' Art du dentiste." In 8vo. Paris, 1805. Baumes. Traite de la premiere Dentition et des Maladies souvent tres-graves qui en dependent." In 8vo. Paris, 1805. I could proceed to mention pages of names, and title pages of works, with which our present subject has been enriched from the pens of eminent French dentists, physicians, and surgeons; but I will merely suffer myself to mention the 20 names of Tenon, Hebert, Fourdain, Laforgue, Duval, Ma- hon, Delabarre, Andibran, Lemaire, &c. &c.; besides the French Dictionary of the Medical Sciences, and a host of French Surgeons and Anatomists, who have directly and in- directly, poured a flood of light upon this subject. Many of whose observations and precepts will be found incorporated into the subsequent work. Among the English, it must be acknowledged, that there has been, and continues to be, rather a paucity of works upon this subject; and especially the practical part. Thomas Berdmore published a practical work upon the teeth in the reign of George the Third, to whom he was Dentist. This work contains nearly as much practical matter, as any subsequent English writer. Mr. John Hunter, published his work upon Odontotechny, in London, 1771, entitled, " The Natural History of the Human Teeth, explaining their Use, Formation, Growth, and Diseases; illustrated with copper plate engravings." A second part of the work was entitled: " A Practical Treatise on the Diseases of the Teeth, and the consequen- ces of them, &c. &c." This work is highly esteemed in some respects, and has passed through several editions. It is enriched with some valuable plates. Mr. Hunter advocated the practice of trans- planting the teeth ; but which in consequence of the numer- ous accidents arising from it and its frequent failures, is at present nearly abandoned. Mr. Blake remarks,* " that Mr. Hunter did not confine his attention to the teeth alone, but procured much of his knowledge from Dentists of his ac- quaintance ; consequently, his opinions were not always the result of his own experience and were not always to be trusted." * Blake, page 6. 21 Mr. Robert Blake wrote an Essay upon the Structure of the Teeth in man and various animals, illustrated with en- gravings, published in Dublin, 1801, having before been the subject of an inaugural dissertation, published in Edinburgh, 1799. This work is justly esteemed. Mr. Fox observes,* that we are indebted to Mr. Blake, for the first correct ac- count of the manner in which the permanent teeth are formed." By others this discovery has been ascribed to Hebert, a Frenchman. Mr. Joseph Fox published the first part of his work entitled, Natural History, and Diseases of the Human Teeth, in 8vo. London, 1803." The second part, " History and Treatment of the Diseases of the Teeth and Gums." London, 1806. This work of Mr. Fox, is at present a standard in the lan- guage ; is enriched with many valuable engravings, and re- flects much credit upon the talents of its amiable and learn- ed author. In it Mr. Fox was guilty of a great error or oversight, in asserting,^ that Mr. Hunter's book was the first scientific work ever published upon the teeth, when those of Fauchard, Bourdet and Jourdain had preceded it. A second edition appeared in 1814. Rushini produced a small Essay upon this subject, London, 1797. Mr. Charles Bew, a pop- ular Treatise upon the Teeth, with an account of the cause of Caries, London. A work of little merit. Fuller, " A Popular Essay on the Structure, Formation and Management of the Teeth, Illustrated by Engravings, London, 1810." Mr. Joseph Murphy published, " A Natural History of the Human Teeth, with a Treatise on their Diseases from In- fancy to Old Age, &c. &c. 8vo. London, 1811." * Fox, page 2 J t Preface page 9th. 22 This work is well written and displays much candour and intelligence, and is worthy of perusal. Considered as a liter- ary work, it is perhaps not excelled by any on this subject in the English language. Several other small works have ap- peared in England, of which I will only mention that of Mr. Hertz. " A Familiar Dissertation on the Causes and Treat- ment of the Diseases of the Teeth," &c. &c. In this country no extensive work has ever been published on Odontotechny. To Mr. Eleazar Parmly of New York, we are indebted for a popular essay upon this subject, containing some valu- able information. Mr. Flagg of Boston, and Mr. L. S. Parm- ly, have favoured us with their views upon it. Besides which we have been presented through the medium of the Medical Journals, some valuable papers upon different parts of our science, of which I will mention one by Dr. Trenor of New York, upon Tic Doloreaux; and another by the same gentleman upon the Structure, Organization, and nour- ishment of the teeth. Also a valuable paper upon trans- planting of the teeth, by Mr. James Gardette of this city, one of our oldest and most respectable Dentists. Finally, I will mention the work of Mr. Leonard Koecker, formerly of this city, but now residing in London. It com- prises about 420 pages, 8vo. published in London, 1826, con- taining some valuable information, but upon the whole, has been rather coldly received in this country. It would now be proper for me to say a few words upon the present state of Dental Surgery, in this country. In most parts of the United States, with the exception of some of the largest cities, it is very little understood. In some of our large towns, we have probably as ingenious and intelli- gent Surgeon Dentists as are to be found in the oldest cities of Europe. Men who are respectable for their litera- 23 ry, scientific, and professional acquirements. It is to be re- gretted that our subject has been neglected by a great pro- portion of the Medical Faculty. They, too generally, con- sider it as having little or no bearing upon their profession. As an instance of the utter want of attention to this sub- ject, by some medical men, I will take the liberty of men- tioning the following case, which came to my knowledge. A Lady having her mouth in a very unpleasant state, her gums inflamed and ulcerated, in consequence of an excessive accumulation of tartar upon the molar teeth of one side, applied to a physician who was a Professor in one of the Medical Universities of this country, for advice and relief from this disagreeable and somewhat alarming state of her mouth. The Surgeon was entirely at a loss to determine what was the real nature of the disease, or what the extra- ordinary tumour or concretion upon her teeth. The affec- tion was finally decided to be cancerous, and in a state of great alarm, the lady was dismissed. She, however, did not entirely despair, but applied to some others of the Faculty, and was at last seen by one that had some little knowledge of the maladies of the mouth, who immediately quieted her fears, and, by the use of suitable remedies, relieved her from every symptom of disease.* At present, a spirit of inquiry is abroad, and I cannot but anticipate a period, when, upon this subject, prejudices shall be removed, mal practices cor- * This ignorance is not peculiar to the physicians of this country. Du- val says, page 80 Dentiste Jeunesse, " Far different was the conduct of a " provincial surgeon, who imagining that he had to remove a tumour which " greatly swelled the cheek, enlarged the opening of the mouth by incision. " This tumour, however, was nothing more than a mass of tartar, which " enveloped the teeth. He then attacked it with a hammer and chisel, " and the piece was sent to the Royal Academy of Surgery in 1789, where " may be seen the tooth of the patient, and the error of the surgeon." 24 rected, the darkness of ignorance be dispelled, and, com- mensurate with the talents and worth of many of its pro- fessors, its extensive bearing upon health, and its happy in- fluence upon society, assume a correspondent rank among the Medical Sciences. pages 25-28 missing » SYSTEM OF DENTAL SURGERY. CHAPTER I. Assimilation is a term, which, when applied to the animal system, implies series of phenomena, by which the food is rendered subservient to the purposes of nutrition. Thefirst of these, the comminution of the food is performed by a set of organs, that in man, not only enable him to masticate his food, but assist in the articulation of language, determine to some extent the expression of his features, and add dignity and beauty to his countenance. I need not for one moment detain the reader by enlarging upon the utility of these or- gans, or their influence upon the health of the animal, but merely remark that nearly all animals that subsist upon solid food, are provided with an apparatus for reducing and divid- ing it into small pieces, whereby it is rendered capable of being readily acted on by the digestive powers of the sto- mach. The maxillary bones with those muscles vvliich give them motion, the teeth arid their appendages, the alveoli, and sums, constitute the masticatory apparatus. The object of the present work, is to convey in a manner as clear and con- cise as possible, the Anatomy, Natural History, and Dis- eases of these organs. The effect of their diseases upon the general system, the means of preventing and curing those diseases, and a description of the mode by which some part of these organs may be substituted when lost, and to give a detailed account of the various articles of the materia med- ica used by the surgeon dentist. 4 fc PART I. CHAPTER I. SECTION I. ANATOMY OF THE MAXILLARY BONES. The Jaw Bones, technically termed the Maxillary, consist of four bones, t o of which form the upper and two the under jaw, usually termed Maxillaria Inferiora and Su- periora. Upper Jaw. Maxillaria superiora, or upper jaw, consists of two bones situated on the inferior and anterior surface of an irregular pile of bones which with the maxillaria superiora, constitute the bones of the face. The superior face of these bones is formed by a thin triangular plate which is the floor of the orbit. ' In the posterior part of this plate is a groove leading to a canal terminating in the front of the bone at the foramen infra orbitarium. This foramen is situated just below the middle of the lower margin of the orbit, and gives passage to the superior maxillary nerve and an artery. Externally the triangular plate is terminated by a rough surface, the malar process v hich articulates with the malar bone. The nasal process arises by a thick strong root, from this front upper part of the bone at its upper side. Its front edge is thin, the posterior margin is thicker, and the upper edge is 31 The substance of this bone is externally hard and compact; internally there is a cellular structure, through the centre of which runs the canal, for the nerves and blood vessels. From this canal smaller ones are detached containing the vascular filaments which run to the roots of the teeth. The maxilla inferior articulates with the temporal bones by means of their glenoid cavities. Very marked differences in many individuals exist in the size and formation of these cavities, in consequence of which some persons are liable to a spon- taneous dislocation of the jaw, in yawning, &c. when the condyle of the lower jaw, is slipped over the anterior rim of the glenoid cavity.* SECTION II. MUSCLES OF THE LOWER JAW. Besides a very strong ligamentous connection of the lower jaw to the temporal and sphenoidal bones, it receives attach- ments from several of the strongest muscles of the system, by which its motions are affected and it becomes a powerful lever; the food being the resistance and the muscles the moving powers. These muscles may be divided into two classes : Firstly, Those which elevate the jaw and keep it in ap- position to the other. Secondly, Those which depress the jaw. * See the Anatomy of Doctor Horner, Adjunct Professor of Anatomy in the University of Pennsylvania. 32 Rotation or a grinding motion and the extension and re- traction of the jaw, are performed by some of the muscles acting singly, and by a compound motion of others. First. Those which elevate the jaw and keep it in oppo- sition to the otiuT. Masseter. The masseter is placed between the chin and the ramus of the lower jaw; it is of an oblong. shape and evidently consists of two portions, an external and an internal, which may be readily recognized by the course of their fibres as they decussate. As a whole it arises tendinous and fleshy from the malar process of the upper maxilla ; from the inferior edge of the malar bone between the maxillary and the zygomatic sutures, and from the zygomatic process of the temporal bone. Of its two portions the internal is the smaller, and is in- serted tendinous into the outer part of the root of the coro- noid process of the lower jaw; while the external extends from the malar bone to the angle of the lower jaw, where it is inserted, tendinous, and fleshy. A part of the internal por- tion may be seen at the zygomatic suture, behind the exter- nal, without the latter being raised up. When both portions act together they close the jaws ; the external alone draws the jaw forwards and the internal alone, will draw it back- ward?. Temporalis. The temporal muscle is placed on the side of the head and occupies its middle inferior region. It is covered externally by the fascia temporalis, a thick, dense, tendinous mem- 33 brane ; which arises by the semicircular ridge on the side of the cranium, and is inserted into the upper margin of the zygoma. The temporal muscle arises from the inner face of this fascia*; from the whole length of the semicircular ridge on the side of the os-frontis and parietale; and from the surface of the cranium between this ridge and the zygoma, includ- ing a part of the frontal bone of the parietal, and of the squamous portion of the temporal. This muscle also re- ceives accession of fleshy fibres from the internal face of the zygoma. From this extensive origin the fibres converge towards the zygoma, and passing beneath it, are inserted tendinous into the coronoid process of the lower jaw, so as to surround it on every side ; some of the tendinous fibres go down in front almost to the last dens molaris. It pulls the lower jaw direct- ly upwards. Pterygoideus Extemus. The external pterygoid muscle, so called from its position, arises fleshy from the outer side of the external pterygoid process of the sphenoid bone ; from the tuber of the upper maxilla ; and from the under surface of the temporal process of the sphenoid bone. It passes outwards and backwards horizontally, and is in- serted into the inner side of the neck of the inferior maxilla, and into the capsular ligament of the articulation. When the muscles of the opposite sides act together, they draw the lower jaw forwards, but if alternately, they give it a grinding motion. Pterygoideus Internus. The internal pterygoid muscle arises by tendinous and fleshy fibres from the internal plate of the pterygoid process 5 34 of the sphenoid bone, along the outer margin of the eus- tachian , be. It fills up the greater part of the pterygoid fossa ; and pas- sing downwards and backwards, is inserted tendinous and fleshy into the internal face of the angle of the lower jaw. When the muscles of the opposite sides act, they close the jaw. Digastrieus.* It is situated immediately under, and a little upon the in- side of the lower jaw, and outside of the fauces, extend- ing from the mastoid process to the chin, nearly along the angle made by the neck and chin, or face. The name of this muscle expresses its general shape, as it has two fleshy bellies, and of course a middle tendon. Yet some of its anterior belly does not arise from the tendon of the posterior, but from the fascia, which binds it to the os-hyoides. These two fleshy bellies do not run in the same line, but form an angle, just where the tendon runs into the anterior belly ; so that this tendon seems rather to belong to the pos- terior, which is the thickest and longest. This muscle arises from the sulcus made by the inside of the mastoid process, and a ridge upon the temporal bone, where it is united with the os occipitis. The extent of this origin is about an inch. It is fleshy upon its outer part, viz. that from the mastoid process; and tendinous on the inside from the ridge. From its origin it passes forwards down- wards and a little inwards much in the direction of the pos- terior edge of the mammillary process, and forms a round tendon first in its centre and upper surface. This tendon passes on in the same direction; and when got near the os-hyoides, it commonly perforates the anterior * Hunter, page 24—32. 35 end of the stylo-hyoidaeus muscle; and from the lower edge of this tendon, some fibres seem to go off, which degenerate into a kind of fascia, that binds it to the os-hyoides; and some of it goes across the lower part of the mylo-hyoideus binding the os-hyoides by a kind of belt. At this part the tendon becomes a little broader, makes a turn upwards, in- wards, and forwards, and gives origin to the anterior belly, which passes on in the same direction, to the lower part of the chin, where it is inserted tendinous and fleshy, in a slight depression on the under, and a little on the posterior part of the lower jaw, almost contiguous to its fellow. Besides the attachment of the middle tendon to the os-hyoides, there is a ligamentous .binding, which serves, in some measure, as a pulley. This is more marked in some subjects than in others; and this depends on the strength of the tendinous expansion which binds the tendon of the digastrieus to the os-hyoides. When we say that these parts are attached to the os- hyoides, we do not mean that they can be traced quite into it like some other tendons in the body; but the os-hyoides seem to be the most fixed point of attachment. Very often we find two anterior bellies to each muscle ; the uncommon one, which is the smallest; does not pass to the chin, but joins with a similar portion of the other side, in a middle tendon, which is often fixed to the os-hyoides. At other times, we find such a portion on one side only; in which case it is commonly fixed to the middle tendon of the mylo- hyoideus. The use of these muscles with regard to the lower jaw, is principally to depress it; but according as one acts a little more forcibly than the other, it thereby gives the jaw a small rotation ; and becomes, in that respect a kind of antagonist to the pterygoideus externus. Besides depressing the lower jaw, when we examine the dead body they would appear to 36 raise the larynx. But, although they have this effect, a proper attention to what happens in the living body will pro- bably show, that their principal action is to depress the lower jaw; and that they are the muscles which are commonly em- ployed for that purpose. Let a finger be placed on the upper part of the mastoideus muscle, just behind the posterior edge of the mastoid process, about its middle, touching that edge a little with the finger; then depress the lower jaw, and the posterior head of the digastric will be felt to swell very considerably, and so as to point out the direction of the mus- cle. In this there can be no deception ; for there is no other muscle in this part that has the same direction ; and those who are of opinion that the digastric does not depress the lower jaw, will more readily allow this, when they are told, that we find the same head of the muscle act in deglutition, but not with a force equal to that which it exerts in depressing the lower jaw. Further, if the sterno-hyoidaei, sterno-thy- roidaea, and costo-hyoidoei, acting at the same time with the mylo-hyoidei, and genio-hyoida?i assisted in depressing the jaw, the os-hyoides and thyroide cartilage, would probably be depressed, as the bellies of the sterno-hyoidsei, and of the other lower muscles, are by much the longest; but, on the contrary, we find that the os-hyoides with the thyroide cartilage, is a little raised in the depression of the jaw, which we may suppose to be done by the anterior belly of the digas- tric : and secondly, if these muscles were to bring about this motion of the jaw, these parts would be brought forwards nearer to the straight line between the chin and sternum, which is not the case in this action whereas we find it to be the case in deglutition, in which these evidently act. By ap- plying our fingers upon the genio-hyoidaeus, and mylo-hy- oidaeus, near the os-hyoides, between the two anterior of the digastric, (not near the chin where the action of these 37 two bellies may occasion a mistake,) we find these muscles quite flaccid; which is not the case in deglutition, nor in speaking, in which they certainly do act; nor do we find the muscles under the os-hyoides at all affected, as they are in the motion of the larynx. It has been observed, that when we open the mouth, while we keep the lower jaw fixed, the fore part of the head or face is necessarily raised. Authors have been at a good deal of pains to explain this. Some of them considered the condyles of the jaw, as the centre of motion; but if this were the case, that part of the head, where it articulates with the spine, and, of consequence, the whole body must be de- pressed in proportion as the upper jaw is raised; which is not true in fact. Others have considered the condyles of the occiput as the centre of motion; and they have conceiv- ed the extensor muscles of the head to be the moving pow- ers. The muscles which move the head in this case, are pointed out by two circumstances, which attend all muscular motion: in the first place, all actions of our body have mus- cles immediately adapted to them; and secondly when the mind wills no particular action, its power is applied by in- stinct to those muscles only which are naturally adapted to the motion, and further, the mind being accustomed to see the part move which is naturally the most moveable, attends to its motion in the volition, although it be in that instant fixed, and the other parts of the body move towards it; and al- though the other parts of the body might be brought towards it by other muscles, and would be so if the mind intended they should come towards it, yet these muscles are not brought into action. Thus the flexors of the arm common- ly move the hand to the body, but if the hand be fixed, the body is moved by the same muscles to the hand. In this case, however, the mind wills the motion of the hand to- 38 wards the body, and brings the flexors into action; where- as if it be wished to bring the body towards the hand, the muscles of the fore part of the body would be put into ac- tion, and this would produce the same effect. To apply this to the lower jaw; when we attempt to open the mouth, while the lower jaw is immoveable, we fix our at- tention upon the very same muscles (whatever they are) which we call into action when we depress the lower jaw; and we find that we act with the very same muscles: for our mind attends to the depressing of the jaw, and not the rais- ing of the face ; and under such circumstances the mouth is actually opened. We find then by these means the head is raised, and the idea that we have of this motion is the same that we have in the common depression of the jaw; and we should not know except from circumstances, that the jaw was not readily depressed ; and we find at this time too, that the extensors of the head are not in action: on the con- trary, when the jaw is fixed in the same situation, if we have a mind to raise the head, or upper jaw, which of course must open the mouth; we fix our attention to the muscles that move the head backwards, without having the idea of opening our mouth; and at this time the extensors of the head act. This plainly shows that the same muscles which depress the jaw, when moveable, must raise the head when the jaw is kept fixed. This is a proof, too, that there are no other muscles employed in depressing the lower jaw, than will raise the head under the circumstances mentioned. This will further appear from the structure of the parts, wherein four things are to be considered, viz. the articulation of the jaw ; the articulation of the head with the neck; the origin, and the insertion of the digastric muscle. Suppose the upper jaw to be fixed, and the lower jaw to be movable on the condyle : if the digastric contracts, its 39 origin and insertion will approach towards one another; in which case it is evident, that the lower jaw will move downwards and backwards. But if the lower jaw be fixed, as in the case supposed, and the vertebras be also fixed, the condyle will move upwards and forwards upon the eminence in the joint, the fore part of the head will be pushed up- wards and backwards by the condyle, and the hind part of the head will be drawn down, so that the whole shall make a kind of circular motion upon the upper vertebras; and the digastric muscle, pulling the hind part of the head towards the lower jaw, and at the same time pushing up the condyles, against the fore part of the head, acquires by this mechan- ism, a very considerable additional power. The action of the buccinator, and styloglossus, are of con- siderable use in mastication. The former arises from the back part of the upper and under jaw bones, and comes for- ward within the cheek ; a considerable portion of which is formed by it. It is of a triangular figure, is broadest behind, forwards it becomes narrower, and is inserted at the angle of the mouth inside. By its action in mastication, it con- tracts, and presses in the cheek, by which the food is kept between the teeth, from the exterior. The stylo-glossus derives its name from its origin, which is on a process of. the temporal bone called the styloid process, from which, extending forwards and downwards, in an oblique direction, it is inserted into the root of the tongue. and running along its sides forms a portion of it. The ac- tion of the stylo-glossus in mastication is opposed to that of the buccinator: it draws the tongue backwards, and gives it a lateral motion, by which the food is kept between the teeth internally. 10 SECTION III. OF THE ARTICULATION OF THE LOWER JAW.* Just under the beginning of the zygomatic process of each temporal bone, before the external meatus auditorius, an oblong cavity may be observed ; in direction, length and breadth, in some measure corresponding with the condyle of the lower jaw. Before, and adjoining to this cavity, there is an oblong eminence, placed in the same direction, convex upon the top, in the direction of its shorter axis, which runs from be- hind forwards ; and a little concave in the direction of its lon- ger axis, which runs from within outwards. It is a little broader at its outer extremity, as the outer corresponding end of the condyle describes a larger circle in its motion than the inner. The surface of the cavity, and eminence, is covered with one continued smooth, cartilaginous crust, which is somewhat ligamentous ; for, by putrefaction, it peels off like a membrane with the common periosteum. Both the cavity and eminence serve for the motion of the condyle of the lower jaw. The surface of the cavity is directed down- ward; that of the eminence downward and backward, in such a manner that a tranverse section of both would represent the italic letter S. Though the eminence may on a first view of it, appear to project considerably be- low the cavity, yet a line drawn from the bottom of the cavity to the most depending part of the eminence, is almost horizontal, and therefore nearly parallel with the line made by the grinding surfaces of the teeth in the upper jaw: and when we consider the articulation farther, * Hunter, page 9—11. 41 we shall find that these two lines are so nearly parallel, that the condyle moves almost directly forwards, in passing from the cavity to the eminence ; and the parallelism of the motion is also preserved by the shape of an intermediate car- tilage. In this joint there is a moveable cartilage which though common to both condyle and cavity, ought to be considered rather as an appendage of the former than of the latter, be- ing more closely connected with it; so as to accompany it in its motion along the common surface of both the cavity and the eminence. This cartilage is nearly of the same dimen- sions with the condyle, which it covers; is hollowed in its in- ferior surface to receive the condyle; on its upper surface it is more unequal, being moulded to the cavity and eminence of the articulating surface of the temporal bone, though it is considerably less and is therefore capable of being moved with the condyle from one part of that surface to another. Its texture is ligamenta-cartilaginious. This moveable car- tilage is connected with both the condyle of the jaw, and the articulating surface of the temporal bone, by distinct liga- ments, arising from its edges all round. That by which it is attached to the temporal bone is the most free and loose; though both ligaments will allow an easy motion, or sliding of the cartilage on the respective surfaces of the condyle and the temporal bone. These attachments of the cartilage are strengthened, and the whole articulation secured, by an external ligament, which is common to both, and which is fixed to the temporal bone, and to the neck of the condyle. On the inner surface of the ligament, which attaches the cartilage of the tem- poral bone, and backwards in the cavity, is placed what is commonly called the gland of the joint; at least, the liga- ment is there much more vascular than at any other part. 6 42 SECTION IV. OF THE MOTION IN THE JOINT OF THE LOWER JAW.' The lower jaw from the manner of its articulation, is sus- ceptible of a great many motions. The whole jaw may be brought horizontally forwards by the condyles sliding from the cavity towards the eminences on each side. This mo- tion is performed chiefly when the teeth of the lower jaw are brought directly under those of the upper, in order to bite, or hold any thing very fast between them. Or, the condyles only may be brought forwards, while the rest of the jaw is tilted backwards, as in the case when the mouth is open; for on that occasion the angle of the jaw is tilted backwards, and the chin moves downwards and a little backwards also. In this last motion, the condyle turns its face a little forwards ; and the centre of motion lies a little below the condyle, in the line between it and the lower angle of the jaw. By such an advancement of the condyles forwards, together with the rotation mentioned, the aperture of the mouth may be considerably enlarged; a circumstance necessary on many obvious occasions. The condyles may also slide alternately backwards and forwards, from the cavity to the eminence, and vice versa; so that while one condyle advances the other moves back- wards, turning the body of the jaw from side to side, and thus grinding, between the teeth, the morsel separated from the larger mass by the motion first described. In this case the centre of motion lies exactly in the middle, hetween the two condyles. And it is to be observed, that in these slidings of Hunter, 12—14. 43 the condyles forwards and backwards, the moveable cartila- ges do not accompany the condyles in the whole extent of their motion ; but only so far as to adapt their surfaces to the different inequalities of the temporal bone: for as these car- tilages, are hollow on their lower surfaces where they re- ceive the condyle, and on their opposite upper surfaces are convex where they lie in the cavity, but forwards, at the root of the eminence, that upper surface is a little hollowed, if they accompanied the condyles through the whole extent of their motion, the eminences would be applied to the emi- nences, the cavities would not be filled up, and the wThole articulation would be rendered very insecure. This account of the motion of the lower jaw, and its car- tilages, clearly demonstrates the utility of these cartilages; namely, the security of the articulation ; the surfaces of the cartilages accomodating themselves to the different inequali- ties, in the various and free motions of this joint. This car- tilage is also very serviceable for preventing the parts from being hurt by the friction; a circumstance necessary to be guarded against, where there is so much motion. Accord- ingly, I find this cartilage in the different tribes of carniver- ous animals, where there is no eminence and cavity, nor other apparatus for grinding, and where the motion is of the true ginglimus kind only. In the lower jaw, as in all the points of the body, when the motion is carried to its greatest extent, in any direction, the muscles and ligaments are strained and the person made uneasy. The state, therefore, into which every joint most naturally falls, especially when we are asleep, is nearly in the middle between the extremes of motion ; by whicli means all the muscles and ligaments are equally relaxed. Thence it is. that commonly, and naturally the teeth of the 44 two jaws are not in contact; nor are the condyles of the lower jaw, so far back in the temporal cavities as they can go. SECTION V.* OF THE INCREASE OF THE JAWS. In a foetus three or four months old, the rudiments of the teeth are placed nearly regular, but as they increase more rapidly than the arch of the jaws, we find some of them at birth as it were, pressed out of the circle for want of room, particularly the cuspidati; so that the sockets of the lateral incisores, and those of the anterior grinders nearly come in contact. However, the jaws gradually accomodate them- selves to the teeth, and increase at this part nearly in pro- portion to the size of the cuspidati, becoming again regular, for indeed we seldom or ever meet with temporary teeth irregular. This Mr. Hunter allows, but says,f " The jaw still increases in all points till twelve months after birth, when the bodies of the six teeth are pretty well formed, but it never after increases in length between the symphysis and the sixth tooth; and from this time too, the alveolar process which makes the anterior part of the arches of both jaws, never becomes a section of a larger circle; and after this time the jaws lengthen only at their posterior ends." Mr. Hunter supposed, as the temporary grinders are larger than the bicuspides which succeed them, that the difference in size of these would be sufficient to allow the permanent in- BJake, Essay on the Teeth, in Man, &c. pages 47 to 55. t Natural History, page 102. 45 cisores and cuspidati, which are much larger than their pre- decessors, to become regular, without any increase of the arch or circle. He was led into this opinion by comparing four lower jaws of different subjects, and at different periods of life; from the age when the five temporary teeth are completed, to that of the entire permanent set. He ac- knowledges, however, that it is impossible there should be a mathematical exactness in four different jaws ; nor indeed is there a mathematical exactness in the lines drawn to sup- port his theory, for they are by no means parallel.* Indeed so varied are the dimensions of jaws, that the arch of one a year old may correspond, or even exceed the arch of an adult; and vice versa, the arch of an adult may be nearly as large again as that of a child; so it is not by com- paring different jaws together that we shall be enabled to draw proper conclusions ; but by comparing the permanent and temporary teeth of the same jaws. It appears from my preparations, and experience convin- ces me, that the space occupied by the temporary teeth would not be sufficient to accommodate the same number of permanent teeth which succeed them, and which on the whole are so much larger, particularly in the upper jaw. This fact Mr. Hunter was aware of, and mentions that irreo-- ularities are more frequently met with in the upper, than in the lower jaw; so far I agree with him. We have seen the rudiments of the permanent teeth at first placed nearly regular, but as ossification advances on them, they become crowded together for want of room. This irregularity particularly happens to the permanent teeth, because they are at first situated at the internal part of the ¥ Nat. Hist. Plate 16, Figure 2. 46 jaw, and of course in a much smaller circle than the tempo- rary. As I have given an accurate representation of the jaws of a child about four years old, and the situation and con- nexion of both sets of teeth, in plate II.—figs. 1 and 2, very little is required to be said on this subject. In the un- der jaw, the lateral permanent incisores, hide nearly half the middle ones, and the lateral incisores and anterior bicus- pides are so close together, that the cuspidati would not have near room enough to pass between them.. In the upper jaw there is a much more confused appearance, and a more striking contrast with respect to the difference in size of both sets of teeth; the lateral incisores rest in part on the middle ones, and the sockets of the lateral incisores and an- terior bicuspides nearly come in contact; so that the cuspi- dati are entirely thrown out of the circle. We have seen also that the pulps and membranes of the permanent teeth were at first very small, and that the sock- ets were in proportion ; but as the pulps enlarged and ossifi- cation advanced on them, the sockets increased likewise. It is but just therefore to suppose, that as the teeth rise and appear through the gum, the alveolar processes should accom- modate themselves to them ; which indeed will presently appear to be the case. If Mr. Hunter was a practitioner in this branch even with very little experience, he must have frequently have observed in children of about six or seven years of age (if the first teeth had not already fallen), large distances between the incisores, which at first were quite close to one another. I have seen hundreds of instances in which the four permanent incisores appeared irregular, but in a short space of time became perfectly regular without any artificial assistance. In a preparation of Dr. Monro's fwhich he was kind enough to allow me to take a sketch of), 47 the four permanent incisores of the under jaw had appear- ed, and also the two middle incisores of the upper, and were perfectly regular, though the temporary cuspidati and grind- ers had remained in the former, and the lateral incisores cuspidati, and grinders in the latter. Surely then these teeth could have gained no room from the difference in size of the grinders and bicuspides ; it must therefore be owing to an increase of the arches of the jaws in these parts ex- actly in proportion to the difference in size of the temporary and permanent incisores. There is still in this case a further necessity for a considerable increase of the arches, on ac- count of the irregular situation of the permanent teeth, as well as because several of them had not as yet arrived at their full size. The pressure of the front teeth on one another as they rise in the jaw, appeals to have some effect in occasioning it to extend at certain parts, or to make the grinders move back- wards, to which indeed all the teeth have a tendency. I have a preparation of the upper jaw of an adult, in which the temporary cuspidatus of the right side remained in ; the per- manent cuspidatus probably from the resistance of the for- mer, penetrated at the internal part of the mouth: in the left side the teeth are all perfectly regular: on comparing the situation of the anterior permanent grinders, I found that of the right side nearer the symphysis than that of the left in proportion to the difference in size, of the temporary and permanent cuspidati. I have met several instances of the permanent cuspidati appearing at first irregular, as they most commonly appear later than the bicuspides, but in ten or twelve months after, the jaw increased sufficiently so as to allow them to become regular. I have met many rases where the arches of the jaws continued to increase, even after the permanent teeth were complete: so that all the 48 front teeth were quite separate from each other; and in one case the middle incisores were nearly half an inch asunder, though there was no defect in the palate. From what is now said I feel myself justifiable in conclud- ing, that the alveolar arches continue to increase during the entire progress of the formation of the teeth: it is however suf- ficiently evident, the greatest increase of the jaw is backwards. I do not by any means deny but that we frequently meet with disproportions between the jaws and teeth, and such that the permanent teeth never would become regular with- out the assistance of art, even in young persons; this may arise from the resistance of the temporary teeth, or from teeth forming so much out of the circle that they have not sufficient power to act on their neighbours and press them back, such as the cuspidati, which are most commonly irreg- ular. Indeed if Mr. Hunter's hypothesis were true, we should never see a regular set of teeth. Duval concurs with Mr. Blake in considering that the jaws increase in all parts during and before the second den- tition, upon which he makes the following observations. Af- ter remarking upon the situations taken by the adult teeth he continues. " At this disposition of parts, who is not struck with admiration ? but we shall be still more so when we learn that the jaw bone grows transversely, in order to make room for the permanent grinders, which are never shed, not only by increasing in size in that part which lies behind the temporary grinders, as the anatomists have published,* but by developing itself equally in all its points in such a manner that the sockets of the large grinders and these teeth them- selves grow and become successively placed from behind * Duval, page 60. 49 to before,"* &c. &c. Although the jaws increase propor- tionably more between the last deciduous tooth and the con- dyles, yet it must be conceded that during the puerile state, every part of the jaws increase, as do all the other mem- bers of the body, the deciduous teeth excepted. SECTION vii. ANATOMY OF THE TEETH.f These organs in the adult are divided into four classes; incisores, cuspidati, bicuspides,! and molares. They differ very much in the figure of their bodies, and in the number and shape of their fangs. The cuspidati are of a middle nature between the incisores and the bicuspides ; as are the latter between the cuspidati and the molares. The incisores, or cutting teeth, are situated in the anterior part of the jaw, and form the front of the mouth. In each jaw they are four in number, and are so placed, that the two central stand somewhat more advanced than the lateral. The bodies of the incisores are broad and rather flat. The anterior surface is convex, the posterior concave ; they both go off from the neck of the tooth somewhat sloping. The two surfaces terminate in a cutting edge, which is placed in a direct line with the apex of the fang. When viewed in front, the cutting edge is seen to be the broadest part of the tooth, but gradually becomes smaller as we approach to the * " See Fox and Hunter." t Fox,'chap. 2. * This class is wanting in the infant set. 7 50 neck. When viewed laterally the cutting edge is the thin- est, and the tooth, to the neck of it, increases in thickness. This gives to the body of the tooth the form of a wedge, which is its true office, it being used to cut or divide soft substances. The enamel is continued farther, and is thicker on the an- terior and posterior surfaces than on the sides; it is even thicker on the forepart than on the back part of the tooth. The fangs are conical, and are shorter than those of the cuspidati. In the upper jaw the central incisores are much broader and larger than in the lateral; in the lower jaw they are all nearly of the same size, but much smaller than those of the upper jaw. The cuspidati are four in number, one of them being placed on the outer side of each of the lateral incisores. The shape of the crown of a cuspidatus is like that of an incisor, with its corners rubbed off, so as to end in a point, instead of a broad edge. The fang is thicker and larger and is more depressed at the sides, which causes it to appear considerably larger, when viewed laterally, than when seen in front. The fang, which is the largest of any of the teeth, may be felt with the finger, running up a considerable length, and projecting be- yond those of the other teeth. The cuspidati of the lower jaw veiy much resemble those of the upper, both in figure and in length. The ena- mel covers more of the lateral parts of these teeth than of the incisores. When they are first formed they are pointed, but by the friction of each upon the other in mastication, they become rounded, and sometimes acquire a flat edge. The use of the cuspidati is not like that of the incisores, to cut and divide substances, nor like the molares for masti- cation, but they arc similar to the canine teeth of the car- 51 niverous animals, and seem to be designed for the laying hold of and tearing substances. • The bicuspides are situated immediately behind the cuspi- dati. They were formerly called the first and second grind- ers, but as they do not possess the true figure of the grind- ers, and only have an intermediate resemblance between those teeth and the cuspidati, Mr. Hunter considered them as a particular class. These teeth are very much like each other, and when viewed as they are situated in the mouth, are not unlike the cuspidati. They are eight in number; those belonging to the upper jaw, have the body divided into two points, one external and the other internal. Their fangs appear as if compressed at the sides, and resemble two fangs united, with a depression running between them. Commonly the first bicuspis has two small fangs, the second has seldom more than one, but in this they are subject to variety. The bicuspides of the under jaw are smaller than those of the upper; the points upon their surfaces are not so distinct, and they have only one fang. The enamel is distributed nearly equally around the crown, and they stand in the jaw almost perpendicularly, and have a slight inclination inwards. The molares, or grinders, are placed behind the bicuspi- des ; there are three on each side of the jaw, making twelve in the whole. The first and second molares are so much alike in every particular, that the description of one will convey a perfect idea of the other. The third grinder, has several pe- culiarities, and therefore must be described separately. The molares are the largest teeth; they have a broader base, and furnished with several points, which fits them for their office in grinding food, and they have several fangs. The molares of the under jaw have an inclination inwards 52 while those of the upper jaw are placed nearly perpendicu- larly with respect to the j»w. The upper grinders have commonly three fangs, two situ- ated on the outer part of the tooth, and one on the inner ; the inner fang is very oblique in its direction, and is larger and rounder than the others. Those of the under jaw have two fangs, one placed forwards, the other backwards ; they are rather flat, and continue broad all down their length. Sometimes molares of the upper jaw are met with having four distinct fangs. I have one with five fangs, which is the only one I ever saw.* The molares of the under jaw now and then have three fangs. The third molaris is called dens sapientise; it is smaller than the others, its body is rather rounder, and the fangs are not so regular and distinct. They often appeal' as if squeez- ed together, and sometimes there is but one fang. The den- tes sapientise of the lower jaw often have their fangs curved, and sometimes they are so much inclined inwards, as scarce- ly to rise above the ridge of the coronoid process. The incisores of the upper jaw being much broader than the same teeth in the under jaw, cause the other teeth to be placed farther back in the circle, than the corresponding- teeth on the lower jaw; hence, in a well formed mouth, when the teeth are shut close, the central incisores of the upper jaw come over the central and half of the lateral incisores of the lower jaw. The lateral incisor of the upper jaw cov- ers the half of the lateral incisor, and more than half of the cuspidatus of the under jaw. The cuspidatus of the upper jaw falls between and projects a little over the cuspidatus and first bicuspis of the under jaw. The first bicuspis of * Fauchard gives a plate of one having five fan°-s. 53 the upper jaw falls partly upon the two bicuspides in the lower jaw. The second bicuspis shuts upon the second bicuspis and the first molaris. The first upper molaris cov- ers two thirds of the first and part of the second molaris of the under jaw. The second upper molaris shuts upon the remainder of the second and part of the third; and the third molaris of the upper jaw, being smaller than that in the under jaw, shuts even upon it. From this mechanism of the teeth, their power in mastication is increased, and if one tooth be extracted, the antagonist tooth does not become useless, since it can in part act upon another. A tooth is composed of two substances, one of which, called the enamel, is spread over that part which is not cov- ered by the gums. The other substance is bone; it con- sists of the fang and all the body of the tooth situated within the enamel. The bone of the tooth is formed from the pulp ; and the enamel, from the investing membrane. The bony part of the tooth is begun to be formed before the enamel. When the ossification of a tooth is commencing, bone is de- posited from the vessels of the pulp upon its extreme points. In the incisores it begins upon the edges, and in the molares upon the points of their grinding surfaces. The ossification usually begins in the incisores in three spots; these increase, soon unite, and produce the cutting edge of the tooth. In the molares it begins in as many spots as there are grinding points, which in the lower jaw are commonly four, and in the upper, five. These soon unite and form one thin layer of bone over the upper surface of the pulp. The ossification soon extends to the sides of the pulp, and a thin shell of bone is spread over its whole surface. If this shell be removed, the pulp, when uncovered, will be found very vascular. This is extremely well seen in the teeth of large animals, when in a state of formation. 54 Some time ago I had the opportunity of examining the pulps of the teeth of a young elephant, which was dissected by Sir Astley Cooper. Upon removing the ossification which had taken place upon the pulps, I found the vessels to be exceedingly full of blood. There was also a consid- erable degree of force required to separate the bone from the pulp, and this strength of union between the pulp and the ossified part, I have always found to be in proportion to the size of the tooth. In the formation of the bone of a tooth the ossific matter is deposited in strata, one within side the other; thus a tooth is formed from the outer part to the inner; and this deposition of bone continues until the tooth becomes com- plete. When the body of the tooth is formed, the pulp elongates, and takes the form of the fang proper to each particular tooth, and bone is deposited upon it. It then be- comes gradually smaller, until it terminates in a point. If a tooth have two or more fangs, the pulp divides, and the ossification proceeds accordingly. The cavity within a tooth, as it is forming, is at first very considerable; it be- comes less as the formation advances, until it arrives at a certain point, when a cavity is left in it extending nearly the whole length, and retaining the shape of the tooth. In the crown of the tooth, the cavity is of the same fig- ure, and it divides into as many canals as there are fano-s to the teeth. A canal extends through each fang connected with the cavity in the body of the tooth. Into this cavity the nerves and blood vessels enter and ramify upon a mem- brane of the pulp, which remains to line the cavity after the formation of the teeth. In this manner the nerves give sen- sation to the teeth, and the internal parts of them are nour- ished. 55 The enamel is situated upon all that part of a tooth which in the healthy state of the gums is not covered by them. This portion of a tooth is called the body or crown. It is formed by the membrane which invests the pulp. When a shell of bone has been formed upon the pulp, this membrane secretes a fluid, from which a very white soft substance is deposited upon the bone; this is at first of a consistence not harder than chalk, for it may be scratched or scraped off by the nail; it however soon grows hard, and seems to undergo a process similar to that of crystalization, for it takes a regu- lar and peculiar form. The deposition of the enamel continues nearly as long as a tooth is contained within the membrane. It is always most in quantity upon those parts where its formation first began; it is thicker upon the edges and grinding surfaces of the teeth, than upon the sides, and it gradually becomes thin- ner as it approaches the necks of the teeth. A tooth, when sawn through, shows the arrangement of the enamel; and as it requires more heat to blacken and burn this hardest part of the animal frame than the bony part of the tooth, we can, by exposing it to the effects of fire, obtain a still more distinct exhibition of it. By the time the enamel is completely formed, the tooth has risen so much in the sock- et, that by its pressure it occasions an absorption of the membrane, which completely prevents any further addition of enamel. When perfect the enamel of the teeth is so hard, that a file, in cutting it, is soon worn smooth, and when struck with it, sparks of fire will be elicited ; an effect I have several times produced with human teeth, and which will be very readily seen, by striking the teeth of large animals with steel, particularly those of the Hippopotamus. 56 The enamel when broken appears to be composed of a greater number of small fibres, all of which are so arranged as to pass in a direction from the centre to the circumference of the tooth, so as to form a sort of radii round the body of the tooth. This is the crystalized form it acquires some time after its deposit; by this disposition of its fibres, the enamel acquires a great degree of strength, and thus it is not so readily worn down in mastication, nor so easily fractured by violent action of the teeth. While some eminent physiologists have contended, that the teeth, when they have attained their full growth, are to be considered extraneous bodies, and that they no longer re- ceive nutriment like the other bones of the body, oth- ers have supposed, that even the enamel is kept up in future life by continued deposits : but that this cannot be the case will be obvious, when it is considered that the mem- brane which invested the pulp and produced the enamel, is destroyed before the tooth can appear. When a tooth first appears, the enamel is thicker than at any other period of life, and from that time begins to decrease; this may be re- marked in some of the permanent teeth. The incisores, when they first pass through the gum, have their edges notched, the cuspidati are sharp at their points, and the grinding surface of the molares is always irregular. This sharpness of the points of the teeth is occasioned by a larger deposit upon those parts where ossification had first com- menced. By the friction of the teeth against each other, and against the food in mastication, the teeth are worn smooth, the notches upon the incisores disappear, the points of the cuspidati are rounded, or in many cases entirely removed, and the surfaces of the molares become much smoother. 57 The case is quite the reverse with the bony part, for when a tooth is first seen through the gum scarcely more than two thirds of the fangs are formed, but the ossification continues for a considerable time afterwards. The enamel upon some teeth has a very defective formation ; instead of being a hard white substance having a smooth polished surface, it is frequently met with of a yellow colour, and having a great number of indentations upon its surfaces. This occasions the teeth to resemble the exterior of a sponge, and gives them what has been termed a honey-combed appearance. Sometimes this appearance* of the enamel is only met with on the front teeth, near the cutting edge, at others it extends nearly over half of the tooth, the remaining parts being perfect. When the roughness is near the edge, it often wears out in a few years, or at the age of maturity it may be filed out. In some cases one, two, or three indented lines, pass across the front of the teeth. This defective formation of the enamel is usually confined to the incisores, cuspidati, and first permanent molares ; it is rarely met with on the bicuspides, or second and third molares. The arteries which supply the teeth with blood are called the dental; they are branches of the internal maxillary arte- ry which arises from the external carotid, at that part where it is covered by the parotid gland, and lies behind the mid- dle of the upright plate of the lower jaw where it divides into the condyloid and coronoid processes. It passes first between "the jaw and the external pterygoid muscle, and * This may, and frequently does arise, from some cause that mechan- ically disturbs the membranes before ossification is completed ; for the enamel is exactly of the shape and figure of the membranes from whicli it is formed. 8 58 afterwards runs in a very winding direction towards the back part of the antrum maxillare; it here sends numerous branches to the parts belonging to both jaws, and to the teeth of the upper jaw. It then gives off one branch to the lower jaw, called by some the inferior maxillary, and by others the dental. This enters the jaw bone at the poste- rior maxillary foramen, passes through the maxillary canal, and gives off branches to the fangs of each tooth, and also supplies the substance of the bone. This vessel having sent a branch to the incisores, passes out at the anterior maxilla- ry foramen; it is distributed to the gums, and communicates upon the chin with branches of the facial artery. The nerves which are distributed to the teeth arise from the fifth pair, the trigemini. This pair of nerves divides into three branches; the ophthalmic, the superior maxillary, and the inferior maxillary. The ophthalmic branch passes through the foramen lacerum of the orbit, and is distributed to the parts in the neighbourhood of the eye. The superior maxillary nerve goes out at the foramen rotundum of the sphenoid bone, and divides into several branches, being con- tinued to the posterior part of the nose, the palate, velum palati, and contiguous parts. At the posterior part, small filaments of nerves, accompanying branches of arteries, en- ter the superior maxillary bone by foramina, which lead to the molares and also to the membrane lining the antrum maxillare. The nerve then goes into the canal under the orbit and forms the infra orbitar nerve. Whilst in the ca- nal, it sends off branches to the bicuspides, cuspidati, and in- cisores ; it afterwards passes out at the foramen infra orbita- rium, and is distributed upon the cheek, under eyelid, upper lip, and side of the nose. The inferior maxillary nerve passes through the foramen ovale of the sphenoid bone, and is distributed to the muscles 59 of the lower jaw: it sends off a large branch, the lingual. which goes to the tongue, which is the true gustatory nerve ; it then enters the maxillary canal of the lower jaw, passes through the bone under the alveoli, and gives off branches which, entering the fangs, ramify upon the membrane within the cavities of the teeth ; it passes out at the anterior max- illary foramen, and is spent about the chin and lip. The teeth are fixed in their sockets by that species of ar- ticulation called gomphosis. They are attached to the alveo- lar cavity by a strong periosteum which is extended over the fangs, and which also lines the sockets; it is connected to the gums at the neck of the tooth, and it is vascular like the periosteum in other parts of the body. SECTION VIII. OF THE ALVEOLAR PROCESSES.* We observe the beginning of the alveolar process at a very early period. In a foetus of three or four months, it is only a longitudinal groove, deeper and narrower for- wards, and becoming gradually more shallow and wider backwards. Instead of bony partitions dividing that groove into a number of sockets, there are only slight ridges across the bottom and sides, with intermediate depressions, which mark the future alveoli, f " In the lower jaw the vessels and nerves run along the p Natural History of the Human Teeth, by John Hunter, London, 1803. t Page 74; 75—6. 60 bottom of this alveolar cavity, in a slight groove, which af- terwards becomes a complete and distinct bony canal. The alveolar process grows with the teeth, and for some time keeps the start of them. The ridges which are to make the partitions shoot from the sides across the canal, at the mouth of the cell, forming hollow arches. This change hap- pens first at the anterior part of the jaws. As each cell be- comes deeper, its mouth also grows narrower, and at length is almost, but not quite, closed over the contained tooth." " The disposition for contracting the mouth of the cell, is chiefly in the outer plate of the bone, which occasions the con- tracted orifices of the cells to be nearer the inner edge of the jaw. The reason, perhaps, why the bone shoots over, and almost covers the tooth, is, that the gum may be firmly supported before the teeth have come through. The alveoli which belong to the adult grinders, are form- ed in another manner: in the lower jaw they would seem to be the remains of the root of the coronoid process, for the cells are formed for those teeth in the root of that process; and in proportion as the body of the bone, and the cells already formed, push forwards from under that process, the succeed- ing cells and their teeth are formed and pushed forward in the same manner." " In the upper jaw there are cells formed in the tubercles for the young grinders, which at first are very shallow, and become deeper and deeper as the teeth grow; and they grow somewhat faster, so as almost to enclose the whole tooth, before it is ready to push its way through that enclo- sure and gum. There is a succession of these, till the whole three grinders are formed." In the adult, the alveoli are usually from one third to two thirds of an inch in depth, being much deeper in the front than on the posterior part of the jaws. They are ap- 61 pendages of the teeth, grow with them, and when they are lost, the alveoli soon disappear. The knowledge of this fact enables us to explain the great changes which take place in the appearance of the features, from the loss of the teeth, and consequent loss of the alveoli: and a knowledge of this circumstance enables us by directing the growth and posi- tion of the teeth and alveoli, to prevent and correct deform- ities from a mal position of these organs. section ix. OF THE GUMS.* The alveolar processes are covered by a red vascular sub- stance, called the gums, which has as many perforations as there are teeth ; and the neck of a tooth is covered by, and fixed to this gum. Thence there are fleshy partitions be- tween the teeth, passing between the external and internal gum, and as it were uniting them ; these partitions are high- er than the other parts of the gum, and thence form an arch between every two adjacent teeth. The thickness of that part of the gum which projects beyond the sockets is con- siderable ; so that when the gum is corroded by disease, by boiling, or otherwise, the teeth appear longer, or less sunk into the jaw. The gum adheres very firmly in a healthful state, both to the alveolar process and to the teeth, but its extreme border is naturally loose all around the teeth. The gum, in substance, has something of a cartilaginous hardness and elasticity, and is very vascular, but seems not * Natural History of the Human Teeth, by John Hunter. London, 18ve each five points, the middle grinders four, sometimes five points, and 83 the posterior or wisdom-teeth three or four. In other re- spects their formation is exactly similar to that of the tem- porary grinders, but they are much larger. In the under jaw they have in general two roots, in the upper three, but the posterior, though they have sometimes two, three, or even four distinct roots, seem most commonly to have but one. SECTION III. OF THE PULP, AND FORMATION OF THE BONY PART OF A TOOTH.* The pulp seems intended for a purpose similar to that of the cartilaginous matter of the other bones, though the pro- cess of its ossification is conducted in a different manner. A tooth is formed from without inwards, the first part formed being the outermost layer, which is as large, and probably as perfect at first, as at any subsequent period of life. I allude here to that part only of the outermost layer, on which the fibres of the cortex striatus are afterwards to be arranged. Ossification commences on the highest or most promi- nent point of what is afterwards to be the cutting edge or orindino- surface of the tooth; as also, on as many points as there are eminences on the pulp. The bony matter being first deposited on these points, it necessarily becomes hol- lowed towards the pulp, and gradually augmenting, at length forms over it small elastic shells. On the incisores and cuspidati, whose formation is more Blake, Essay on the Teeth, in Man, Pngcs 5 to 15. 84 simple than that of the others, there is in general only one shell formed, but on the grinders several of them appear. On the anterior or small grinders, there are four shells form- ed, sometimes however but two. On the posterior or large grinders there are in general five shells, of which, in the un- der jaw, three are placed externally or next the cheek, and two internally. In the upper jaw, they are so situated that their eminences are adapted to the hollows of the opposite teeth in the under jaw. As ossification advances, the bases of these shells come in contact, and at length unite, so as to form one shell, after which ossification proceeds for some time, as in the incisores and cuspidati, gradually extending over the greater part of the pulp ; and when so far advanced as to form the body of the tooth, it begins to contract from without, thus shaping the neck, from which the root or roots are to commence. As the bone of the tooth increases in thickness, the pulp is proportionally diminished, and seems as it were converted into bone ; its connexion however with the bony part is very slight, except at its extreme elastic edge, so that when the membrane surrounding the tooth is cut open, the shell can be taken from off the pulp, without any apparent violence ; in- deed without altering the shape of the pulp, or scarcely its connexion with the vessels. When the shell is removed, the pulp appears covered with a very delicate membrane, on which the vessels form a net-work. This seems to be a propagation of the periosteum which enters the cavity of the jaw, along with the vessels, and probably from whence are derived the bony lamellae of which a tooth consists. Though this membrane is so slightly connected with the in- ternal part of the shell, I cannot think Mr. Hunter's assertion warrantable, when he says, "nor are there any vessels going 85 from the one to the other.* He might as well have denied the existence of vessels in the crystaline lens, as it more readily slips out of its capsula, than this pulp from its shell. As the pulp has originally no process answering to the root or roots, it has been supposed that it is lengthened, or squeezed out so as to form them, according as the cavity in the body of the tooth is filled up by the ossification.! I have already mentioned that the pulp at first assumes little more than the size of the upper part of the body of the tooth, which is to be afterwards formed upon it; but it is deposited and extends in proportion, as ossification advances. It is the pulp and its vessels which give a determinate shape and size to the body of the tooth, and it will in its proper place be shown that its processes determined the size and shape of the roots. How it is possible that the simple fill- ing up of the cavity in the shell of a grinder, could occasion the pulp to lengthen out into two, three, and sometimes four roots ? Of those teeth which are to have but one root, the pulp increases in length as I have described, becoming more and more contracted towards the point; and as ossification ad- vances, the bone forms on it a kind of conical tube. But, in those teeth which are to have more than one root, a beau- tiful process is carried on. In the grinders of the lower jaw, which in general have but two roots, the pulp is divided into so many processes a little below the neck: at this period there is but one general opening in the shell, from the oppo- site sides of the edge of which, osseous fibres or little bars shoot across, through the division of the pulp; these meet and unite in the middle, and so divide the cavity of the shell into two openings, forming over it a little arch. In the grind- ■ Nat. Hist, page 89. t Nat. Hist, page 90. 86 ers of the upper jaw, which have in general three roots, the pulp is divided into as many processes, and the osseous bars shoot- ing through them, from as many different points in the mar- gin of the shell, and uniting in the middle, divide the cavity into three openings, two of which are placed externally, and one internally. Sometimes an osseous point is deposit- ed in the centre of these processes, and fibres shooting across from the margin of the shell join it, which answers the same purpose.* From these openings, the processes of the pulp commonly become more and more divergent and ossification extending on them forms a conical or flatted tube on each, as in teeth which have but single roots. Sometimes the pulp is divided at the neck only into two processes ; ossifica- tion goes on for some time as usual, but one tooth or both of these become divided again, and so three or four roots are formed. I have met a few of the permanent grinders, in which the pulp did not divide into processes, so that only one root was formed. The pulp continues to advance faster than the ossification, until each process has acquired its proper length and shape; then the pulp except where the vessels and nerves enter, becomes entirely surrounded with bone. Mr. Hunter mentions,f " by the observations which I have made in unravelling the texture of the teeth when softened by an acid, and from observing the disposition of the red parts in the tooth of growing animals, interruptedly fed with madder, I find that the bony part of a tooth is formed of lamella?, placed one within another. The outer lamella is the first formed, and is the shortest: the more internal lam- ellae lengthen gradually towards the fang, by which means in * Albin. Acad. Annot. Lib 11. P. 17. i Nat. Hist, page 92. 87 proportion as the tooth grows longer, its cavity grows small- er, and its sides grow thicker." Now, from my observa- tions, the fact is directly the reverse ; the outer lamella, which is the first formed is longest, the internal lamellae be- come shorter and shorter, and the last formed is the short- est. Hence in teeth with single roots, the cavity of the shell is not only diminished, but it recedes from the apex or cutting edge of the tooth, whilst a conical tube is left for the admission of vessels, &c. the base of which ending in the fyody of the tooth, has its opening or point nearly in the ex- tremity of 'the root. The lamellae of a grinder, are distrib- uted more irregularly than those of any other tooth, on account of the protuberances of its pulp. As its exter- nal lamella advances very slowly, a great number of the internal ones are advancing, at the time that the external lamella has got so far as to form the neck. So that the cav- ity of a grinder recedes from the grinding surface, more rapidly than that of any other tooth. After the roots com- mence, the cavity is soon diminished, the ossification going on at the same time at both the upper and under parts of it. As many conical or flatted tubes are left leading to the cavity, as there are roots; and as many hollows or depressions in the superior part of the cavity, as there are protuberances on the grinding surface. The pulp, though very much dimin- ished, still retains nearly its original shape. It may appear singular, that the pulp should not be en- tirely obliterated, and the ossification completed, without any remaining cavity; it however affords this advantage, that the vessels and nerves distributed on the soft membrane of the pulp may have free action and not be compressed; by which means the internal bony part of the tooth may be more readily nourished. 88 It is asserted by a celebrated anatomist that he has con- stantly found two holes near the point of each root, for the admission of vessels, not only of the incisores and cuspidati, but also of those of the grinders ; which he supposes to have been established by nature, in order to guard against acci- dent, lest if one vessel were injured or destroyed, the other might continue to nourish the pulp. I confess I was never so fortunate as to meet a single instance of this kind, even in the incisores of large animals; except in such cases as Eus- tachius mentions, where he says, (speaking of the roots of the permanent grinders,) " Many of these roots (s. c. roots,) being flattened, their sides thus approach; so that, instead of a circular opening, an oblong one is formed, the central points of whose sides coming into contact, leave at either end a small canal." In such roots, however, I have fre- quently found but one opening externally, for the admission of vessels, &c. but after their entrance each divided into two branches. Haver mentions, * that in a tooth which had but one root, he met two passages, one at each side. This must have been formed in the manner Eustachius describes. I have seen a few of the permanent incisores with almost two distinct roots, the cuspidati with two, sometimes with three roots, and the grinders with four and even five roots, and of course as many openings as roots. * Ostreologia, page 79. 89 SECTION IV. OF THE GRADUAL WASTE OF THE MEMBRANE WHICH SUR- ROUNDS THE BODY OF A TOOTH, AND THE PERIOD AT WHICH THE TEMPORARY TEETH IN GENERAL APPEAR.* The membrane which deposits the earthy matter of the cortex striatus, does not adhere to, but closely surrounds the body of the tooth ; but as soon as the neck is formed, the margin of the membrane adheres to it so firmly at that part, # that it cannot be separated from it, without lacerating several vessels which pass from it to the bone. The membrane be- comes much thinner at this part, and I could not separate it at any period into two lamellae. As ossification advances on the root or roots, the body of the tooth rises in the socket, and of course the investing membrane rises with it. The cortex striatus is first perfect- ed or crystalized on the cutting edges or protuberances of the tooth, and proceeds gradually from thence to the neck where it terminates ; and in proportion as the first part of the cortex striatus is crystalized, that portion of the mem- brane which formed it becomes thinner, less vascular, and at length, having performed the particular function for which it was designed, is totally wasted or absorbed. The gums also partake of this tendency to waste, and the tooth gradu- ally appears through it; part of the membrane still remains on the body of the tooth, this however is wasted as the cor- tex striatus covered by it, attains to perfection. So that all that portion of the membrane, which loosely surrounded the • Blake,, pages 16 to 26. 12 90 body of the tooth, is destroyed when the tooth has risen to its proper height. De La Sonne,* and other physiologists, attempt to assign a cause why the teeth rise and pass through the gum, by say- ing that as roots are added, the bodies of the teeth are push- ed or forced up through the gum, this being softer than the bottom of the sockets. But when we come to consider the appearance of the permanent teeth, we shall be fully sensi- ble how inadequate such a theory is. It has been mentioned by most authors, who have written on dentition, that the membrane which surrounds the body * of a tooth is stretched, bruised, and even lacerated by the increased size of the tooth. Dr. Underwood supposes it to be strong and nervous, and adds, " The most painful part of dentition, and that in which children are most exposed to con- vulsions, is usually from the teeth cutting through the perios- teum, (or nervous membrane mentioned above,) that covers the teeth." Van Swieten although he did not believe the temporary teeth had roots, says, " These rudiments of the teeth are placed in the sockets of the jaws ; but the opening from each of these sockets, is covered by a thick coriaceous membrane, which must be bruised, or even torn by the tooth in bursting out, so that after the tooth had burst out, the rag- ged edges of this membrane have been observed by the ac- curate Herissant. These edges becoming dry fall away spontaneously. Therefore the tooth in endeavouring to make its way out, must exert a considerable force in order to break through this membrane."! It appears rather strange that Van Swieten could imagine that the temporary teeth, which in another part of his work, ■*■ Acad des Scien, in4to. L'an. 1752. Mem. p, 168. t Comment. Vol. xiv. page 743. 91 he observes have no roots, could perforin all these violent efforts, so as to burst through this membrane. Even Mr. Hunter says,* " When the tooth cuts the gum, this mem- brane or capsula is likewise perforated, after which it begins to waste." Others are of opinion, that the membrane being lacerated, the body of the tooth passes up through it, and that it afterwards becomes the periosteum of the root. From what I have already said, the impossibility of a tooth burst- ing or rising through its membrane will be readily perceived, for as it is firmly united to the neck of the tooth, it must take of the same precise motion with the tooth, and therefore must, after such motion of the tooth, retain the same#relative position towards it as before. So that the disappearance of the membrane is not owing to a rupture of it, but to a wasting or absorption of it, in proportion as it has perfected the cor- tex striatus. This fact will be more fully explained, when we come to speak of the teeth of animals in general. I have seen the ragged edges of the membrane, appearing above the level of the gum ; a similar appearance was no doubt observed by Herissant, though he attributed it to a wrong cause. Galen, Eustachius, and others, were of opinion that the upper teeth appeared sooner than the under; they were fully aware, however, that they appear irregularly and at different periods. Mr. Hunter describes their appearance in the following words.f " The incisores begin to cut or pass through the gums; first, generally, in the lower jaw; but the cuspidatus and molares of the foetus, are not formed so fast as the incisores ; they generally all appear nearly about the same time, viz. about the twentieth or twenty-fourth month ; * Natural History, page 87. t Natural History, page 78. 92 however, the first grinder is often more advanced within the socket than the cuspidatus, and most commonly appears be- fore it." Chirurgical writers in general, give us a most curi- ous jumble, respecting the appearance during dentition; and most of the strenuous advocates for cutting and hacking the gums of children, seem perfectly ignorant of the order in which the teeth appear. Dr. Underwood says, " The two front teeth in the lower jaw are usually cut the first, and it is commonly a few weeks longer, before the corresponding ones in the upper jaw make their appearance. After which it is frequently a considerable time before the next under teeth come out; but sometimes, though not often, six or eight are cut in a hasty succession. Children sometimes cut their teeth irregularly, or cross, as it is called, both by the teeth appearing first in the upper jaw, and also at a distance, instead of being contiguous to each other: this is accounted, and with some reason, an indication of painful or difficult dentition." It is unnecessary at present, to enter more fully into the inaccuracies of these authors, or to say any thing re- specting their operations, (which are blindly, and I may say, very often rashly performed, for want of anatomical know- ledge of these parts,) as I intend to enlarge considerably on this subject, when I come to treat on dentition. As ossification does not commence on all the pulps at the same time, in general those on which it first commenced are soonest perfect, and of course they appear through the gum first. I have observed on examining the teeth of a number of children, that the bodies of the middle incisores of both jaws were most perfect; the lateral incisores and the small grinders next, and the cuspidati and small grinders least per- fect. In general the teeth begin to appear about the sixth, seventh, or eight month after birth ; but there are some ex- ceptions to this rule, owing to the rapid progress of ossifica- 93 tion in some children, and the slowness of it in others. There are a few instances of children at birth having one or two of the incisores already cut, and in such cases it is often necessary to remove them immediately ; on the contrary, in children apparently healthy, they have not begun to appear till the first, second, or even the third year. They for the most part appear in pairs, or the two corresponding with each other, nearly at the same time. The first are the middle incisores of the under jaw; in a few weeks after the middle incisores of the upper ; in a month or six weeks after, we have reason to expect the lateral incisores of the under jaw, and in a short time after those of the upper ; about the twelfth or fourteenth month, the anterior or small grinders of the under jaw appear, and frequently about the same time those of the upper; about the sixteenth or twentieth month the cuspidati appear first in the lower jaw, and from the twentieth to the thirtieth month the posterior or large grinders appear in the same order: so that in general about the second or third year, the twenty temporary teeth are complete. We must not expect however to find the teeth always appear in the precise order I have just now mention- ed. I have frequently met with some irregularities, such as one tooth appearing a considerable time before its fellow ; all the incisores of the under jaw appearing before any of the upper; and the reverse, though very seldom, has some- times taken place: the anterior grinders sometimes appear sooner than the lateral incisores, and the lateral incisores of the upper jaw, sooner than those of the under. I have some- times observed the posterior grinders appear earlier than the cuspidati; but I never saw an instance of the cuspidati ap- pearing previous to the small grinders; sometimes three or four teeth appear nearly at the same period, but I never met an instance of the cuspidati and grinders appearing in such 94 rapid succession as Mr. Hunter and Dr. Underwood men- tion. Dr. Armstrong says * that he met with two cases, where the small grinders appeared first of all; I have lately met a similar case; however, by carefully examining the gums of a child, we can seldom mistake what tooth is about to appear, as the gum is frequently somewhat higher over it, than elsewhere, or it becomes so thin, that through it the shape of the tooth can be perceived. section v. OF THE SHEDDING OF THE TEMPORARY TEETH AND OF THE PERIOD AT WHICH THE PERMANENT TEETH APPEAR.f We meet with such strange opinions in the works of a celebrated author, (Van Swieten,) respecting the temporary teeth, that I think it worth while to insert some extracts from them: He says, " I have taken out and examined several of the first teeth when they begin to loosen, and in most of them I did not observe the slightest appearance of a root. This surprised many surgeons, who, in the treatment of dis- orders of the teeth, were esteemed exceedingly skilful. They were of opinion that the teeth which are usually shed about the seventh year have had roots, but when they took out those that were already loose they found no roots. To account for this, they said that the second tooth while it rises, rubs away the roots of the first and so reduces them to the most minute powder, which, being so very fine, en- * Diseases of Children, page 82. t Blake. Essay on the Teeth, &c. pages 55 to 70.„ 95 tirely disappears, for no body could ever perceive it. But could the action of the second tooth, gently rising, whilst it moves the first out of its place, be so great as to reduce the roots of them to powder ? Bourdet, celebrated for his skill in this branch of surgery, asserts, that the first teeth before they loosen, have roots nearly as strong and hard, as the second are observed to have. And whilst he refutes the opinion of Bunon, who supposed the roots of the first were destroyed by the friction of the second teeth when rising, he refers to those which are found in the jaws of fresh subjects, at that period when the second teeth are forming, and the first (called milk-teeth) are still in their sockets; whether they are still firm, or are more or less loose; for it seems that the second tooth whilst it rises, remains enclosed in its proper membrane, until it is about to appear. There- fore a membrane is interposed between the roots of the milk- tooth and the second tooth. However the roots of the milk- teeth are destroyed before the second tooth can touch them. Besides a small space is observed between the first and second teeth, from whence Bourdet concludes, that the roots of the milk-teeth are destroyed by some other cause, and not by the friction of the succeeding teeth. He there- fore thought that some acrid humour was secreted from the neighbouring parts, which might consume their roots. 1 confess it appears to me much more probable that the milk- teeth are without roots. Nevertheless some observations seem to show that the milk-teeth, if they are not shed, at the proper period, or when loose are not taken out, are ca- pable of protruding roots from their body, by means of which they often remain fixed in the jaws through life."* " Comment. Vol. siv. page 743, kc 96 It is almost superfluous to mention that the temporary teeth have as perfectly formed roots as the permanent, in- deed as far as I recollect, Van Swieten is the only person who at all doubted the fact. Mr. Hunter ingeniously observes, * " that the first set of teeth are pushed out by the second ; this, however is very far from being the case: and were it so, it would be attend- ed with a veiy obvious inconvenience; for were a tooth pushed out by one underneath, that tooth must rise in pro- portion to the growth of the succeeding one, and stand in the same proportion above the rest." Mr. Hunter, however, does not seem to be acquainted with the writings of the very accurate Albinus ; if he were, he would be induced to give a very different description of what takes place, with respect to the wasting of the roots of the temporary teeth and the appearance of the permanent, as will appear from the following quotations. Mr. Hunter says, f " it would be very natural to suppose that this wasting was owing to a constant pressure from the rising teeth against the fangs or sockets of the first set: but it is not so, for the new alveoli rise with the new teeth, and the old alveoli decay in propor- tion as the fangs of the old teeth decay, and when the first set falls out, the succeeding teeth are so far from having de- stroyed, by their pressure, the parts against which they might be supposed to push, that they are still enclosed, and covered by a complete bony socket. From this we see that the change is not produced by a mechanical pressure, but is a particular process in the animal economy." And page 100 he makes use of the following words, " when the in- cisores and cuspidati of the new set are a little advanced, but long before they appear through their bony sockets, there * Nat. Hist, page 98. t Nat. Hist, pages 98 and 99. 97 are small holes leading to them on the inside, or behind the temporary sockets and teeth, and these holes grow larger and larger, till at last the body of the tooth passes quite through them. Mr. Hunter supports this theory still farther in page 90 &c. " As the body of the tooth is pushed out, the socket at the same time contracts at its bottom, and grasps the neck, or beginning fang, adheres to it, and rises with it, which contraction is continued through the whole length of the socket as the fang rises ; or the socket which contained the body of the tooth, being too large for the fang, is wasted, or absorbed into the constitution, and a new al- veolar portion is raised with the fang." The observations of the ingenious Mr. Hunter are however entirely hypothetical and do not accord with anatomical truth; indeed they en- tirely overturn some of his former opinions. For if, as he affirms, the permanent teeth were formed at the internal part of the jaw and in a new series of alveolar processes, it is evident that they must necessarily be placed in a smaller circle than the temporary teeth. As if the processes and sockets of the temporary teeth, as Mr. Hunter asserts, were absorbed or totally destroyed, the permanent sockets should extend to the anterior part of the jaw, accommodate them- selves to the teeth, and thus form a segment of a larger circle. Albinus however comes very near the truth, for when speaking of the holes by which the connexion between the membranes of the permanent and temporary teeth were pre- served, he says, " as the new teeth increase, the contracted part of the sockets is gradually dilated, and afterwards in like manner the little opening, and thus they appear. But if previous to the formation of the new teeth, the temporary had fallen out, or were loosened in consequence of their roots being wasted, then the socket of the temporary tooth is gradually destroyed, while that of the other being dilated Jo 98 anteriorly, the new tooth passes into its place, so that the root of the new tooth is contained in a socket formed partly of that in which it was before, and partly of the socket which belonged to the temporary tooth. But if contrary to what commonly happens, the tooth which ought to be shed, is not shed, then the permanent tooth appears behind it, and re- mains similar to it fixed in its own appropriate socket."* Had Albinus been acquainted with the use of the small holes leading to the permanent teeth, he would immediately have discovered what usually takes place. I have already shewn that the temporary and permanent teeth were about the fourth year separated from each other by a bony partition, each root being at this period contained in a distinct socket. Now according as the permanent teeth rise, they have a natural tendency to come more and more to the anterior part of the jaw ; whilst in consequence of the pressing forward of the rising tooth, a change is induced in the mode of action of the surrounding vessels, such,.that that portion of the bony partition immediately pressed upon, as well as the root of the temporary tooth, with the adjacent parts, become fit to be absorbed, and actually are absorbed. In some cases part of the roots of the neighbouring tem- porary teeth are absorbed, particularly where the jaw does not increase as rapidly as the permanent teeth. So that in proportion as this absorption takes place, the permanent tooth passes partly into the socket of the temporary tooth proper to it, and partly into the sockets of the neighbouring temporary teeth. And as Albinus justly remarks, a socket is formed for the reception of the root of the new tooth, in part by its own appropriate socket, and in part by the tem- porary socket of the tooth with which it was originally con- * Acad. Annat. lib. II. pages 14 and 15. 99 nected, and sometimes in part by the neighbouring tempo- rary sockets. When the permanent teeth pass into the cavi- ties which surrounded their membranes, they are always very irregular and appear as Albinus remarks at the inside of the temporary teeth, which frequently remain in their sit- uations. This irregularity however is seldom the case, un- less where the temporary teeth retain their roots, and resist the influence of the permanent. In some cases they appear more internally than the cavities through which the connect- ing membranes passed. It is worth remarking that when the temporary teeth fall out, if we examine their bodies, we find them quite excavated, and the bony part reduced nearly to its former pulpy state. Mr. Hunter, in support of his theory, has represented the wasting of the roots of the temporary teeth, as it were, pro- ceeding from the point gradually upwards to the neck.* This, however, is seldom or never the case, for the part first affected is considerably above the point; how this takes place will be easily understood by viewing plate ii. fig. 5, and plate iv. figs. 26, 27, and 28. This circumstance Albi- nus was fully aware of, and has given drawings to illus- trate it.f With respect to the appearance of the permanent teeth, Dr. H., in a letter he wrote to me at Edinburg, judiciously remarks, " the time of shedding is very various, happening a year or two, or three, earlier or later in some than others; and in many subjects some of them remaining to adult or even old age; and this is so common, that almost every day I meet with them from one to three or four, or double the number in the same person. I have seen two instances where scarcely any of them fell, and such I may affirm must ** Nat. Hist; plate xv. i Acad. Annat. lib. II. Tab 2. 100 have been those historic facts, handed down to us, of a third set appearing in the old age of heaven-favoured mortals where it could be nothing else than the then matured second set. Such I have met with, but never any thing like a third set, at least, which I was convinced was such." It appears from the foregoing observations, that the permanent teeth, whilst they are rising in the jaw, have considerable in- fluence with respect to the wasting of the temporary roots ; for while they are at rest, the roots of the temporary teeth are not wasted. However it does not appear to me, that the wasting of the temporary roots, is in any degree the effect of mechanical trituration, as Mr. Bunon and other authors would affirm. In general, children begin to shed their teeth about six or seven years of age, and the permanent teeth appear nearly in the following order. First, the middle incisores of the under jaw, soon after, those of the upper, then the lateral incisores of the under jaw, and nearly at the same time the anterior grinders ; then the lateral incisores of the upper jaw appear, though some time elapses between their appearance and that of the former: the anterior bicuspides appear about the ninth year, the posterior about the tenth or eleventh, and the cuspi- dati and middle grinders nearly at the same time, that is, about the twelfth or fourteenth year, and finally, the posterior grinders or wisdom-teeth from the sixteenth to the twenty- fifth year. Though Dr. H. remarks, there are many excep- tions to this general rule, yet I do not think it necessary to dwell so much on the order or period of their appearance, as I have done with respect to the temporary. The anterior permanent grinders frequently appear a con- siderable time before any of the temporary teeth are shed, and there are many varieties with respect to the wisdom-. teeth, for in some cases they do not appear until a very late 101 period of life ; sometimes they appear in one jaw and not in the other, and sometimes it has been observed that in ex- treme old age they have not perforated the sockets. It is certainly a curious fact, how very long some of the perma- nent teeth remain within the jaws without appearing; and if there ever was a third set of teeth, it is sufficiently evi- dent, that their rudiments must have been deposited, pre- vious to the appearance of the second set through the gum. In the preceding remarks of Dr. Blake I can readily concur as to their general application. With respect to the tardy appearance of the adult teeth it is an occurrence fre- quently observed. We often notice the retention of the in- fant teeth to the fifteenth, twentieth, twenty fifth and even thirtieth year. A lady aged about twenty seven called upon me last November, for the purpose of having some opera- tions performed upon her teeth, and upon examining them I found she had never shed the infant molares, and as the per- manent molares appear behind the infant molar teeth, if she had not have lost some of these last, her rows of teeth would have presented the novelty of twenty instead, as usual, of twelve molares. I am acquainted with a gentleman in whom one of the infant lateral incisores is retained, and as the permanent incisores have appeared and are perfect, he has five instead of four incisores. Great aberrations from what we have described as the usual order of nature are occasionally noticed in regard to the appearance, numbers, renewal of the teeth, &c. Cases have been noticed when the teeth have been en- tirely wanting. Mr. Murphy observes,* " A few instances have occurred of persons who never had any teeth. One case was conimunicated to me by a lady on whose veracity I * Page 48. 102 place the highest dependence. It is. very well known to his numerous private friends, as well as to the gentlemen of the faculty in Lincoln, and its vicinity, that the late Mr. Brom- head of the above place never had any teeth." The bicus- pides are often wanting as I have noticed in several instances* Duval observes—*" We read in the Ephemerides des Curieux de la Nature, that a magistrate and a surgeon of Frederick- stadt had never any teeth but the grinders, and were left en- tirely without the incisores and canine. But what ap- pears very surprising is the fact of several persons having been totally destitute of teeth from their birth, several ex- amples of which are given by authors. Boxelli reports in his Medical Centuries that a woman had never any teeth, who nevertheless lived to the age of sixty years, and M. Baumes knew an hussar, who had never cut a tooth. It may happen that some of the milk-teeth may never be cut, but only the secondary ones as I witnessed in 1790, in the son of a Russian nobleman. By an inverted order nature some- times preserves the milk-teeth, and withholds the permanent ones ; this observation is very important as it may tend to render us cautious in having the temporary teeth extracted, unless there be a necessity for it. In other cases nature is more prodigal and gives much more than the ordinary number, many such examples have been furnished by anato- mists : these teeth which should be regarded as supernumer- ary are not always well formed nor well arranged as I have had occasion to observe: sometimes they are conical and are placed either betwixt the incisores or before or behind the spaces which separate these teeth, at other times they are regular and properly arranged; sometimes we find these supernumerary teeth on the outside of the large grinders: * Dentiste Jeunesse, pages 66«—57—58—59. 103 but to see two rows of teeth as in the son of Mithradatus or three as in Hercules, must excite our astonishment: perhaps we might be tempted to doubt these facts if in a collection of observations published at Brusland in 1772 and dedicated to the celebrated Haller Arnold had not reported that he had seen a child, aged fourteen years, who had seventy-fwo teeth, thirty-two for each jaw, which were healthy and well placed in two rows, except the front ones, which were slightly irregular. The number of the teeth is generally fixed but it is not exempt from those sports of nature which sometimes produce six fingers on each hand." A highly respectable physician of New York, informed me that he had in his anatomical museum, the lower jaw of an adult negro, procured in the Southern States, in which were twenty-seven teeth. Whether this number arose from not having lost all the deciduous teeth it is difficult to say without a particular examination. A great many more in- stances of this kind might be adduced, but I deem it unne- cessary. In many instances the teeth are reported to have been re- newed the third time but from the fact that the deciduous teeth may be retained for many years and after this the germs of the second be brought forward, the reports of third dentition have been generally considered as fabulous. However, I am rather persuaded that a third dentition may have taken place in some very rare cases. A highly respect- able gentleman, and remarkable for probity of character, with whom I am well acquainted, has assured me that he has thrice renewed the front incisores of the upper jaw, the second set having been lost by accident. It is said by the celebrated Lord Francis Bacon,* that the Countess of Des- y Refrospective Reviev 104 mond with whom he was very intimate, and who died at the. age of 140 years thrice changed her teeth. It is also said by Alexander Benedictus that there was a lady of his acquaintance, who at the age of fourscore years, had a com- plete new set of teeth.* Mentzelius a German Physician assures us that he saw at Cleves an old man, aged 120 years who two years before had renewed his double teeth.f He likewise saw, at the Hague, an Englishman, who renewed a complete row of teeth at the age of 118 years. I subjoin a case of this kind from the Dentiste Observa- teur by Coustois, and which bears every mark of authen- ticity. J " A Lady aged from 50 to 52 years, had three artificial teeth in the upper jaw for the space of twelve years, and which I renewed from time to time. Some months after I had put in the last, she sent for me to show me that these teeth were neither so good, nor solid as they were accustom- ed to be. Not being able at once to comprehend why these teeth were so bad, I cut the wires by which they were at- tached to the neighbouring teeth. I searched to no purpose to discover the defects of the artificial piece. I at length turned my attention to the side of the jaw of this lady: In examining her gums, I perceived some slight eminences that inclined me to judge that they were the only obstacles which opposed the solidity of the artificial teeth. These eminences which I saw for the first time, made me examine it with much more attention. I found that two large incisors had nearly divided the gum : my surprise was still greater since " Retrospective Review. t Traite d'orotalgie par Pierre Auzebi Chirurgion Dentiste a Lyon, 1771 page 81. t Le Dentiste Observateure, pages 198 to 200. Paris, 1775. 105 I did not know that the teeth of this lady had been renewed by a second germ, and had been privy to it only by accident. This lady, still more astonished than myself that at her age she should cut teeth, could not be convinced of the truth of what I told her, until her eyes persuaded her. These teeth grew up, but they were neither so long nor so strong as the others, they became, in the mean time fast enough to preclude her any more from having artificial teeth." Is it not astonishing that at so advanced an age, these two large incisors had neither the same strength, nor the same solidity which might be expected at 30 years or under; the nourishing liquid is not furnished so abundantly at this age as it is in youth. Besides the sanguineous vessels obliterate; from whence comes a less abundant nutrition and a defect on the part of nature, which appears to stop at the time when she operates at the formation of the different parts of which we are constituted." Instances more recent may be mentioned. I am acquaint- ed with an old lady resident in this city who renewed sev- eral teeth, after she was 50 years of age. The following instance is mentioned in one of our daily papers for August 19th, 1828. " It is stated that a Mrs. Galusha of Mon- mouth Maine now 88 years of age, has had, within the last three years, an entire set of new teeth, a new head of hair, and her sight, of which she had been for some time deprived has been so perfectly restored that she is now able to read the finest print without the aid of spectacles." U. S. Gazette. In some cases a bony union is said to have taken place be- tween the jaw and the fangs of the teeth, so that the alveoli and roots of the teeth, formed one inseparable bone: Aa has been reported in part of Pyrries king of Epyrus, and a son of the King of Bythinia. Courtois mentions a case of 14 106 this kind which involved the teeth of both jaws and with which I close the present section, without any longer de- taining the reader with a detail of anomalies with which, to say the least, we very rarely meet. Courtois observes ;— " My brother being at the Hotel-Dieu, where he lived in quality of Surgeon, furnished me with the following observ- ations. ' A man of about thirty or thirty-five years of age being dead in the said Hospital, was brought to the Amphi- theatre to undergo the different operations practised by M. Moreau, for the instruction of the young students of this house. This dead man having very fine teeth, my brother wished to extract them, particularly the incisors and canine which the dentists occasionally want. All his teeth broke off when cautiously seized hold of them by the pincers to draw them out of their sockets. The two jaws being stripped of all the flesh with which they were covered, were sawed through; and it was observed with much surprise that not a single trace of the alveolar partition nor any difference of the spongy substance could be distinguished, of which the maxillary bones, together with the substance of the roots of the teeth are so commonly composed. The bones of the jaw and teeth of this man were composed but of one sub- stance ; the germs of the teeth were so much confounded with the osseous juice of the maxillary bones, that it was im- possible to recognise the least trace of the teeth in the alveo- lar region, whilst on the exterior the teeth were seen well formed and arranged in the most regular order.'" M. Petit a celebrated anatomist reports in his course of anatomy a sim- ilar case. I will ask a question rather than any other should ask of me. Had this man ever any milk-teeth ? This prob- lem as difficult as it appears to resolve, is in the mean while susceptible of some conjectures, it is very likely that in the subject of whom I speak,, the teeth were cut but once only; 107 from whence the teeth of this man 'cannot be regarded as milk-teeth, since they never fell out, during dentition; the germs of the teeth were so much amalgamated and con- founded with the osseous juice of the maxillary bones, that it made but one and the same body; it could not have been possible that a second germ, supposing that it existed, would have made its way through, and not been checked by the presence of a body as hard and as compact as the com- bination of the teeth with the maxillary bones. I have omitted to mention many cases of endentula or toothlessness with which I have become acquainted, either by personal observation or the observation of my friends. I know one gentleman in whom the bicuspid teeth of the lower jaw, have never appeared. It is but a few days since a highly respectable lady of this city showed me the teeth of her daughter, a young lady of about eleven years of age, in whom the lateral incisores of the upper jaw had never ap- peared, and she informed me that this was the case with every member of her family. There is at present resident in * Charleston, South Carolina, a family of whom several indi- viduals have never had any teeth, and this has been remarked for several generations. SECTION VI. OF SUPERNUMERARY TEETH, &C* When we consider the formation of the teeth, and the con. tiguity and intimate connection subsisting between their ru- t Blake. Essay on the Teeth in Man, pages 110 to 116. 108 diments, we cannot be surprised to meet with such frequent deformities and varieties as occur amongst them. Though deviations in the shape or size of their bodies seldom occur, yet their roots vary considerably, some being much larger than those commonly met with, others curved in different directions, or exceeding their usual number. Eustachius, Jussieux, Fauchard, and other writers, mention some instances remarkable for the singular position of the teeth in the jaws. They also speak of having met with a few cases where two or three of the front teeth, and as many even of the grinders, were completely joined together by os- sification. I have met with more than a dozen cases some- what similar for instance, the bodies and roots of the lateral temporary incisores and cuspidati joined together, and among the permanent teeth, the middle and lateral incisores, as also the lateral incisores and cuspidati. Here it is evident that both pulps must have been contained in the same investing membrane or sac, for their ossification is in general so com- plete, that one hole serves to both for the admission of ves- sels, &c. In those cases the body of each of the teeth so *. conjoined commonly retains its own appropriate form, though both are completely surrounded by the cortex striatus. Among the permanent teeth however I have met with one instance, where one of the middle and lateral incisores were so intimately united, that on viewing them externally, they appeared as one large middle incisor, no trace being left of their having originally two distinct bodies ; but on the in- ternal surface there is a very marked difference, and each re- tained nearly its proper shape. Excrescences of the cortex striatus are very seldom met with ; one singular instance of it occurred to me, in a patient about seventeen or eighteen years of age. The right permanent cuspidatus in this per- son did not appear through the gum until the sixteenth year, 109 on the side of it next the lateral incisor there was a bulbous protuberance of the cortex striatus, with a hollow or depres- sion in the middle ; this protuberance did not, however, extend to the apex of the tooth. Between the bulbous part and the perfectly formed body of the tooth, there was also a deep groove, which perhaps retained part of the investing mem- brane longer than usual, or the external lamella of the mem- brane was not wasted, for there was a substance somewhat similar to the Crusta Petrosa of graminivorous animals depos- ited round the protuberance of the cortex striatus, and even on a considerable portion of the root. This substance stuck out and formed a sharp hook under the lip, which was very troublesome to the person, and as there was not sufficient room for the tooth in the arch of the jaw, it was of course advisable to have it removed. This is the only instance I have met with, or even heard of, where a Crusta Petrosa was deposited on a human tooth. With respect to the uncommon situation of the teeth in the jaw, by far the most curious case is related by Albinus of an adult in whom he found "two teeth, one on each side of the nose, between it and the orbits of the eyes, enclosed in the roots of those processes, which extend from the maxil- lary bones to the eminence of the nose. They were long and remarkably thick, similar to the canine teeth, and seem to have been these very teeth which had not in this case ap- peared. But there were, besides these, other canine teeth, unusually small and short, placed in their proper sockets. The former seem therefore to have been the new canini which had not penetrated their sockets, on the contrary they were situated where the new ones usually are observed to be in children. But what is still more strange, the points of their bodies were turned towards the eyes, as if they had been the new canine teeth inverted, convex on the posterior part, 110 concave on the anterior, the reverse of what generally hap- pens." This case fully shews the great accuracy of Albi-- nus : he did not mistake those singularly situated canini for supernumerary teeth though he was aware that such fre- quently occur. Mr. Hunter mentions his having met with a case some- what similar, and gives* " a sketch of the upper jaw of a child, where the cuspidatus was inverted, so that its point was turned up against the jaw, and the growing mouth of its cavity towards the gum." Amongst the temporary teeth supernumerary ones are seldom observed. Dr. H. however has met with a few in- stances of this kind ; they are much more frequently found amongst the permanent teeth, and especially in the upper jaw. Their shape in general resembles the cuspidati. He further observes, " They are not confined to the front of the mouth. I have found them in every part of the jaw, be- tween the middle incisores, between the middle and lateral, between the lateral and cuspidati, &c., among the large grind- ers, on the outside or inside of them, and in the palate. I have also ten or twelve times found teeth beyond the dentes sapientiae superiores. They were all small, the enamelled part shaped like the adult grinders, but never with more than one fang. I call them second wisdom-teeth, and always compliment my patient on the probability of possessing a double portion of sagacity." How supernumerary teeth are formed we can easily con- ceive, but how teeth could be inverted as Albinus and Mr. Hunter have shewn, is much more difficult to be accounted for. I have sometimes observed a supernumerary tooth, firmly attached to a grinder; Fauchard has noticed similar Nat. H'ret. explanat. of Tab. VIII. Fig. 9. Ill appearances and also mentioned his having met with two grinders joined together, and a supernumerary tooth like- wise connected with them.* However I do not think it ne-: cessary to dwell on this subject, particularly as it is a subject of curiosity more than of importance. Mr. James Gardette of this city has mentioned to me hav- ing seen and extracted a considerable number of supernum- erary teeth, situated in different parts of the jaw. I have met with one instance of this kind; the tooth was situated on the outside of the dens sapientia, was small, round, and had but one fang. Mr. Gardette mentioned to me that he had seen complete and perfect supernumerary bicuspid teeth, sit- uated in apposition to and on the inside of the natural and perfect bicuspids. SECTION VII. OF THE IRREGULARITY OF THE TEETH.f During the shedding of the teeth there are several circum- stances which prevent the permanent teeth from acquiring a regular position, and often give rise to very great irregularity in their arrangement. The most frequent cause is a want of simultaneous action between the increase of the permanent teeth and the de- crease of the temporary ones, by the absorption of their fangs. It rarely happens that so much of the fang of a tem- porary tooth is absorbed as to permit its removal by the ef- forts of the cluld, before the permanent tooth is ready to Tom. 11, Planche 27, Fig. 16. f Fox, Part First, pages 45 to 51. 112 pass through : on which account the new tooth takes an improper direction, and generally comes through on the inside. Cases are very frequent in which scarcely any absorption of the fangs of the temporary teeth have taken place, pre- vious to the appearance of several of the permanent teeth ; and it often happens, that upon the removal of the shedding teeth to give room for the permanent ones, that no absorption of the fangs of the temporary teeth has taken place. Irreg- ularity of the permanent teeth is most commonly occasioned by the resistance made by the nearest temporary teeth; this is always the case if the temporary teeth are small and close set, for, as the permanent incisores are much larger than the temporary, they require more room ; but as the space left by the shedding of the temporary teeth is too small for the regular position of the permanent; they are exposed to the pressure of the next tooth, and hence are frequently turned out of their right direction. Another cause of the irregularity of the teeth arises from the permanent teeth being too large for the space occupied by the temporary ones; those parts of the jaws not being suf- ficiently extended to permit a regular position of the new teeth. In this case the irregularity is considerable, and occa- sions great deformity in the appearance of the mouth. The incisores and cuspidati being much larger than those of the child, require more room, for want of which they are turn- ed out of their proper positions. The central incisores over lap each other, the lateral incisores are either placed obliquely, willi their edges turned forwards, or they are pushed back, and stand between and behind the central incisores and the cuspidati; the cuspidati are projected, occasioning the lip to stand out with considerable prominence, and the bicuspides are placed very irregularly. 113 It will be proper in this place to observe the manner in which the jaw bones grow, (the under one being taken as an example,) and to point out the difference between the tem- porary and permanent teeth. After a child has obtained all the temporary teeth, the jaw, in general, grows very little, in the part which they occupy. In those children who are an exception to this rule, the tem- porary teeth become a good deal separated from each other, and these are the cases in which the shedding of the teeth is effected without the assistance of art. When the jaw of a child is compared with that of an adult, a very striking dif- ference is observed; that of a child forms nearly the half of a circle, while that of an adult is the half of a long ellipsis. This comparison clearly points the part in which the jaw re- ceives its greatest increase, to be between the second tempo- rary molaris and the coronoid process ; and this lengthened part of the jaw is destined to be the situation of the perma- nent molares. By the elongation of the jaw, a great change in the form of the face is produced ; that of a child is round, the cheeks are plump and the chin flat; in the adult the face is more prominent with a flatness of cheek and a considerable length of chin. The temporary incisores and cuspidati are much smaller than the permanent, while the molares of the temporary set are larger than the bicuspides which suceeed them. Henco it is that the incisores and cuspidati are so frequently irregu- lar, and they never could be otherwise, were it not that some space were gained from the molares, in consequence of the bicuspides being much smaller. This circumstance is ren- dered intelligible, by examining jaws at various ages, and observing in what particulars they differ from each other. Until about twelve months after birth, the jaw grows uni- 15 114 formly in all its parts, and at that time as far as the teeth ex- tend, it approaches nearly to a semi-circle; at about three years of age, when all the temporary teeth have appeared, it begins to lose its semi-circular form, and become somewhat elongated ; an extension takes place between the last tem- porary molaris and the coronoid process ; and in that part in an advanced state of formation, the first permanent molaris will be found. At about seven or eight years of age, the jaw is more ex- tended, the first permanent molaris has grown up, and the second is advancing in formation. At about eleven or twelve years of age, it will be found still longer ; the second mola- ris is ready to come through the gum, and the third molaris has begun to form. The jaw acquires its full proportion, at about eighteen or twenty years of age, when the third molaris makes its ap- pearance, and the teeth are seen in the figure of their ar- rangement to form part of an ellipsis. The growth of the jaw being nearly confined to the part situated behind the temporary teeth, where the permanent •Uiolares are placed, the anterior part of the jaw undergoes little more than an alteration in form; it adapts itself to the permanent teeth there situated, and scarcely receives any in- crease of size. The same comparison of jaws exhibits the cause of irreg- larityin the permanent incisores and cuspidati. When a child is about to shed its teeth, the first permanent molares come through the gums behind the temporary molares, and therefore the teeth which are situated anteriorly to the per- manent molares can obtain no additional space. The permanent incisores occupy the space of the tempo- rary incisores, and half of that of the cuspidati. It com- monly happens that the bicuspides are earlier in their appear- 115 ance than the cuspidati; therefore, when the first temporary molares are shed, a little room is gained, as the teeth v. inch succeed them are smaller. When the second molares are shed, still more room is gained ; the two bicuspides go back against the first permanent molares, and thereby give suffi- cient room for the cuspidati. Thus by the change of the molares of the child which are large, for the bicuspides of the adult which are small, room is obtained for the increased size of the permanent incisores and cuspidati. This change of small teeth for larger, and of larger for smaller, points out the necessity of giving some assistance to nature in one of her processes, viz. that of throwing out the temporary teeth before the permanent teeth appear; if this be done at a proper time, the teeth will always take a regu- lar position, and every deformity arising from irregularity be prevented. During the progress of the second dentition, an opportu- nity presents itself for effecting this desirable object; but every thing depends upon a correct knowledge of the time when a tooth requires to be extracted, and also of the partic- ular tooth; for often more injury is occasioned by the re- moval of a tooth too early, than if it be left a little too long ; because a new tooth, which has too much room long before it is required, will sometimes take a direction more difficult to alter than an irregularity occasioned by an obstruction of short duration. If an improper tooth be extracted, irrepara- ble mischief will ensue ; as in the case where young perma- nent teeth have been removed, instead of the obstructing temporary ones, which I have several times known to have been done. As regards the growth of the jaws, y hard, as the clinching of my jaws adds much to my sufferings; my eyes are beginning to be much affected, which must plead an apology to Mr. Koecker for this sad scrawl, which I think you will need to help him to decypher. There are various opinions respect- ing 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 covering of the bone. I am satisfied it is in some diseases of the antrum. Could it injure me to have the antrum opened to ease my mind ? There is one place where I think there is a part of a fang of a tooth, which I am certain was broken, as the dentist burnt the tooth without letting me see it; perhaps that may torment me." 260 CHAPTER V. DISEASES OF THE MAXILLA. It is not my intention to discuss this subject at much length, but as the surgeon-dentist often witnesses them, and as they may have a connexion with diseased teeth, or the irritation of dead ones, I presume to say something upon it, and intro- duce a few cases which conclusively have, in some instances, their connexion with diseased teeth, &c. The maxillary -bones are subject to inflammation, mortifi- cation, and likewise to bony growths or deposits around them, of which I shall hardly take a cursory notice. In the upper jaw the antrum maxillare is occasionally sub- ject to inflammation, formation of pus, mortification, to can- cerous growths, and in some cases, accumulation of mucus. I subjoin a history of these affections from the pen of Messrs. Fox, Koecker, &c. referring the reader to a case which came under my own observation, and described in the sec- tion upon Phthisis, as caused by bad teeth, &c. I will com- mence with diseases of the antrum. * Inflammation in the antrum is often occasioned by dis- eases of the teeth, but it also occurs when the teeth are quite sound. Sometimes in examining the prepared bones of the head, one or more fangs of the large molares may be found passing into the cavity. In such a case, inflammation, exci- ted by a diseased tooth, would speedily communicate to the membrane lining the cavity and cause suppuration. I think mischief usually follows the neglect of an abscess of the antrum. The natural opening from the cavity is usu- * Fox, Part II, pages 125 to 131. 261 ally rendered impervious; hence the matter is obliged to make its exit by an ulceration through one of its sides, which most frequently is that situated under the cheek. It is com- mon to membranes under inflammation to become thickened, and as the opening into the nose is through a membranous part, it is probable that when inflammation takes place, it is in consequence of the thickening of this membrane that the opening of the antrum into the nose becomes closed. During inflammation in the antrum, the patient af first con- ceives the pain to proceed from the tooth-ache, but if the tooth should not be diseased, a more accurate observation is made upon the peculiar sensations excited. The pain usu- ally extends towards the forehead, in the direction of the frontal sinus, and a sensation of tightness and weight, with throbbing, is felt on the side of the face. In a short time the cheek becomes red, and appears as if swollen; it feels very hard, and on raising the lip a considerable fulness above the fangs of the teeth may be observed. If the disease be not attended to in this stage, as the mat- ter rarely passes out at that side leading into the nose, an ab- sorption of the bone above the molares takes place, and the matter discharges itself through the gums; but this does not cure the abscess; the formation of matter still continues, and the ulcerative process goes on, until so great a destruction of the bone is caused as to render the disease incurable. This case requires the same kind of treatment as abscesses in general, viz. an outlet to be made for the matter; the best mode of effecting this is by extracting one of the molares, and making a perforation into the antrum, through the socket of the fangs. If it should happen, that either the first or second molaris be carious, it will be proper to extract it: but when the teeth are perfectly sound, the second molaris is to be preferred, as the antrum descends the most at that 262 part, and it is desirable to have the opening in the most de- pending situation. When the matter has been discharged, the object must be to restore the parts to their former condition; with this view a solution of the tincture of myrrh is to be frequently inject- ed, with a syringe, through the opening. As the inflamma- tion subsides, the natural opening usually becomes pervious, and the injection will pass into the nose ; and when this open- ing is restored, the discharge gradually diminishes ; the gum may then be suffered to heal over the artificial opening, and a cure is effected. As there is always a disposition in the gum to close over the part from whence a tooth has been extracted, it may be kept open where the socket has been perforated, by introducing a piece of bougie, which, sticking at the upper part of the socket, and hanging just low enough to be taken hold of, may be withdrawn at the time of syring- ing, and then be again returned. If the natural opening into the nose has become perfectly obliterated, it will be requisite to preserve an artificial one ; this may be accomplished by wearing a silver tube in the per- forated part, through which the mucus will constantly pass into the mouth, and future accumulations be prevented. I have met with several cases of disease in the antrum, occasioned by carious stumps, in which a considerable en- largement, with absorption of some of the anterior part of the bone, had taken place. The extraction of these stumps has been followed by a great discharge of glareous fluid from the socket; the discharge continues for some time, but it grad- ually diminishes, until the part acquires a healthy state. The antrum is sometimes the seat of formidable diseases, but these cases are not common. That which most frequently occurs, is the formation of a polypus, or fungous tumour, within the cavity. The usual progress of this malady is, 263 that the tumour, having acquired a certain size, an absorp- tion of the bone is induced by the pressure; this absorption commences in the internal part of the cavity, which is grad- ually rendered thin, until the whole is completely removed. The alveolar processes, and even part of the fangs of the teeth, are absorbed, when the remainder of the teeth becom- ing loose, irritate the gum, and must be extracted. The tu- mour continuing to increase, the cheek becomes much en- larged, and instead of bone or fungous substance, occupies the whole side of the face ; at length ulceration takes place in some part, which, as it increases, is attended with so con- siderable a discharge of matter, that the strength of the patient is gradually diminished, and at length the disease terminates fatally. The antrum is sometimes most dreadfully affected with cancerous disease. Happily, these cases are very rare ; the only specimens that I have seen are in the possession of Mr. Heaviside and Mr. Taunton. The histories of these cases are very similar ; the patients were both elderly women ; at first they complained of pain in the side of the face, extend- ing up to the forehead, and the eye, and back to the ear; these symptoms continued for about four months, when a tumour formed near the ear, from which, shortly afterwards, there was a discharge of very fetid, dark-coloured fluid. Ulceration then began in the cheek, over the maxillary bone, by which, after great ravages had been committed, their strength was gradually exhausted until death terminated their sufferings. These cases were about fourteen months in their progress. In the patient under Mr. Taunton's care, the disease which was on the right side, occasioned the absorption of the os- maxillare superius, the os-palati, the os-malse, the os-unguis, 2G4 and the condyloid, and coronoid processes of the os-maxil- lare inferius; also there was an opening of communication from the orbit to the dura mater, by an absorption of part of the os-sphenoides and of the os-frontis; but the dura mater was not injured. In Mr. Heaviside's museum is the skull of a woman, who had a disease of the antrum, attended with a very great en- largement : in the course of the disease an ossification in the substance of the tumour took place. Mr. Heaviside, who very kindly favoured me with drawings, is not in possession of any accurate history of the case. It occupied, in its pro- gress, about five years. When it had existed about four years, matter began to form under the skin of the face, which ulcerating, was attended with a great discharge, under which the patient finally sunk. A few years since, I had the opportunity of observing the progress of an antrum case in a respectable gentleman, Mr. W. The disease first exhibited itself as a tumour above the molares, occasioning a slight prominence of the cheek. By the direction of Mr. Cline, about once a fortnight I made an incision with a lancet into the tumour, which being attended with a considerable haemorrhage, greatly diminished the ten- sion which arose from the fulness of the vessels. As the tumour increased, an absorption of the maxillary bone took place, together with the fangs of the teeth, which, becoming loose, were extracted. At length the tumour be- came so enlarged as nearly to fill the mouth, and by its pro- jecting of the cheek, greatly deformed the countenance. By adhering to the occasional use of the lancet, the disease was retarded in its progress for about five years, when ulceration commenced, by the distressing effects of which the fife of the sufferer was terminated in a few months. 265 Mr. Cooper is in possession of a remarkable case of ossi- fication from both antra ; a tumour projected from each an- trum, which, by their gradual enlargement, effected such a change in the structure of the orbits, that the eyes consider- ably projected; at length the ossification proceeded up- wards, and produced so much pressure upon the brain as to cause the death of the patient. Mr. Koecker mentions having seen one case of diseased antrum. Mucus occasionally from obstruction of the canal leading from the antrum to the nose is accumulated in the antrum, of which I will insert an interesting case. '* The most interesting example of the effects of this lodgement of mucus in the antrum, is that recorded by Du- bois : a boy, between seven and eight years of age, was ob- served to have, at the base of the ascending process of the upper jaw bone, on the left side, a small, very hard tumour of the size of a nut. As it gave no pain and did not appear to increase, his parents gave themselves no concern about it; when he was about sixteen, it increased in size, and began to be somewhat painful. Before he was eighteen, its aug- mentation was so considerable, that the floor of the orbit was raised up by it; the eye thrust upwards, the palpebrae very much closed, the arch of the palate pushed down in the form of a tumour, and the nostril almost effaced. Below the orbit, the cheek made a considerable prominence, while the nose was thrown towards the opposite side of the face, and the skin at the upper part of the tumour below the lower eyelid, was of a purple-red colour, and threatened to burst. The upper lip was drawn upwards, and behind it all the gums on the left side were observed to project much further than those on * Wake, Surgeon-Dentists' Manual, page 81 34 266 the opposite side of the face, and at this point alone, the thinness of the bony parieties of the antrum was perceptible. The patient spoke and breathed with great difficulty ; he slept uneasily, and his mastication was painful, the case was at first supposed by Dubois, Sabatier, Palletan and Boyer, to be a fungus of the antrum, and an operation was considered advisable. In proceeding to this measure the first thing that attracted the notice of Dubois, was a sort of fluctuation in the situa- tion of the gum, behind the upper lip ; a circumstance which led him to give up the idea of the case being a fungus, though he expected that on making an opening, merely a small quantity of ichorous matter would escape, affording no kind of information. In this place however, he determined on making an incison, along the alveolary process, whereby a large quantity of a glutinous substance, like lymph, or what is found in cases of ranula was discharged. A probe was now introduced, with which Dubois could feel a cavity equal in extent to the forepart of the tumour; and in moving the instrument about, with a view of learning whether any fun- gus was present, it struck against a hard substance, which felt like one of the incisor teeth, near the opening that had been made. Five days after this operation, Dubois extrac- ted two incisors and one grinder, and then removed the cor- responding part of the alveolary process. As the haemorrhage was profuse, the wound was now filled with dressings, which in two days came away, and enabled Dubois to see with fa- cility all the interior of the cavity. At its upper part he perceived a white speck, which he suppo-ed was pus, but on touching it with a probe, it turned out to be a tooth, which was then extracted, in doing which, some force was requisite. The rest of the treatment merely consisted in injecting lotions into the canity, and applying common dressings. In about six 267 weeks all the hollow disappeared, but the swelling of the cheek and palate, and the displacement of the nose still con- tinued. In the course of another year and a half every ves- tige of deformity was entirely removed. (Dubois, Bulletin de la Faculty de Med. an 13, No. 8. I will close this subject by two anomalous cases from the pen of Mr. Koecker, given in his late work on diseases of the maxilla, and one I have seen, and two from Fauchard not connected with the antrum. I will mention the one I have myself seen, which although I did not at that time understand its pathology, I am now fully satisfied was occasioned by the irritation of inflamed gums and teeth. The case occurred about seven years ago in the town of Georgia, state of Vermont. The subject of it was a boy of about seven years old, the tumour appeared to take its rise from the first, permanent grinding tooth of the under jaw, which at this time was first passing the gum. The tumour soon after its commencement | increased very rapidly, involving all that side x>f the face, pushing the tongue out of its place, and likewise extending back so as to press upon the esophagus, and upper part of the larynx of that side. The mouth was kept permanently open, and the cheek of the same side greatly protruded, so as finally to show one enormous mass of diseased growth. The child sunk under the progress of the disease, I think in about seven weeks. A great number of physicians residing in that neighbourhood saw the case, and I believe generally pronounced it cancerous, but I could not learn that any one of them was able to give any satisfactory conjecture of its cause. I will give two cases from Fauchard of bony deposit on the lower jaw, merely with a view to hint to the surgeon the propriety of ascertaining the situation of the teeth in these cases. 268 Cases. * " We have an instance," says Fauchard, " in the person of M. Holland, keeper of the Chateau de Moudon, who had carious molar teeth on the left side of the lower jaw; their caries was communicated to the alveolus ; the alveolar pro- cesses spread it to the body of the bone ; where considera- ble deposits were formed, which placed it in a short time in a very pitiful state. The king came to reside for some time at the Chateau de Moudon: M. de la Peyronie was requested to visit this patient. He found him in such a situation as obliged him to have recourse to a capital operation in order to save his life, and the repeated application of the potential cau- tery." " M. Lambert performed on M. de Barca's son, about I twenty years ago a similar cure ; he had recourse nearly to the same means; he was actually obliged to bring away a part of the maxillary bone. This patient was radically cured, and the cicatrice was but very little seen." " These two cases are of notorious publicity; they made much noise, at court, and they were communicated to me by Mr. Anel, who had seen the two patients." I will close this chapter with the cases from Mr. Koecker's late work, and one case of a fatal fungoid swelling of the gums given by Mr. Hill in the Edinburgh Medical and Sur- gical Journal, No. LXI. as follows : f It succeeded to the extraction of a tooth in an atheletic man, aged 52, who had some uneasiness in the socket and adjoining parts for several weeks after the operation, but * Fauchard, pages 248 and 249. t The Study of Medicine, Vol. I. page 48. By J. M. Good, Boston. 1823. 269 which gradually disppeared. At the distance of about two months, a puffiness was discovered in the cavity formed by the loss of the tooth, preceded by a sense of soreness in the roof of the mouth. The excrescence soon assumed the character of a bleeding fungus, spread very extensively to- wards the roof, and so much affected the patient's speech, that it was difficult to understand him ; at the same time the sublingual glands began to sympathize in the morbid ac- tion, to inflame and tumefy. At this period, " the mouth presented a spongy, bleeding fungus swelling, protruding the upper lip, and extending backwards to the centre of the ossa palati. The teeth on each side of the tumour were loose and divergent, appearing as though stuck in a thick jelly. The slightest handling of these parts produced a discharge of venous blood. I removed the loosened teeth, each of which brought away with it a large piece of fungus with the scalpel. I also removed the whole of this substance as clear as I could." This however, was not sufficient. Though the bones did not at this time, on examination appear diseased, both the maxilla, and os-palati so soon afterwards, and por- tions of them were separated by Mr. Hey's circular saw. Still the disease held its ground; it was scotched but not killed. Fresh and more extensive excrescences were pro- truded, and bid equal defiance to the knife and to various caustics. It does not appear, however, that the actual cau- tery was tried. " Feeling at length too feeble to labour, he suddenly adopted the resolution of retiring to his native place, as he said, to die." And truly enough he said. He retired into the country, and about three months afterwards, being less than a twelve-month from the attack, fell a sacri- fice to pain, debility, and distress ; at which time the tumour extended from the ang'e of the jaw to the top of the shoulder, surrounded by various others, one on each side of the nose, 27® all moveable and elastic ; the fungus on the gum filling the cavity of the mouth, rendering the speech inarticulate, and the poor sufferer's swallowing extremely difficult. Case III*—Captain M----, of the East India Company, from Calcutta, laboured under a most distressing and com- plicated affection of the mouth, the effect of an unparallelled abuse of mercury, which had been exhibited only eleven months previously. He came to England, accompanied by a medical gentle- man, on leave of absence from his regiment, to seek for sur- gical advice, and visited Mr. Lawrence June 11th, 1826, soon after his arrival in London, who requested him to consult me immediately. The patient was a tall, well-formed, handsome young man, about twenty-one years of age. According to his own statement, his health was originally excellent, and his consti- tution strong, and only one year previously he was in the possession of a complete set of teeth; they, as well as all their contiguous parts, being perfectly sound, regular, and beautiful; this was still evident from the appearance of the remaining parts, which in the morbid and dead state, evinced the most striking evidence of their previous perfection. All the teeth, although entirely free from caries, or any disease of their bony structure, were now perfectly dead, and only mechanically held in their sockets. The perios- teum was also totally destroyed, either by absorption or cor- rosion. The alveoli were not only dead, but in a state of putrefaction; their upper edges all round the semicircle of the mouth, being from an eighth to a quarter of an inch ex- posed, and exhibiting from their cadaverous appearance, a * An Essay on the Diseases of the Jaws, kc. &c.—By Leonard Koecker, London, 1828, pages 63 to 69. 271 very frightful aspect. The gums were partially destroyed, and the remaining portion of them either gangrenous and sloughing, or in a state of inflammation and suppuration. The disease had already extended to the maxillary bones, and their osseous structure as well as the periosteum of their cavities, was more or less under the influence of inflamma- tion, suppuration, and mortification ; but more especially the left side of the upper jaw, which was already much increased in size, accompanied with a correspondent swelling of the cheeks. The face was flushed, and the skin had a bloated erysipelatous appearance, and the patient suffered excessive pain of the whole mouth, the jaw-bones, and other parts of the head, as well as of other more remote parts of the sys- tem. There was a constant flow of viscid, ropy discharge from the mouth, like that of great salivation, mixed with greenish matter, and accompanied by a fetid, cadaverous odour, ema- nating from this fluid, and the dead and morbid parts, and so exceedingly offensive as to be almost insupportable to the bystander. The malady was also particularly complicated, as well as highly aggravated by a great many adhesions of the muscles of the jaws to each other, which had taken place during the excessive salivation previously mentioned, in consequence of which, the unhappy patient had lost almost all power of moving the under-jaw. From these causes, the teeth were mechanically pressed into their dead sockets, and by this unnatural and permanent pressure, the absorption and exfoli- ation of the sockets were greatly retarded, and the immense irritation already produced by the dead teeth and sockets upon the gums and other soft parts, highly augmented; not to mention that these adhesions particularly impaired the enun- ciation of the patient. 272 In addition to these evils, this almost complete closure of the mouth and teeth had, for a long time, prevented the patient from taking solid food, and indeed hardly admitted a sufficient quantity of fluids to preserve his deplorable existence, especial- ly during a long and tedious sea voyage ; an evil which would have been nearly destructive to the patient, had it not been in some degree lessened by the removal of one of his inci- sors. He laboured under excessive debility and nervous irritability, accompanied by fever and general emaciation; in short, his general health had suffered to such a degree that his life might be regarded to be ma most precarious state. Treatment. The principle indication of treatment in this interesting case was evidently to relieve the inflammation of the survi- ving osseous and soft structures, by promoting the exfoliation of the carious sockets and other bones, and more especially, by removing all the dead teeth. These operations, however, were rendered particularly difficult and painful by the fixed state of the under jaw; to this the great debility of the pa- tient added another very considerable obstacle, notwithstand- ing his surprising fortitude. The following treatment, however, was adopted: June 12th, 1826.—Seven dead teeth were removed, and the patient directed to wash his mouth frequently with a mixture of the tincture of myrrh, honey, and sage tea. June 16th.—Two dead teeth were extracted, and the use of the mixture continued. The patient's health and strength were already improving, and by the extraction of his front teeth, he was enabled to take some nourishment. 273 June 19th.—Four teeth more were removed, the health of the patient still continuing to improve. Some parts of the sockets had come away by exfoliation. The patient com- plained of pain in the jaws. July 7th.—I found our patient almost recovered, and in excellent spirits. Mr. Lawrence, who had seen him a few days previously, had taken away the greater part of the re- maining teeth and sockets, which had become so loose as to be removed without much difficulty. August 11th.—Captain M. visited me, to state that all the remaining dead teeth and sockets had been removed some time previously, by Mr. Lawrence. His health had much im- proved, and his mouth was healing very rapidly. His speech, however, remained very defective ; a misfortune principally owing to the almost total loss of motion of his under jaw. He intended in a few days to depart for Ireland, to visit his relations and friends, and to return after some time to sub- mit to the necessary operations to cure the adhesions of his mouth, agreeably to the advice of Mr. Lawrence, and then to supply the deficiency of his teeth by a double set of an artificial masticating apparatus. Case IV.* Mr. S----, from----, a gentleman of about fifty five years of age, of a very robust and plethoric constitution, and constantly active habits of life, gave the following state- ment of his case. His health had been generally good, but during the last six years he had sometimes suffered from swellings of the face, accompanied by an erysipelatous appearance, and heat of the skin, as well as an abtuse pain particularly situated in the nose, and its surrounding parts. * An Essay on the diseases of the jaws, fyc. Sic. by Leonard Koecker. London, 1828, pages 79 to 84. 35 274 About eighteen months previously to his coming to town, he discovered a small excrescence in his nose, followed by a considerable discharge of fetid greenish matter. His sur- gical attendant removed the tumour with the forceps, assist- ed by the application of lunar caustic, but without effecting a permanent cure. The disease continued after a variety of surgical treatment, and its repeated extirpation was uniformly followed by returns of the excrescence. The general health of the patient becoming evidently affected, he was urgently ad- vised by his physician and surgeon to visit London, in order to avail himself of the professional talents of Mr. Lawrence. On an examination of the case, this gentleman instantly de- tected the actual disease as well as the particular exciting cause. Viewing it as a case of osteo-sarcoma of the nose, and suspecting the state of the teeth to be the cause of the disease, he directed the patient to take my opinion with res- pect to the condition of his mouth. By a careful inspection I found the whole of the gums and sockets more or less suffering from that disease, of which I have more particularly treated in the 2nd part of my Dental Surgery, chapter III, p. 270, under the title " Of the Devastation or Absorption of the Gums, and Sockets of the Teeth." These parts were in a state of great inflammation and suppuration, his teeth were much encrusted with green tartar, and many of them so far deprived of their gums and sockets as to have become very loose, and their preservation was not only impossible, but their retention appeared to be a powerful exciting cause of the disease of the mouth, not- withstanding they were entirely free from caries. The upper and under cuspid teeth were much out of their natural line ; and from the permanent irregular action of one jaw upon the other, the lateral incisor, cuspidatus, and first bicuspis of the left side of the upper jaw had been deprived of their vi- 275 tality, the fangs of which, by their irritation, had produced the exostosis. The tumour adhered to the mucous membrane of the left nostril, and was about two-thirds of an inch in length, and a quarter of an inch in diameter ; and I gave it as my opinion that a permanent removal of the exostosis, and a complete cure of the disease, could not be obtained without the ex- traction of every tooth, which, from the loss of its vitality, or deprivation of a considerable part of its sockets, and irregularity of its situation, acted as a powerful permanent exciting cause of the disease ; and the truth of this assertion will be particularly proved by the sequel of the case. The Treatment. It was in the beginning of March, 1827, when the excres- cence was removed by Mr. Lawrence, and soon after the operation, the patient called on me, and stated that it was the request of this surgeon, that I would do every thing the case might require. March 9th.—Five teeth were extracted, and the patient directed to wash his gums with an astringent lotion eight or ten times a day. March 13th.—Two teeth were removed, and the use of the lotion requested to be continued. March 16th.—Four teeth were extracted and the removal of three teeth more was particularly urged, but the patient would not submit to the operation. March 21st.—The teeth were scaled, and the use of a proper powder and brush directed. March 27th.—The scaling of the teeth was repeated, and every direction given to preserve a perfect cleanliness of the mouth: I again very particularly explained the necessity for 276 the removal of the remaining injurious three teeth, which were the lateral incisor and cuspidatus of the left, side of the upper, and cuspidatus of the right side of the lower jaw, but nothing would induce the patient to submit to the supposed disadvantageous loss of them. Having already so much re- covered his general health from the removal of the stated eleven teeth, and the local disease seeming to him also to be very rapidly improving, he hoped that the extraction of these three teeth might prove ultimately unnecessary, and he in- sisted, at all events, upon giving them a sufficient trial, before submitting to their removal. After returning home to the country, the local disease con- tinued to improve, but did not perfectly subside ; some inflam- mation remained, and a return of the tumour was appre- hended ; in consequence of which the gentleman visited Lon- don again, and on consulting Mr. i awrence, that gentleman now positively insisted on the extraction of the three teeth I had pointed out as the cause of the irritation kept up in the affected parts. May 10th.—These three teeth in question were extracted. May 15th.—The teeth were again scaled and all the tar- tar perfectly removed. After this complete removal of the local exciting causes, the inflammation and pain in the nose almost immediately subsided, and healthy inflammation and absorption of the diseased gums and sockets followed, as well as a complete cure of the local affection. The patient was now rapidly restored to vigorous health, which he has ever since continued to enjoy. *"Dr. Regnoli, of Forli, relates a case, in which a fungoid affection of the maxilla and gums, was successfully treated *An Essav on the Diseases of the jaws, and tlieir treatment, &c. &c. by Leonard Koecker, London, 1828, pages 20 to 23. 277 by the removal of the alveolar process of both jaws. The patient, a woman of thirty five years of age, had had carious teeth from her infancy, and was almost constantly tormented with severe tooth-ache. She was, besides, subject to fre- quent erysipelas of the head and neck. " Towards the close of 1824, she discovered a small tu- mour, behind the last molar tooth of the lower jaw on the right side. It soon ulcerated, and rapidly spread to the gums and alveoli of both jaws. These parts were much swollen, and considerably contracted the cavity of the mouth. The fungoid excrescences poured out blood on the slightest touch, and continually produced a thin and fetid discharge. The deformity was considerable, and the voice was altered. The limits of the disease were well defined, and the lymphatic system did not appear to be affected, but the patient experi- enced much pain ; her countenance was dull and cachetic ; she lost flesh, and had febrile exacerbations in the evening. In this state of things the patient was admitted into the Hos- pital at Pesaro, where, after having first performed the oper- ation on the dead subject, Dr. Regnoli" [no doubt, after hav- ing divided both cheeks to a considerable extent at both an- gles of the mouth,] " removed the teeth and alveolar pro- cesses of both jaws, with the exception of the last molar tooth on the left side of the lower jaw, the socket of which appeared to be sound. From the situation of the parts, the saw could hardly be employed ; hence, it was merely used to form a shallow groove in the most prominent parts of the bone, the separation of which was effected by means of a chisel and mallet. Actual cautery was applied to the bleed- ing vessels, and to such suspicious parts as were not accessi- ble to the knife. The lips of the external wound were brought together by three gold needles, and the twisted su- ture. 278 " The first day after the operation, the patient referred her pain to the throat, rather than to the parts which had been operated upon. She had severe head-ach, which was at- tributed in part to the shock given to the head by the strokes of the mallet, and to the division of the dental nerves. The needles were removed on the fifth day. On the fifteenth, seventeenth and eighteenth, some portions of exfoliated bone were detached. On the nineteenth, the lips could be closed' for the first time. By the twenty-third all tumefaction had subsided, the voice was improved, the catamenia which had been long absent, had reappeared, and the other functions were in a natural state. On the thirtieth the sole remaining tooth was removed, as it interfered with mastication. Five days later, she left the hospital in good health. The lips fell in a little, especially the lower, but the deformity was very slight. The voice, which had not quite recovered itself, was daily improving. " Dr. Regnoli concludes that though the disease should re- turn, the operation was still proper and necessary. With- out it, he considers that death would have been inevitable, and he urges in its favour, that it incurred but little danger; that the practice of Dupuytren and Vacca support it—and that the disease does not always return. From the description of the above case, I have no hesita- tion in positively asserting, that the mere extraction of all dead roots and such teeth as were loose, or suffering from complicated caries, would have been better calculated to af- fect an expeditious and radical cure than the above extreme- ly painful and destructive treatment." 279 DENTITION. This is a term applied to a beautiful process of Nature, by which the teeth are passed from the jaw through the sof parts and gain situations above the gums. In a majority of cases this process is effected with little pain, and without ex- citing any symptoms of constitutional sympathy ; in others, great constitutional irritation is produced. In chap. 2nd, section 4th, was shewn the manner in which dentition is af- fected: in this section I only wish to notice constitutional and local affections, which are the result of difficult dentition. In this process, the teeth, by their developement are pressed against the gum, which, by a process of ulceration, is removed. Such is the beautiful harmony of nature, that in a majority of cases, these two operations will proceed with- out, in the least, affecting the health of the individual, and he will be reminded of the approach and complete develope- ment of the teeth only by a slight tenderness of the gums. In adults whose systems possess slight mobility, dentition is rarely productive of constitutional irritation, and seldom, in- deed, does the cutting of any of the second teeth produce any bad effects, save in some rare cases with the cutting of the dens sapientiae. In general, it is only in the premier denti- tion that the aid of the surgeon is required. Delicate chil- dren, possessed of considerable irritability and mobihty of constitution, and inclined to costiveness, are most apt to be affected by the first dentition. In this process, if the gum is not absorbed away as fast as the young tooth grows, then it becomes distended, swells, and great irritation usually fol- lows, indicated by fever, restlessness, fretfulness, crying, &c. The child often puts its fingers in its mouth, and is often qui- eted if this is done by its nurse : sometimes it will refuse the 280 nipple, or if it attempts to nurse, starts back, as if hurt in the attempt. Various constitutional affections are apt to arise, and na- ture appears to make, in many cases, a sanative effort to re- lieve the infant system. Among many, I will mention those which are the most common: Diarrhoea is apt to take place in some cases; in others, critical eruptions appear upon the skin, inflamed blotches, soreness behind the ears, and dis- charge of matter. In some cases an eruption somewhat re- sembling small pox will appear; at other times, a rash will come out on the breast, face, &c, called the red gum. If the irritation is not soon relieved, convulsions are apt to en- sue, and often endanger the child's life. Upon looking into the mouth the gums appear swollen over the new tooth, and often extending some distance on each side of it. A great many anomalous symptoms are sometimes noticed, so that the physician or surgeon ought to be perfectly acquainted with the time when each tooth is expected to appear, so that if any singular symptoms of disease present themselves in the child, he may be able to detect the cause of them. The surgeon or physician should likewise bear in mind, that all the diseases of infants do not arise from cutting teeth, and for this reason he ought to be perfectly acquainted with the symptoms which denote the appearance of new teeth, and the precise time when they are expected to appear, and also what teeth are expected; for if he does not understand these circumstances, he will often be led into erroneous prac- tices, at once derogatory to himself, and most deplorably in- jurious to the child. The treatment of children during dentition, must be regu- lated by the state of the system. No critical evacuation should ever be checked, if it is not excessive, or so long-con- tinued as to greatly impair the strength of the child. If a 281 gentle diarrhoea comes on, it may be encouraged by giving the child a few grains of rhubarb or magnesia, and if exces- sive, opiates may be given. Blisters behind the ears are often useful, or upon the nape of the neck. Leeches may be applied behind the jaw, or at the chin, or upon the temples, or on the cheeks. The child may be allowed some soft substance, as a piece of bread, &c. to put in the mouth and its fingers, but hard gum-sticks it should not be allowed. Washing the gums with a little laudanum and rose-water will be often found useful. A copious flow of saliva at times relieves the child. The child should be dressed warm, and kept as quiet as possible. If convulsions ensue, opiates, the warm bath, &c. are of essential service, and should never be omitted. If there is great heat about the jaws, ether and laudanum, about equal parts, may be rubbed over them externally with great advantage. But the remedy upon which we are principally to rely is the dividing the gums over the new tooth, so as to allow it to pass out. This operation is often unsuccessful from not being effect- ually performed ; but if properly done, it seldom fails to re- lieve the child. The lancet should be carried deep upon the tooth, so as to completely divide the gum over it, and if it is a double tooth, two incisions should be made in the form of a cross, so as to allow the large tooth to pass out, or entirely remove a piece of the gum. The bleeding which follows cutting the gums is of great service in relieving the irritation occasioned by the young tooth. If properly performed this operation is perfectly safe, but if the surgeon does not ascertain the identical tooth which 36 282 affects the gums, and does not then perfectly cut through them, the operation will be of little or not any benefit to the child, but on the contrary will occasion increased pain and distress; and hence I may again repeat, that unless the surgeon is per- fectly acquainted with the manner of the growth, and the period of the developement of the teeth, he cannot treat the diseases of dentition with any just precision and correctness* The common round-edged gum-lancet is a very suitable instrument for cutting the gums. The second dentition is seldom attended with any consid- erable pain: rarely is any thing but slight scarifications re- quired. The cutting of the wisdom-teeth is at times attended with considerable pain, but may be usually relieved by cutting the gum, or blisters behind the ears, &c. The gums after being divided, sometimes heal before the tooth passes out, but the first cutting, if well done, so destroys the firmness of the gums as seldom to require a second divi- sion, which, however, is sometimes necessary. I do not wish to expatiate upon the great utility of incising the gums in cases of difficult dentition, but will merely pre- sent the reader with a case in which its great utility is fully demonstrated. It is given by Mr. Baumes in his Premier Dentition, from a work of M. Robert. Case XXXIX.—An infant, after having suffered much from its teeth, died, and it was in the evening. M. Lemonnier having business there, was told unexpectedly, the infant had lost its life. After having accomplished his object, he was curious to know the state of the alveolus in a case where the eruption of the teeth had not made its appearance; he made a great incision on the gums. But at the moment when he was preparing to follow up his examination, he saw the child open its eyes, and show signs of life ; M. Lemonnier called 283 for assistance; the infant was freed from its winding-sheet; care was taken of it; the teeth came out; and the infant re- covered its health. M. Robert has deposited this case in the 2d volume of his Treatise on the Principal Objects of Medicine, page 311. OF GUM-BOILS AND ABSCESSES.* Carious teeth frequently become inflamed at the root, and suppuration takes place in the socket, attended with swel- ling and soreness of the gums. In these cases the same laws are observed for the exit of matter as in abscesses in gen- eral, viz. ulceration takes place in some part of its surface, so as to make an outlet for the matter in the best possible situation. When matter forms at the root of a tooth, the periosteum which covers its fang thickens, and in some cases becomes detached from it; the matter is accumulated as in a bag, by the extension of which, considerable pressure is made against the sides of the socket, the consequence of which is, that that part of the alveolar process, situated on the outside, becomes absorbed, rather than that within the mouth. The ulcerative process continues until the gum bursts nearly opposite to the place where the point of the fang is situated, and thus the matter escapes from this natural open- ing ; the edges of the opening are generally raised, having the appearance of a small, red fungus; sometimes, after the discharge of the matter, the inflammation will subside ; but * Natural History, and Diseases of the Human Teeth. By J. Fox, Lon- don, 1814. 284 the gum-boil rarely disappears, and a small fistulous opening remains, at which matter continues to be discharged; or, upon taking cold, persons are liable to a recurrence of in- flammation, occasioning a re-accumulation of matter, but which is seldom attended with much pain. These gum- boils, being occasioned by diseased teeth, are seldom cured without their removal; but, as the operation of extraction cannot always be submitted to, means must be employed to render them as little injurious as possible. At the first appearance of a gum-boil, that is, as soon as gums by swollen condition and soft feeling, together with the sensation of throbbing pain, indicate that matter is already formed, a puncture should be made with a lancet, in order to suffer it to escape ; this will relieve the pain, and prevent any extensive effusion. Sometimes the tooth becomes very sore and rather loose, in which case it will never be service- able, it would be far better to extract it, which will prove a cure to the gum-boil. When the inflammation occasioned by a carious tooth is very great, we should be particularly careful to guard against its effects. The formation of matter is often so considerable, as to produce an abscess of no small extent. In some cases the matter is contained within a cavity, extending through the length of one side of the jaw. The teeth which produce the most distressing symptoms, are the dentes sapi- entiae of the under jaw ; when inflammation extends from either of those teeth to the contiguous parts, the swelling is speedily diffused over all the cheek, so as to close the eye, and cause a considerable hardness at the upper part of the neck, near to the angle of the jaw. The muscles of the jaw are also affected by the adhe- sive inflammation, and they become so rigid that it is with great difficulty the mouth can be opened. 285 These cases require the utmost attention, for a large ab- scess is usually formed, which if left to itself, generally points externally; the ulceration extends through the sub- stance of the cheek, there producing a most troublesome sore, which when healed leaves a deforming scar. To pre- vent these sad consequences, when the matter is formed, a free opening should be made on the inside of the cheek, into the softest part of the tumour. A common notion exists, that it is dangerous to extract a tooth at the time the gum is inflamed; but this is erroneous. Certainly, at this time, the operation is attended with rather more pain than at another; but as the carious tooth is the cause of all the disease, the removal of it is the most cer- tain, and always the most speedy mode of cure. In those cases where the mouth is closed, as this practice cannot be adopted, we must wait until the inflammation be sufficiently subsided for the mouth to be opened. When inflammation and swelling of the gums and face arise from a carious tooth, they seldom subside without go- ing into the suppurative stage. I have frequently attempted by leeches, cold applications, &c. to prevent suppuration, but have rarely succeeded; the progress of inflammation having been by these means only retarded, not prevented; for, after a certain time, it has come on with redoubled vio- lence, and has gone through its progress; on this account whenever there is any considerable swelling, and the patient too timid to submit to the extraction of the tooth, or if the mouth be so much contracted that the instrument cannot be conveyed into it, I think it advisable to hasten the suppura- tive process by fomentations, &c. and as soon as a soft place can be felt on the inside of the cheek, to introduce a lancet, and discharge the matter. People very often continue poul- ticing as welling of this kind, in order, as they term it, to bring 286 it to a head: in so doing, they cause ulceration to take place through the substance of the cheek. If the tooth producing the abscess be situated in the upper jawr, it will discharge in the middle of the cheek ; if in the lower jaw, the opening will be at the lower part of the jaw, either near the angle, or at the edge of its base. These abscesses are rarely healed, the painful symptoms may subside, but the opening remains fistulous, attended with a consequent discharge of matter. I have known persons persist in their attempts to heal these kind of abscesses for some months. One lady continu- ed the application of dressings and lotions to a sore of this kind for two years, but with no benefit. In all these cases the fangs of the teeth become very much diseased, and are the cause of the perpetual discharge; therefore no cure of these abscesses can be expected with- out the extraction of the tooth. In these cases, at the opening where the matter was dis- charged, the skin rises and acquires a sort of fungous ap- pearance, being very red, and of a loose, spongy texture: when the tooth has been extracted, the discharge gradually diminishes, and the external opening closes ; but, as the inner part of the integuments have been destroyed by the ulcera- tive process, in healing the skin becomes contracted, and a deep scar or pit remains. From the situation and appear- ance of these scars, they are liable to be attributed by super- ficial observers to the effects of scrofula, which to a female, or a person of nice feelings, is always a source of un- easiness. When teeth which have caused abscesses of this kind, are extracted, the fangs are found covered with a fleshy sub- stance, which are granulations extending to the bottom of the socket; this being only an effort of nature to effect the heal- 287 ing process, and to fill up the cavity occasioned by that ab- sorption of substance which always attends the formation of matter. When unfortunately the patient is so much under the in- fluence of fear, that neither acute pain nor protracted suffer- ing is sufficient to induce submission to the extraction of the tooth, the inflammation of the jaw-bone is often so great as to terminate in the mortification of a large portion of its substance. The process of exfoliation is necessarily a tedious one, the patient is in a continual state of uneasiness, and the mouth is constantly filled with an offensive discharge. As the pro- cess of separating the dead portion of the jaw from the liv- ing advances, the gums gradually recede from the alveolar processes; at length the dead bone begins to separate, it gradually becomes loose, and when it is completely separated from the bony attachment, it may be taken away. In plate 1, are two specimens of the mortification of por- tions of the jaw-bone, in consequence of carious teeth. Fig. 8 represents a portion of the superior maxillary bone, containing a central and lateral incisor, and the cuspidatus of the left side ; this case occurred to a gentleman whose lateral incisor was decayed, he had pain for a day or two, when his gums and lip became swollen; in this state, instead of taking proper advice, he poulticed and fomented his face for several days in succession ; a considerable quantity of matter form- ed and discharged itself under the lip ; in this state it con- tinued for some time ; when he applied to me, I found that not only the diseased tooth was loose, but also the one on each side. I extracted the carious tooth, but found the socket quite rough, arising from the destruction of the peri- osteum. I told him I expected that the socket of this tooth would exfoliate : a short time afterwards I saw him again, 288 when, on touching the other teeth, I perceived a motion un- der the gums, through the extent of the three teeth. Some weeks after, the whole became so loose, that a slight force brought it away. The parts then healed but not without leaving an immense cavity. Fig. 9 exhibits a similar case, which occurred to a young lady, a patient of Mr. Williams in the Borough of Southwark. This lady was tormented with the tooth-ache for a long period ; her face swelled, and matter formed, but all the en- treaties of Mr. Williams, and the dreadful consequences which he taught her to expect, could not raise in her mind sufficient courage to permit the tooth to be extracted. The consequence was, that a large piece of the jaw mortified, the bicuspides, in consequence of their attachment to the bone being destroyed by the ulcerative process, became loose, and being single fanged teeth, were easily taken away; at length the piece of bone was so completely detached, as to allow of its removal, bringing away with it the diseased tooth; at this time, the second molaris, having lost almost the whole of its support, was found to be so loose as to ren- der it necessary to be extracted. Here is an instance where a person lost four teeth, and a large portion of the jaw, through an obstinate determination of not submitting to the extrac- tion of the originally diseased tooth. I saw also a woman in Bartholomew's Hospital, who from a similar cause, lost all the teeth with the alveolar processes of the anterior part of the lower jaw. When abscesses form in the mouths of children, from dis- eases of the temporary teeth, the greatest care should be taken, as by an exfoliation of part of the jaw-bone, the teeth may be destroyed.*. ¥ Vide Natural History of the Teeth, Part II. page 71. 289 A knowledge of the evils which may result from a carious tooth, ought to influence all persons who may be affected with this malady, to take such early steps for their preven- tion as prudence shall dictate. Sometimes an indolent kind of inflammation will exist at the bottom of the socket of a carious tooth, occasioning a hard lump, or small tumour, of the size of half a nutmeg. In this state it will continue for months, with no other altera- tion than being rather sore, when, in consequence of a cold, a little active inflammation may arise. These hard swellings should always be regarded as very dangerous, because, as during their indolent existence they have caused a certain degree of absorption of the inner part of the integuments of the face, if any active inflammation occur, it very speedily runs on to suppuration; and, as the skin has already become thin, ulceration to the external part takes place so rapidly, that I have known an opening formed through the cheek in a very few days. On these accounts I always endeavour to persuade patients to have any tooth ex- tracted, which may be accompanied with any hardness, or swelling. It is also much better to submit to the extraction of any carious tooth which has produced an abscess; for it will be always a source of trouble, as well as occasion an of- fensive state of the breath. I will, after what has already been adduced, introduce a few more cases and their treatment, which will sufficiently illustrate these affections, with one from the work of R. Woof- fendale, who observes: * "A lady, about twenty-one years of age, applied to me about four years ago, who had an open sore in the side of *» Practical Observations on the Human Teeth, by R. Wooffendale, ho* don, 1783. 37 290 her face, nearly opposite the roots of the first large double teeth of the lower jaw on the left side, from whence there was a continual discharge of matter, over which she wore a piece of black silk to conceal it. About two years before, she had been under the care of an eminent surgeon, who had taken out part of a tooth, leaving the other part in: the discharge of matter was not, however, decreased by it, nor by any other methods used. She was attended by him three months without any advantage; at the end of which time she went home, she living at a distance from him. I exam- ined the teeth, and found one root of the first large double tooth of the left side in the under jaw, which I suspect to be the cause of the complaint; the other root had been drawn by the surgeon as mentioned above. I recommended the re- maining tooth to be taken out, w hich was consented to, and the operation performed immediately. The day following, the discharge from the wound was much lessened ; she went home the next day, and I have since heard that she got well in a very short time, without any farther assistance." The following case is mentioned by Mr. Koecker. *Case XXIV. Mrs. K. of Philadelphia, a lady about twenty eight years of age, had been suffering for some time from an abscess under the chin, on the left side. Being igno- rant of the nature of the disease, she sought no surgical aid, under a hope that it would get well of itself; but it grew worse, and was attended with a constant discharge of fetid pus, with great pain in the whole jaw and mouth, extending as far as the ear. These symptoms at last became so violent as to produce general disorder and fever. At this time Dr. Physick was consulted, who, having discovered the malady to be a fistulous abscess passing through the under maxillary . * Koecker, pages, 262, 263. 291 cavity and bone, immediately suspected that the teeth were the cause of it; and desired that I should be consulted. On examination T found that three large grinders on the side af- fected, had been so completely carried away by decay, that the parts of the roots remaining were entirely covered by the gums which were greatly inflamed. 1819. October 8th.—These roots, six in number, were extracted ; and so effectual was the relief obtained from this operation, that in a very short time the patient perfectly re- covered. *Case XXVI. Mr. L. of Pittsburg, consulted me on the 17th of May 1818, on account of an abscess which he had suffered for several years, in his left cheek, produced by the dead fangs of the left first upper large grinder. He was about thirty years of age ; had an excellent con- stitution, and enjoyed good general health. He had never suffered from any illness whatever. All his gums and teeth I found, to my great surprise, perfectly sound, although the dead roots above mentioned had excited considerable suppu- ration in the alveoli at their upper extremity and the maxillary cavity, and had forced an opening through the muscles of the cheek to the external surface. The discharge was so great that, during the time that the patient explained his case, two table-spoonsful at least of purulent matter ran out over the cheek. On examination, I found that nature had been so actively engaged in endeavouring to rid herself of the cause of this disagreeable malady, that the roots were quite loose and hanging on the outside of their respective sockets, mere- ly attached to the gums. The removal of these roots, and the usual surgical treatment of the fistulous opening in the ' Koecker, pages, 265,266. 292 cheek, effected a perfect cure of the disease in a short time. A considerable depression and scar, however, remained in consequence of the long neglect of proper treatment. THE EFFECTS OF MERCURY UPON THE TEETH, &C* When mercury has been introduced into the system, cer- tain circumstances occur which are usually regarded as crite- ria of its specific and constitutional action. The most evident of these are, an increased discharge from the salivary glands, soreness of the mouth, and fetor of the breath. The gums become tumid and spongy, are very tender, and liable to bleed; the teeth also become loose, and cannot bear the pressure necessary for the mastication of hard substances; this loosened state of the teeth arises from the thickening of the periosteum which covers the fangs, and by which the teeth are held in the sockets; the soreness of the gums is probably occasioned by that fulness of the vessels which the peculiar action of the mercury induces. These affections of the teeth and gums generally subside soon after the use of mercury is discontinued ; the teeth again become fast, and the gums acquire their natural firmness. A common consequence of the use of mercury is, an in- creased action of the absorbent vessels ; and there is no part on which this action is more evident than the alveolar processes. On examining these parts in persons who have died during the use of mercury, they will be found much less dense, and of a more porous texture than the bone ought to be in its sound and natural state. The use of mercury ie * Fox, Natural History of the Teeth, pages 115 to 120. • 293 therefore no uncommon cause of premature loss of the teeth, by inducing absorption of the alveolar processes: this injuri- ous consequence, arising from the use of this remedy, is now greatly obviated by the improvment adopted in its exhibition, namely, by keeping up a longer but slighter action of it upon the system, rather than that violent one which accompanied the old practice of salivation. Where the use of mercury is carried very far, the teeth, even during its exhibition, often become so loose as to drop out: in other constitutions, still greater mischief is experi- enced ; there is a considerable inflammation of all the parts of the mouth, attended with great swelling and ulceration. This sometimes extends even to mortification of parts of the jaw-bones. It would not be difficult to collect cases of ex- tensive mischief following an injudicious use of this valuable medicine; several striking examples of which have been presented to me by various surgeons of my acquaintance. In Plate V, fig. 2, is the representation of a large piece of the anterior part of the under jaw, containing _.the incisors and cuspidati, which exfoliated in consequence of a long- continued salivation. Fig. 3, represents nearly the whole of the under jaw, which mortified and exfoliated; this person also lost almost every tooth of the upper jaw, which became loose and dropped out. A very similar case occurred to a patient in Guy's Hospi- tal, who applied for advice on account of great disease in his mouth, as the consequence of a late salivation. He had an exfoliation nearly similar to the last case, and it was sur- prising to observe how small a deformity attended the loss of so great a part of the jaw. During the progress of the exfoliation, so large a deposit of new bone took place around the dead portion, that it became, as it were, enclosed in a 294 case; and after it came away, the new bone was rounded, and the gums healed over very perfectly. Last year I saw a most dreadful instance of the injurious consequences of an improper use of mercury, in a lady, a patient of Mr. Norris, who had just arrived from the East Indies, where she had been salivated on account of a liver complaint. She had been advised to employ so much mer- cury, that she was literally poisoned; her mouth became completely ulcerated, and the whole constitution was so much affected, that she lay for some time in a state of insen- sibility. As she recovered, the soreness of the mouth ren- dered the opening of it painful and difficult; and as the ulcers healed, so much adhesion and contraction took place at the posterior part of the mouth, that it could scarcely be opened even to admit a tea-spoon; at length the contraction in- creased to that degree that she completely lost the power of opening it. On this account, she was under the necessity of receiving nutriment in the form of thick milk, soups, &c. in- troduced into the mouth by a large syringe, the pipe of which being curved, was passed into the mouth through an opening formed by the loss of one of the molares. In addition to these calamities, the great inflammation which had been ex- cited, caused the mortification of nearly the whole of the alveolar processes of both jaws. On separating the lips, a most dreadful appearance presented itself; the gums had re- tired from the teeth, leaving the alveolar processes uncovered and quite black. I removed several teeth which had become loose, and in two or three places exfoliation was beginning to take place. The constant discharge of matter made a very frequent syringing of the mouth with tincture of myrrh and water absolutely necessary, and had she not possessed a mostexem- 295 plary patience and composure of mind, she must have been completely miserable. Some time since a man became a patient in Guy's Hos- pital, who had been so injudiciously treated in a course of mercury as to cause a complete ulceration of the gums and the inner surface of the cheeks and lips. The consequence of which was, that, as the process of healing advanced, so much adhesion of those parts took place that the mouth could scarcely be opened. The man could only be relieved from this distressing situation by the dissection of the lips and part of the cheeks from the gums, which was performed by Mr. Cooper; the parts were then preserved from re-uniting by the interposition of lint, until they had perfectly healed. During the use of mercury, when the mouth becomes af- fected, it should be frequently washed with a mild astringent lotion: for this purpose I have usually recommended the in- fusion of roses with a small quantity of alum; and, if the soreness of the mouth be very considerable, some tincture of myrrh may be added. During the exhibition of mercury, there is, usually, a considerable deposition of tartar about the teeth; to obviate the ill effects of which, it should always be removed as soon as the medicine is discontinued ; the gums will then soon recover their healthy state, and material injury to the teeth be prevented.. In farther confirmation of this subject see case mentioned by Mr. Koecker, in the section on diseases of the maxilla, and another, which came under my own observation, upon cleanliness of the teeth necessary during sickness, &c. &c. I have mentioned the foregoing effects of mercury, not under an impression that they often happen in the practice of our enlightened physicians, but that they have, and may hap- pen, if mercury is exhibited to excess and care is not taken to obviate its dangerous effects upon the mouth, teeth, their appendages, &c. &c. 296 TOBACCO. This article, as well as mercury, perhaps, is used or taken by as many different individuals as any other active or medi- cal substance whatever. That under some states of the con- stitution it exerts an injurious influence upon the stomach and digestive organs, there cannot be a doubt. But whether it directly injures the teeth or not, has been disputed. I will give the opinions of a few authors upon this subject. Fauchard remarks: *"The smoking of tobacco is also very hurtful to the teeth; it makes them black and ugly, and besides, if the precaution is not taken to cover the end of the pipe, the rubbing which it makes against the teeth never fails, in the using of it, by slow degrees to uncover their sensible parts. Experience proves this fact, and to which their has not been paid ordina- ry attention. This smoking produces bad effects; it heats the mouth, and a stream of cold air coming immediately in contact with the teeth, these two extremes might give occa- sion to the fixation of some humour in the tooth also, in the gums, or in some one of their neighbouring parts; which might occasion very inconvenient pains and defluxions, and caries also, which is the most mischievous of all accidents." It is not my intention to prohibit the use of tobacco en- tirely. I know that the teeth are blackened by smoking, if great care be not taken to keep them clean, and to rinse the mouth often ; but I know also that the smoking of tobacco may contribute to the preservation of the teeth, by procuring the evacuation of superabundant humours, which might by * Fauchard, pages, 68, 69, 70. 297 acting upon, destroy them. My intention is only to remark, that immediately after having smoked, they should not be ex- posed in the mouth to any sudden impressions of cold. "A dentist of this city, and a great enemy to tobacco, was not willing that it should be used by the nose, pretending it was pernicious to the teeth. It were to be wished that it might be moderately used ; but even used to excess, I do not believe it has the power to do any hurt to the teeth. The use of it might be useful to persons subject to defluxions. Tobacco determines the humours to run off by the nose, and diverts, and prevents them from falling on the teeth, which is no small advantage.". *"Smoking tobacco is also wrong, and is what makes them black and ugly, for they being heated by it in the mouth, and a cold air coming immediately in contact with the teeth, these two extremes might give occasion to some humour, either to the tooth or gums, which might cause pains, consid- erable fluxions, which are very inconvenient, and caries also, which, of all accidents, is the most mischievous, and for which the fewest remedies are to be found " Longbothom, in his treatise or Dentistry, remarks: f " The smoking or chewing of this herb is frequently intro- duced from the vehement pain of the tooth-ache, and with most constitutions paves the way to a far more dangerous disease than it is intended to remove, by its acrid and inter- nally violent qualities, in the act of fumigation being inhaled; and the chemical oil which it leaves within the hollow of the teeth, disposes them to blackness and premature decay; which, though less obnoxious for the present, proves a last- ing enemy to the mouth and stomach." "* Le Dentiste Observateur, par Courtois, pages 50 and 51, Paris, 1775. t Longbothom's Treatise on Dentistry page 30. 38 298 I have had occasion before to remark that I have noticed persons having good teeth who had used tobacco, both smok- ing and chewing it, for a great number of years. On the other hand, I have seen persons with very bad teeth who used tobacco. In some constitutions tobacco removes its irritability ; in others, it increases the irritability of the sys- tem. And when we look over the causes of caries, diseased gums, &c. we shall find that the fact respecting the opera- tion of tobacco, which we have noticed, explains its good and bad effects on different individuals. There is an acri- mony or impurity about some tobacco, which causes it to in- jure the teeth; but my observations, as to the effect of good tobacco, are, that by some individuals it may be chewed with impunity, and that smoking tobacco may be allowed; and, probably, used as an errhine it never injures the teeth; but as it is a dirty, and in many instances pernicious substance, perhaps its use might, with advantage, be entirely dispensed with. CHAPTER VI. SECTION I. DISEASES PRODUCED BY DISEASED TEETH, &C. I need not, in the commencement of this chapter, for one moment detain the reader in proving the well-known fact, that disease in one part of the living system may be produc- tive of disease in another and remote part; or endeavour to explain the rationale of that mysterious sympathy by which this effect is produced. A vast many pathological facts are yet to be explained, whilst the few that have been are every day assailed by new and more plausible theories. At pres- ent the truly intelligent physician is satisfied with clearly un- 299 derstanding causes and effects of diseases; considers disputes respecting the modus operandi of the causes of disease to be, to say the least, unprofitable. In the subsequent chapter it will be my object to lay before the reader a few plain and undeniable facts which unequivocally establish the important principle, that the diseases of the teeth, the gums, and maxil- lar organs, exert a powerful and extensive sympathy with the rest of the system. The diseases which I shall mention as produced by dis- eased teeth, gums, maxillar organs, &c. are the following: Phthisis Pulmonalis. Perhaps many persons may start at seeing this set down as ever being caused by diseased teeth, and consider its having a place here, as arising from the caprice or fancy of the writer, but which cannot be placed here either by facts or sound reasoning. Phthisis pulmonalis, the scourge of the human family, the destroyer of our race, the baneful siroc, whose course is marked by its destructive energies, that spares nei- ther age nor sex, enumerates in the number of its causes, a diseased state of the teeth. If this is so, why are not these diseases knowTn by the practitioners of medicine, and made an object of their especial attention ? I answer, because in this country they form no part of the education of the stu- dent of medicine preparatory to his entering upon-the prac- tice of his profession; and after that period, either from the multiplicity of their engagements, or from a want of indus- try or enterprize, few of them ever enter upon those untrod- den fields of disease, or their causes which had never been hinted to them, either by their preceptors or the authors they read. 300 The diseases of the teeth, or their destructive effects upon the system in general, are at present very little known to the medical practitioners of this country, although > they have occupied the pen of a Hunter to detail them, and the name of Rush, has borne testimony to their injurious and dangerous consequences. Need I ask for greater names, or higher au- thority to give evidence or consequence to this subject ? No, for none greater are wanted, or can be found. Their illustri- ous names are identified with the science of disease, and have descended to posterity as stars of the first magnitude in the horizon of their day, and shine as beacons for the guidance of distant generations. One of the first effects of diseased teeth, is to contaminate the air that passes over them ; this they do, more or less, proportionate to the extent and state of their disease : in some cases very slightly, in others, the affected tooth or teeth are in a complete state of putrefaction, and the air which passes to the lungs, through the mouth and back, is greatly contaminated and rendered exceedingly of- fensive to every person near the individual, and oftentimes to the sufferer himself. It is to the writer of this, at times, a subject of astonishment to reflect upon the quantity of of- fensive matter thrown off from one or more diseased teeth; although the air which passes over them is changed every instant, still it is constantly affected, and rendered offensive, and the air of a close room is soon contaminated by the breath of such a person. We respire about 20,000 times in twenty-four hours, and yet for months and years, this vast quantity of air is rendered poisonous by one or more dis- eased teeth. How little does it avail an individual, if by every possible means the purity of the air is preserved, if no impurities are suffered to remain in the streets, his tenements kept clean, his apartments ventillated, or that he make dis- 301 tant journeys, at a great expense of time and money, for the benefit of pure air, and at the same time that he carry the very cloaca of filth in his own mouth ? If this state of the breath, caused by bad teeth, so affects the olfactory nerves of a person near an individual having bad teeth, what must be its effects upon the delicate and sensible tissues of the lungs of the person himself? Nature has formed the lungs most delicate and sensible, and susceptible to the slightest in- jurious impression ; she has also finely tempered the atmos- phere for its safe and healthy reception in these delicate or- gans ; but an accident or disease may render it impure, unfit for respiration, and cause it, instead of harmoni- zing with the lungs in the most perfect manner, and give to them and the whole system health and strength, to be a baneful influence, armed with pestilence, and scattering the seeds of disease over the lungs, and pouring the streams of deadly poison through every vein of the system. The matter thrown off from the teeth in a state of disease and putrefaction, and also some states of diseased gums, is very acrid in its nature, as is demonstrated by its vitiating the saliva so much as to cause it to dissolve and oxidate metals, even silver, and to tarnish gold: and we have noticed its ef- fect upon the respired air, that it is present in a great degree in it, and consequently its acrid qualities are blended with it, and must render it extremely pernicious to the lungs. We know that many of our organs have the power of resisting, for a length of time, in a wonderful manner, the effects of injurious impressions; but with the lungs I am disposed to believe, that even slightly injurious impressions, if continued, will sooner or later prove to them a cause of disease and disorganization. The records of medicine are somewhat barren upon this subject, but there is not a doubt but the reason of this is, 302 because a vast majority of physicians and surgeons have never made themselves acquainted with the diseases of the teeth; consequently they have imputed phthisis to other causes, have seldom attended to the state of the teeth and gums, or the effects of their diseases upon the lungs, and yet conclusions drawn from well authenticated facts and the most logical reasoning, justify the assertion, that diseased teeth and gums do produce phthisis, and a few well authen- ticated cases positively demonstrate the alarming fact. We have only thus far considered the effects of diseased teeth on the respired air, and through this medium on the lungs, but we should also remember that the records of medicine, are full of cases when disease in one part, is produced by some irritation in another; for instance, a wound upon the head has been known to produce an abscess in the liver, and worms in the bowels, are known to produce dropsy in the brain, hydrocephalus ; and a wound in the foot, to produce lock-jaw ; and a small tumour beneath the skin of the leg, to produce epilepsy. If these apparently slight causes have produced such alarming affections of the system, is it unfair or unreasonable to suppose, that a diseased state of the teeth, or their being in a state of putrefaction and con- stant irritation and inflammation, should not, at times, pro- duce the most fatal diseases in the general system and in the lungs, as well as any other organ. I will con- clude these observations in the language of Dr. Rush. He says,* " When we consider how often the teeth, when de- cayed, are exposed to irritation from hot and cold drinks and aliments, from pressure by mortification, and from the cold air, and how intricate the connection of the mouth is with the whole system, I am disposed to believe they are often un- suspected causes of general and particularly- of nervous dis- * Medical Inquiries, Vol. I. pages 349 to 353. 303 eases. When we add to the list of these diseases, the mor- bid effects of the acrid and putrid matters which are some- times 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 advising 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 diseases, for splinters, tumours and other irritants before mentioned, often bring on diseases and death, when they give no pain, and are unsuspected as causes of them. This transition of sensation and motion to parts remote from the place where impressions are made, ap- pears in many instances, and seems to depend upon an origi- nal law of the animal economy." There are so many causes of phthisis, that we are often unable to determine, in each case, what is the precise one ; and the only positive proof is, the cure of the disease upon the removal of the supposed cause ; and if we suspect a dis- eased state of the teeth to be the cause, and, upon having them extracted or cured of disease, the phthisical affection is cured, it is then often demonstrated that the teeth were the exciting cause. Dr. Rush quotes from a French writer, a case of phthisis cured by the extraction of some diseased teeth ; this is positive proof. We must also remember that phthisis, excited by whatever cause, is cured by the removal of that cause only in its early stage, for after the disease has proceeded so far as to disorganize the lungs, it is probably never cured ; the removal of its early cause then will have no effect. The following case occurred in my practice, 304 which to me seemed conclusive, that the diseases of the teeth do at times excite pulmonary affections. Mrs. S----, a married- lady, aged about thirty-five years, residing in this city, with whom I had been acquainted for some months, sometime in May or April 1827, suffered me to examine her teeth. She was at the time troubled with a hacking cough, which she had had for several months, and said, " that she was afraid that she should have the consumption or had got it:" upon examining her teeth, I found that several of them were in the worst state of disease, and rendered her breath exceedingly offensive. I indeed wondered that the lungs of any person could bear the ingress and egress of such offensive matter. Upon assuring her that I thought her cough would be relieved by having her teeth extracted and cured, she consented to have it done. I accordingly ex- tracted eight diseased teeth and stumps, and by a suitable ap- plication of remedies succeeded in rendering her mouth, teeth, and gums, perfectly healthy, and soon after this with- out the farther aid of medicine her cough left her, and her general health became perfectly good, and continues so to this time. I also am acquainted with a lady who has been affected with a cough for several years, and, as far as I can learn of her, it commenced soon after a diseased state of the teeth had taken place : at this time her teeth are in the worst state of disease, and the pulmonary affection is gradually un- dermining the powers of the system. I have urged her to have her diseased teeth extracted or rendered healthy by dental operations, but from an alleged fear of the pain atten- ding it, she declines having any thing done for their cure. The following case of phthisis, has confirmed me in the fullest degree, that consumption is occasionally produced by disease in the teeth, jaws, &c. June 10th of the present year, Dr. George M'Clellan of this city sent to me a patient of 305 his, Mr. F---- P----, a gentleman resident in the south part of this city, aged about forty-five years, with a request that I would perform such operations upon his teeth and gums, as, if possible, to restore them to health; and likewise informed me that the antrum of the right side was exten- sively diseased. When this gentleman called, it was with difficulty that he could walk from the carriage into my house. The following was the state of his general health ; extreme debility, great emaciation, pale countenance, slight hectic fever, frequent cough, attended with a copious expec- toration, tongue covered with a light flocculent fur, loss of appetite, dejection of spirits, &c. &c. The following was the situation of his mouth, &c. The right antrum was extensively diseased, all that part of the jaw-bone of the right side situated anterior to the last molar tooth, and below the antrum, as far as the anterior symphysis of the superior maxilla, had mortified and been ulcerated away, so that all the upper teeth of that side, with the excep- tion of two, which had been extracted, and the last molar tooth, were destitute of alveoli and hung loosely in the gum. The whole interior of the antrum was exposed by a very large opening, made by the loss of the two anterior grinders. A copious discharge of pus from the antrum, had been con- tinued for a long time. On the left side of the upper jaw were several fangs of decayed teeth, and the soft parts around them ulcerated to the very bottom of their sockets, which were almost totally absorbed away. Upon a slight examination, I suspected that the left antrum was in a state of disease, but after removing the loose and dead fangs, and cleansing the cavity of the pus, I had the pleasure to ascer- tain, that the disease had not reached the antrum of that side. After considerable inquiry, I found that the diseased state of the antrum before mentioned, and the teeth of the 39 306 same side, was of three years' standing; that the general health of the patient had been uniformly good, until a few months after the disease of the antrum was noticed, when his lungs became affected, attended wiih cough, pain in the breast, and expectoration. The gentleman informed me that since that period he had never been free from cough, although he had experienced temporary relief from change of air and travelling. With regard to the disease of the an- trum, he paid so little attention to it, and kept it so private, that it was not known even to his own family or physician, until quite recently, when it became so aggravated as to force itself upon the attention of the patient, his friends and physician, who, greatly alarmed, immediately sought the as- sistance and advice of that eminent surgeon Dr. M'Clellan. Upon inquiring whether phthisis was hereditary in the fami- ly of this gentleman, he assured me it was not; that none of his relations or family had ever had it, that his father died an old man, of a fever, and that his mother was still living, and in the enjoyment of good health. It was the unqualified opinion of the gentlemen, of his family, and of his physician, that pulmonary affection proceeded from his teeth and dis- eased antrum, and what might appear rather singular, that for a year before the disease of the antrum was detected, the physician had imputed the exciting origin of the affection of his lungs, to use his own words, " to be somewhere in his head." The gentleman was a man of excellent habits, remarkable for his temperance and correct christian deportment. I immedi- ately extracted all those teeth whose alveoli had been affec- ted by the disease of the antrum, and the fangs and decayed teeth on the opposite side of the same jaw. I then partially cleaned his teeth, gave him an astringent wash for his mouth, and dismissed him with a request to see him at the expiration of one week; in the interval of which time, constitutional 307 and local remedies were prescribed by Dr. M'Clellan. At the expiration of five or six days I again received a visit from him, when a few slight operations were performed, and in a very short time his mouth became perfectly healthy, with the exception of the diseased antrum, which continued rapidly improving. Under this treatment the health of the patient improved. For a short time nature seemed willing to rally the almost exhausted powers of life, but the exces- sively warm weather, joined to the previously extreme de- bility, and the harassing symptoms of his malady, urged the disease to a fatal crisis, and he died in July after I saw him. It was the confirmed belief of the patient, that by an early attention to the disease of his antrum and teeth, the ac- cession of phthisis, would have been prevented; and from this opinion I think few can reasonably dissent. I think we may safely infer, although diseased teeth do not in every instance excite general diseases of the system and of the lungs, still like an insidious enemy, they are ever ready to unite with or exasperate other causes, so as to finally undermine the powers of the system. I have dwelt at con- siderable length upon this subject, and would earnestly solicit the attention of the Medical Faculty in general, to a critical inquiry into the state of the teeth in all cases of pulmonary affections, and there is hardly a doubt but what their en- quiries would eventuate in the general conclusion, that a dis- eased state of the teeth and gums do very frequently excite pulmonary affections, especially in persons predisposed to them, and always aggravate these complaints, let them be excited by whatever cause they may. 308 SECTION II. DYSPEPSIA PRODUCED BY A DISEASED STATE OF THE TEETH AND GUMS. There are three ways in which diseased teeth, and gums, &c. may cause this distressing complaint. Firstly,—By preventing a proper mastication of the food. Secondly,—By the putrid and ulcerated matter which passes from the teeth and gums along with the aliment of the stomach. And, Thirdly,—The irritation of a diseased tooth being often so great as to disturb the healthy functions of the system, and of the stomach in particular. Firstly,—By preventing a proper mastication of the food. Mastication is one of the first steps in that series of process- es by which the food is rendered subservient to the purposes of nourishing and supporting the animal system. It seems to be an indispensable requisite that in order to the accomplish- ment of healthy and speedy digestion that the food should be reduced to very small pieces. It is an old proverb that food well masticated is half digested.* This, with few excep- tions, is an universal law of the animal economy The di- gestive powers of the stomach act with much more facility upon the food if finely comminuted, than if swallowed in large pieces; and, indeed, the practice of swallowing the food in large pieces, in almost all cases, sooner or later pro- duces dyspepsia and greatly weakens the powers of the stomach. I need not enlarge upon this subject, for it is a fact known to every scientific practitioner of medicine, that the food must be perfectly masticated in order to be digest- ed in a healthy manner; and one of the first and indispensa- * Fauchard, Vol. I, page 64. 309 ble injunctions of the judicious physician to his dyspeptic patient is, to masticate his food with the utmost care, and never to swallow solid food, that is, not perfectly masticated. This becomes a sine qua non, for, without it, there is hardly a hope of ever curing the dyspeptic. The influence, in this case, is direct and positive ; for if the teeth and gums are in such a state of disease as to prevent proper mastication of the food, dyspepsia must and will be occasioned and con- tinued, from the causes I have before mentioned, and all the evils resulting from this cause, follow as certainly, and are shown as clearly, as any possible demonstration. I will not detain the reader by any more observations upon the influ- ence of proper mastication upon digestion, but will refer him to almost every judicious writer upon dyspepsia. Secondly,—Dyspepsia may be occasioned by the putrid and ulcerated matter from diseased teeth and gums mixing with the aliment and passing to the stomach. Upon this head of the subject I need hardly make a remark, as it must be self- evident to every reflecting mind, for no person can doubt that matter received into the stomach, which is the result of mortification and diseased animal secretion, must impair the tone of that organ, and vitiate, more or less, all the fluids of the system. The carious matter from decayed teeth is in a state of putrefaction, and the matter from ulcerated gums is the result of diseased animal secretion. I could mention many cases of this kind, but will mention but one. Case. P. S.—A gentleman residing in Front-street, called on me in April 1827, with a diseased State of his teeth and gums, at 310 the same time mentioning to me that he had but little hope of having his teeth and gums restored to health, as he had been for some time under the care of one of the most res- pectable surgeons in this city, with whom I had the pleasure of a personal acquaintance, for the cure of his gums ; that, although he had fulfilled his prescriptions, still they were of no use to him, and that he had had his teeth examined and operated upon by a dentist without any service. Upon ex- amining his teeth, I found many of them were in a state of decay, and that his gums, in consequence of the tartar depos- ited around the teeth, and pressing upon and irritating the gums, were in a state of suppuration, and that the alveolar processes were much absorbed away—the front under inci- sors were completely dead ; their sockets were nearly re- moved by absorption, and the gums surrounding them were in a complete state of suppuration, attended with a constant discharge of matter. He naturally seemed to possess a good constitution, but his general hea'th was, at this time, much impaired, attended with obstinately dyspeptic symptoms. I think he had imputed all his dyspeptic complaints to the dis- ease of his gums. I succeeded by cleaning his teeth and the use of the oak bark decoction to arrest the disease for some time, but as he refused to have the dead teeth and stumps of teeth extracted, as they always should be, I did not succeed in making a perfect cure of the disease. I men- tion this case to show how greatly dead teeth, and stumps, and suppurating gums, do affect the healthy action of the stomach, and also again to remind the reader that dead teeth and stumps must be extracted, in order to cure a suppurating state of the gums, and to remove consequent effects. For another case of dyspepsia produced by diseased teeth and gums, in consequence of not masticating the food in a proper manner, and in consequence of decayed and ulcerative matter 311 passing into the stomach, see the case of Mrs. F—, narrated in the chapter upon Scurvy of the Gums. (See Koecker, page 110.) And, Thirdly,—Dyspepsia may be occasioned by the irrita- tion of a diseased tooth being so great as to disturb the heal- thy functions of the system, and of the stomach in particular. It is a well known fact in the pathology of disease that ex- cessive pain occurring in any part of the system will derange all its healthy functions, and no organ is sooner affected than the stomach, as it is the centre of sympathetic action in the animal system. We have often noticed the deadly sickness produced by a slight injury upon delicate parts. The appli- cation of caustic to a wound will sometimes, in some individ- uals, have this effect; and hence, we can easily understand that an acute inflammation of a tooth will disturb the action of the stomach, as I have often witnessed. I will give one case of this kind from Dr. Rush's paper on this subject. He says, " soon after this I was consulted by Mrs. R----, who had been affected for several weeks with dyspepsia and tooth- ache. Her tooth, though no mark of decay appeared in it, was drawn by my advice. The next day she was relieved from her distressing 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, although it had produced the disease in her stomach. It is not my de- sire to protract the consideration of this subject any farther than will be necessary for a correct understanding of it. I have endeavoured to seize and display its principal points to the physician. We have seen that three distinct effects of diseased teeth and gums will, alone, and singly, produce dys- pepsia, and how certainly will they do it when all these ef- fects act upon the stomach in conjunction ; and I cannot for- 312 bear remarking, in conclusion, that every practitioner of med- icine, when prescribing for dyspeptic patients, ought to at- tend to the state of their teeth and gums, and if they are not in a state of health to have them made so by judicious dental operations. Another remark we might make, and which was obligingly suggested to me by Dr. Chapman, the highly intelligent pro- fessor of the theory and practice of medicine, in the University of Philadelphia, which clearly proves the influence of disease in the mouth upon the stomach is, that dentition in infants, in a great majority of cases, excites diseased action in the stomach and bowels, manifested by the loss of appetite, nausea, and diarrhoea; and it is a fact notorious to the medical faculty, that the occurrence of dentition is apt to aggravate all other complaints which may be present, and especially those of the stomach and bowels of children so prevalent in the summer months, and so certain and well assured are they of this, that even the probability of dentition occurring during the prevalence of summer complaints, is ever productive of alarm, as they know that they will be aggravated, and the lives of their little patients placed in the greatest jeopardy. The following case of dyspepsia, produced by a diseased state of the teeth and gums, is taken from the public lectures of the present professor of the theory and practice of med- icine in the University of Pennsylvania, Nathaniel Chap- man. M. D. Some years since a lady came from a distant part of the country to this city in pursuit of medical aid, and placed her- self under the care of Dr. Chapman. He found her labpur- ing 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 imme- 313 diately led him into an inquiry into the state of her teeth and gums, lie found that her gums were in a high state of in- flammation, and that many of her teeth were loose and dis- eased. 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, 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 constitu- tion, proved a source of irritation, and again brought On a return of the distressing dyspeptic symptoms, which com- pelled her to entirely dispense with the artificial teeth, when her health wras again completely restored. I will mention two cases of dyspepsia, caused by diseased teeth, which came under the notice of Mr. Koecker. Cases.* Mr. F. 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 con- stant state of derangement of his digestion. Much sedentary occupation, and some excessive grief, had of late greatly augmented the distressing symptoms general- ly accompanying this cruel disorder. His disease had as- sumed the character of hypochondriasis. His spirits were so dejected, and the state of his bodily health was so low, *"■ Koecker, Part I, pages 110, 111. 40 314 that he was no longer capable of attending to his ordinary business. Having had some conversation 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 putrefaction, three large grinders only excepted, which were either suffering from complicated caries, or producing mor- bid irritation upon the other parts from some other causes. Four upper and two under incisors, two upper and two under cuspidati, and two under bicuspides; fourteen front teeth in all, wrere left remaining. These and all the other parts of the mouth were restored to perfect health in the course of about six weeks. During the progress of this treatment of the diseases of the mouth, the general health improved very surprisingly; and after the restoration of perfect health to all the remain- ing teeth and their relative parts, the patient enjoyed uninter- ruptedly good health, and returned to his ordinary profes- sional avocations. *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 an- * Koecker, pages 108 to 110. 315 noying 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 den- tist 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 attendant, were all that could be extracted. The disease, however, was only aggravated by this interfer- ence, and the sufferings 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 ex- traordinary sympathy of all the glands, in any way connect- ed with the teeth. On the previous night, and indeed, for many nights preceding, she had been suffering such violent fits of convulsion, as to alarm the whole family. The face was affected with an acute erysipelatous inflammation, ac- companied with head-ache, as also with considerable de- rangement of the digestive functions, such as sickness, vom- iting, loss of appetite, &c. By examining the mouth, I found that the previous dental treatment had been but very partial, and I proposed the removal of every tooth and root which produced irritation. The lady consented immediately 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 directed 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. Baglivi, one of the best medical writers of a former pe- riod, observes in his Canones de Medicinae:— 316 * " Persons whose teeth are in an unclean and viscid state, though daily washed, have universally a weak stomach, bad indigestion, and offensive breath, head-ach 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 stomach they are natur- ally somnolent, scarcely wakeful in the morning, and never satisfied with sleep." I will mention one case more out of many I have wit- nessed in my own practice, where the stomach was affected by the state of the teeth. July 2d of the present year, Mrs. S-----, aged about 38 years, residing in Frankfort, was sent to me by one of our most eminent physicians, with a request that I would examine her teeth, and perform such operations upon them as I judged proper, to render them and the gums healthy. The state of this lady's health was miserable ; she was har- rassed with the most distressing symptoms of dyspepsia. Her digestion was very imperfect, the stomach irritated, loss of appetite, and a most melancholly depression of spirits. When she first called, it was necessary for her to repose her- self for some time, before she could have her mouth exam- ined. Upon examining her teeth and gums, I found nearly *" Qui quotidie sordidos, viscidosque dentes habent, licet eos quotidie abstergeant, ii ut plurimum sunt stomacho debilas. male digerunt, ore fcetent, post prandium capite dolent, msssti sunt, atque debiles : et si studiis, atque negotiis eo tempore dent operam, irascuntur, impatientes fiunt, capiplenio cum dolore corripiuntnr; ad venerem minus proclives sunt: generaliler enim stomacho debiles, venerei non sunt, i'.:6potiusi frigidi et impotentes. Debiles quoque stomacho, nature sunt somnolenti; mane vis evigilant, imd nunquam somno satiaientur." Georgii Baglivi, Opera Omnia Medico. Practica et Anatomica, Lug- duni, 1710. 317 all the former in a state of disease, and the latter were in a state of suppuration, much inflamed and swollen. A con- siderable deposit 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, as the principles of treatment are elsewhere in this work fully detailed. Suffice to say, that in about four weeks her mouth was perfectly well. The amendment of the gen- eral health after the first operations were performed on her teeth, was almost 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 first saw her, every vestige of disease in her digestive organs left her, and she was apparently in perfect health. SECTION III. PAIN IN THE EAR, AND FORMATION OP MATTER IN THAT ORGAN. It often happens that painful teeth and those affected with complicated caries, are the cause of great pain in the ear, and occasionally affect the functions of that organ; and so great is the nervous sympathy between the nerves of the teeth and the ear, that remedies applied to the latter, will re- lieve pain in the former. Laudanum dropped upon a lock of co;ton, and introduced into the ear, will often relieve the tooth-ache. This is quite a popular remedy. Upon the same principle or a knowledge of the same facts that the 318 actual cautery has been applied to the antihelix of the ear to relieve pained teeth. It is often the case, that persons suffering pain in their teeth, from cold, &c. find great and occasionally complete relief by simply filling the ear with cotton. I will give a case of this kind from the work of the cele- brated Jourdain. * " A lady experienced for a long time, very severe pains in the ear on the right side. All the means were tried but in vain, to remove this painful affeetion. Eventually, those who were most discerning, asked her if she had not some carious teeth. She assured them that her teeth were very good, performed their functions well, and had never given her any pain. Nevertheless, she was advised to have her mouth examined. She addressed herself to me, and after the ac- count she gave me of her case, what had been done, and the suspicions entertained, I examined all her teeth with the most scrupulous attention. Their first aspect was very im- posing. At length proceeding farther in the examination, and removing the cheeks upon the wisdom molar teeth of the lower jaw, I perceived the one on the right side was ca- rious very deeply externally, and that the internal part of the cheek was lodged in this caries. As the pains of the ear ex- tended to the posterior angle of the jaw, and also a little along its base, I beseeched the patient to have the true cause of her malady removed. This tooth having been extracted, the pains entirely ceased on the third day, and the malady never returned." Mr. Koecker has given a case of disease in the ear from dis- eased teeth. He remarks,f " Miss G. of Philadelphia, about * Jourdain, Tome. 1, page 486. i Koecker, pages 1*36 to 159. 319 16 years of age, was troubled with a complaint in her ears, at- tended with severe pain and discharge of yellowish matter from them, difficulty of hearing, much general debility, and great depression of spirits. No means had been omitted to obtain the best medical and surgical advice ; but it had been utterly unavailing. Her father and the greater part of her brothers and sisters were also hard of hearing, and some of them were sometimes troubled with a like discharge from the ears, although not to such an extent, nor accompanied with such severe pain. The case was consequently regard- ed as incurable, and supposed to be owing to some natural defect in the organization of the parts. Nov. 23,1818. She consulted me with a view of obtain- ing relief from the tooth-ache, by the advice of her brother, one of the few members of the family possessed of a per- fect hearing. He had been some years previously under my care, and was greatly impressed with the belief, that the health of his teeth was one of the principal causes of the preservation of this sense, and for this reason he was induced to believe that the sufferings of his sister originated from the diseases of her teeth. I found her exceedingly agitated, and so full of apprehen- sion that she actually wept; and I had the greatest difficulty in persuading her to let me look at her teeth. Having been previously apprised of the nature of her malady, I had al- ready bugun to suspect it was owing to diseases of her teeth, particularly as she had been under the care of the most emi- nent surgeons and physicians, who, I had every reason to be- lieve, w-ould have been successful, if the disease had not been symptomatic. This opinion seemed confirmed by ob- serving that there was no visible defect in the organization of the ears, and by the reflection, that if any defect did 320 really exist, it was not likely to produce symptoms so violent, as those present, however it might affect the sense of hearing. After a little consideration, I gave my opinion, that there was great reason to hope for a complete recovery, if she would allow me to investigate the case more minutely. The effect of hope was wonderful. She readily permitted me to examine every tooth, and every part of her mouth very particularly. Her teeth were, generally, under the influence of caries, and the disease had penetrated to the cavity in some of them. They were all more or less encrusted with tartar, her gums and the sockets of her teeth were in an inflamed state, and bled at the slightest touch. The left under second large grinder was carious and painful, and the opposite one was also carious, and the crowns of the two upper second bicus- pidati were nearly destroyed. There was but little room for the dentes sapientiae, and knowing that in the warm and changeable climate of America, their formation is frequently hastened at a premature age, particularly in delicate and irritable constitutions, I readily suspected that their preco- cious formation, and the want of room for them to pass through the gums in combination with the diseases of the teeth, were the causes of# the inflammation, and the pain in the ears." Mr. Koecker obtained consent, and performed such ope- rations upon her teeth and mouth, as to render them perfect- ly healthy, and in conclusion remarks,* " These measures were followed by great improvement of the general health, cessation of pain in the ears, as well as of the discharge from them. The hearing was good, but not quite so acute * Koecker, page 161. 321 in the left as in the right ear. The gums and teeth were perfectly sound and beautiful. Care had been taken to pre- serve their natural shape and appearance, and particularly to prevent the stopping being visible on the exterior surface of such front teeth as had been filed. "Before I left Philadelphia in 1822, I saw the patient fre- quently. Her health and spirits were good, and her hearing, if not perfect, was as good as that of any other member of her family." SECTION IV. INFLAMMATION AND PAINFUL AFFECTIONS OF THE EYES FROM DEFECTIVE TEETH, &C In some instances a remarkable sympathy is found to ex- ist between the eyes and their integuments, and inflamed teeth. A few weeks since a lady, residing in the northern part of this city, called on me with a request that I would examine her teeth, and extract those which were so far defective as to be incurable from dental operations. She at the same time showed me the fang of the first bicuspis of the upper jaw on the right side. The crown of the tooth was nearly all decayed away, and the fang was subject to frequent in- flammation. It was remarkable that whenever the fang of the tooth was inflamed, the lining membrane of the lachry- mal duct became inflamed so much as to entirely close the duct, and prevent the passage of the tears to the nose, in consequence of which they would be constantly trickling down over the cheek. For a considerable length of time 322 the duct remained closed ; at which period she called upon one of our oldest and most eminent surgeons, mentioning to him the state of her teeth, and showed him the diseased eye, duct, &c. and asked his advice. He at once said that there was no connexion between the disease of the lachrymal duct and the defective tooth—that the extraction of the tooth was not necessary, and that, in a few days, he would pass a silver canula down the canal of the duct, which would form a passage for the tears to the nose. The chronic inflamma- of the tooth, by the use of an antiphlogistic regimen for a short time, was reduced and relieved. With the subsidence of pain and inflammation in the affected tooth the inflamma- tion of the membrane of the lachrymal duct was entirely re- lieved, and the tears passed by it to the nose. Some time after this, upon taking cold, an inflammation was again ex- cited in the tooth before affected, and almost simultaneously with this, the lining membrane of the lachrymal duct, before mentioned, became inflamed so as to obstruct the passage of the tears. The eye itself was likewise much affected. She now called upon me to ask my advice. I proposed the im- mediate extraction of the tooth, to which she consented. The extremity of the fang was in a state of ulceration. The inflammation of the integuments of the eye and lachrymal duct immediately ceased, and the lady has remained in the enjoyment of good health ever since. I present the reader with two cases of this kind from Jour- dain. Opthalmia and loss of an eye by a defiuxion on the teeth.* A lady of Cologne was tormented for a long time with a defiuxion on the last molar tooth of the left side of the jaw, * Jourdain, Tome I, pages, 484, 485. 323 where there was erosion and caries. She was purged frequent- ly by the advice of a physician, and cupping glasses were ap- plied to the shoulders. But as she would not consent to the extraction of her tooth, the continual pain not ceasing, the ir- ritation and attrition of the defiuxion on the gums gave birth to an Opthalmia of the same side. Cataract and the loss of sight followed this opthalmia ; because a part of the humours were dissipated, while the use of cold medicaments had con- densed another part of the humours. Singular Opthalmia. A young lady from sixteen to eighteen years, had the second great molar tooth of the upper jaw of the right side extreme- ly carious, without being painful, only in drinking or eating any thing too hot or cold. This reason was sufficient to op- pose the intention I had to extract it; she consented to have it plugged, which I did with the greatest precaution. The following month, and about the time of her courses, the eye on this side became irritated and inflamed: the tooth became apparently loose. The time for her courses having passed, the opthalmia disappeared, and the tooth became solid. On another return of her courses, the same opthalmia returned, but more severe than the first, which also disappeared at the end of her courses. The accident re-appeared a third time : I removed the plug from the tooth—on the following day there was no more of the opthalmia, and the courses regular. After this third time I cauterized the tooth with red hot iron, and plugged it. New term of the courses, new opthalmia. I removed the plug from the tooth; the opthalmia disap- peared. I put cotton in the tooth, and every day that I took it out I found it charged with a sanguineous and purulent hu- mour of a very fetid smell. These accidents made the pa- 324 tient more reasonable, and solicited by her parents, she was determined to have this tooth extracted. After what has been said, it ought not to be wondered at that these opthal- mias were repeated, and followed by like consequences. There was a discharge from this tooth when it was not plugged, but the plug prevented it; the refluxion fell upon the neighbouring parts, where the fluids themselves put it in motion during the term of the courses, and contributed to the swelling and irritation of the eye. The reader is likewise requested to note how greatly the eyes wTere affected in the case of exostosis given by Fox, and inserted in our article on that subject. He will likewise re- mark the same effect in the dreadful case of cartilaginous growth of the gums communicated to him by letter from a lady in Scotland, and inserted in the section of this work under the head Cartilaginous Excrescences from the gums. I will close this subject with one case from Mr. Koecker's Book. Case.* "Alexander Stuart, aged sixty-four, had lost all his teeth from this destructive disease, except two upper, and one of the under cuspidati, which had been for some time very loose and painful. His sight had been declining for above fifteen years, and one of his eyes had been affected with incipient cataract for about five years. In January 1824, he requested my assistance for some acute inflammation of his mouth. One of the above canine teeth, the principal cause of the in- flammation, was immediately extracted, and at the same time I gave my opinion, that by the removal of the other two, not only his mouth would be restored to perfect and perma- * Koecker, pages, 278, 271) 325 nent health, but, most probably also, very salutary effects might be produced with regard to his sight: in consideration of this, he consented to their immediate extraction. My anticipation proved just, for by this treatment the dis- ease of the mouth was perfectly cured in one or two days, and since that period, not only has the general health of the patient been much benefitted, but the pain and weakness of his eyes have greatly diminished, and their sight has gradually much improved. section v. NERVOUS AFFECTIONS. Epylcpsia and Hysteria. The teeth being supplied with nerves from the fifth pair, exert, in many instances, a remarkable sympathy over distant parts of the system. The nervous affections which are oc- casionally excited by diseased teeth, are epilepsy, hysteria, hypochondriasis, rheumatic affections, tic douloureux, sympa- thetic head-ach, hemicrania, palsy, &c. It is not my intention to discuss this subject at large, but to merely mention a few cases in reference to it, with a view only of pointing out the injurious effects of diseased teeth, as seen in their producing these diseases. Dr. Rush mentions the following case of epilepsy, pro- duced by diseased teeth. The doctor says, " Some time in the year 1801, I was consulted by the father of a young gen- tleman in Baltimore, who had been affected with epilepsy. I inquired into the state of his teeth, and was informed that several of them in his upper jaw were much decayed. I di- 326 rected them to be extracted, and advised him afterwards to lose a few ounces of blood any time when he felt the premon- itory 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." The following case of an hysterical affection I lately witnessed in my own practice: about the last of October, 1827, I was requested to call and see a lady, living in a small alley be- low Christian-street. I found she had been afflicted with a most distressing tooth-ache for about three weeks, and to that degree had the pain in her tooth affected her nerves, that any thing which was unusual, as any kind of mental emotion, &c. threw her into fits of hysteria; as for instance, when she sat in a chair to have her pained tooth extracted, she fell into a violent paroxysm of hysterical convulsions, and her mother informed me that when her tooth was in pain, without any other apparently exciting cause, she would have the hysteric paroxysms. As I found she could not be in any way composed so as to allow of extracting her tooth, I gave her a preparation of nitrous ether and pulverized alum, directing to apply it upon a piece of cotton to the diseased tooth, and directed them, as soon as her health and spirits would allow, to have her tooth extracted. I have never heard from her since. SECTION VI. HYPOCHONDRIASIS. Hypochondriasis is usually an attendant upon a disordered state of the gastric functions; and all the cases of dyspepsia 327 I have seen, which were occasioned by diseased teeth and gums, have been more or less complicated with hypochon- driasis. section vn. RHEUMATIC AFFECTIONS. Dr. Rush mentions the following case of a rheumatic affec- tion of the hip-joint, occasioned by a diseased tooth. He says, " Some time in the month of October, 1801, I attended Miss O. C. with a rheumatism in her hip-joint, which yield- ed for a while to the several remedies for that disease. In the month of November, it returned with great violence, ac- companied with a severe tooth-ache. Suspecting the rheu- matic affection to be excited by the pain in her tooth, I di- rected it to be extracted. The rheumatism left her hip immediately, and she recovered in a few days. She has continued ever since to be free from it."* I will give another case of a rheumatic affection, which was communicated to me by Dr. Dewees, of this city, and fell under the notice of Dr. Rush, by whom it was mentioned in his public lectures; and the subject of it afterwards came under the care of Dr. Dewees. Case. A lady, resident in this city, was attended by Dr. Rush, one entire winter, for an obstinate rheumatic affection, but during the cold weather his prescriptions were unavailing: * Koecker, page 118. 328 her health recovered in some measure during the warm weather of the succeeding spring and summer, but her rheu- matic complaints returned on the accession of cold weather, and she was confined to her room all that winter. Warm weather again relieved her from her rheumatism. At the commencement of the third winter, she was again attacked with rheumatism, as in the two preceding winters, when the doctor examined her teeth, and found that some of them were in a state of disease ; these he ordered extracted, which done, she immediately recovered from every symptom of rheumatic complaint, and was free from them ever after. SECTION VIII. TIC DOULOUREUX. This affection is now so generally known to be excited at times by diseased teeth, that very few intelligent surgeons, in cases of this kind, omit to notice the state of the teeth, and if they find any of them diseased, they, in all cases, di- rect their extraction. The following case of this kind was men- tioned to me, some years ago, by the present professor of surge- ry in Yale College, Dr. Nathan D. Smith: as I relate from mem- ory, I have entirely forgotten the date of the occurrence of this case. A young man, somewhere in the state of Vermont or New Hampshire was troubled with most acute and severe nervous pains and twitchings in his face, chiefly along the infra-orbitar nerves: this affection baffled the efforts of several respecta- ble physicians for several months, I think four, when it was perfectly cured by the extraction of a diseased tooth of the under jaw. This case is remarkable for the sympathy be- * Koecker, pages 279 to 281. 329 tween the nerves of the under teeth and those of the upper part of the face. I will continue a few cases of this kind from Mr. Koecker's book, and Mr. Bew's work on Tic Dou- loureux. Mr. Koecker observes,* " Mr. J----, a gentleman of great respectability, a native of this country, but for many years a resident of Smyrna, aged about thirty-nine years, had suf- fered upward of ten years, from this distressing malady, at- tended by all its torturing symptoms, in a most unparallelled manner. His whole constitution, but particularly the gland- ular system, was so much affected as to produce swellings and indurations in the most distant parts, accompanied with great pain and inconvenience; but its effects on his head were frequently agonizing; indeed, he assured me, that so great were his sufferings, that he had been so far driven to despair, as to implore Heaven to relieve him by putting an end to his miserable existence. He repeatedly applied for the best medical and surgical advice that the country could afford; but the real causes of his sufferings were not detect- ed ; and such was the character of his disorder, that it baf- fled every exertion and all the remedies which were applied for many years. At length the effects of a sea-voyage, and a visit to his native country were proposed, and at the same time a trial of such remedial measures as he might be able to command in England. Immediately after his arrival in London, this patient con- sulted Mr. Lawrence. This sagacious and disinterested sur- geon soon suspected his teeth to be the chief cause of his malady, and recommended him to have my advice without delay, and to submit to any treatment I should deem neces- sary and proper. ♦ Koecker, pages 270 to 281. 42 330 On examining the gentleman's mouth, I found his gums and all his alveolar processes more or less diseased. His double- teeth, however, had most especially suffered; and so consid- erable a part of their sockets was destroyed, that their pres- ervation was rendered altogether impossible. I therefore proposed their immediate removal; and although the gentle- man was exceedingly nervous, he acceded to my proposed plan of cure without the least hesitation. February 14th, 1826. Thirteen roots and teeth were ex- tracted, and the mouth was subsequently cleansed with a gen- tle stimulant lotion, every hour or two in the course of the day. February 21st. The remaining front teeth of the upper and under jaws were carefully scaled as far as the diseased state of their gums would allow of; and the patient provided with the means of preventing the re-accumulation of tartar. He was requested to continue the use of the lotion. February 28th. The above operation was repeated, and cleanliness particularly recommended. March 7th. The same operation was completed, and a perfect removal of the tartar was accomplished: the patient was also directed to proceed as before." Thus, by the judicious management of the case, by Mr. Lawrence, and the above treatment, the patient was now, in less than one month, restored to perfect constitutional health. His mouth was rapidly recovering from a disease, probably of more than fifteen years standing ; and the most important of his teeth were saved from total destruction, and perma- nently preserved. Mr. Charles Bew says,* " A Miss E----, whose interesting * Opinions of the Causes and Effects of the Disease denominated Tic Douloreaux ; deduced from Practical Observations of its Supposed Origin, &c. &c. By Charles Bew, London, 1824. 331 appearance, pleasing manners, and elegant accomplishments, (though scarcely eighteen,) have been thus early, as an in- structress, highly beneficial, having been medically reconv mended sea-air and recreation on the coast of Sussex, in the autumn of 1823, was attacked with what appeared, and was denominated rheumatic pains in the face, ear, and head, sub- sequently followed by deprivation of rest and appetite. The painful sensation being so unsteady as to position, and so fluctu- ative, as to effect, as never to have awakened even the slight- est suspicion, even in herself, or medical attendant, as to the precise sphere from whence her suffering might have arisen; except, indeed, that in the height of some of her paroxysms, with her hand frequently placed on the parietal bones of the head, above the left temple, she would exclaim, " O my dear mother, I shall lose my senses ! my face burns like fire, and something seems forcing up into my brain !" The distressing sensation thus depicted, and doubtlessly described to the physician, (who, as I hear, most kindly acted on the well- known liberality of principle in the faculty, " that sons and daughters of Apollo should help each other gratuitously, gave his attendance,) probably determined from the diagnostics delivered to him, that being similar in effect, it could be no other than a general bilious derangement of stomach, mani- fested to the head, through the immediate or recurrent chan- nel of the sympathetic nerve. Upon this supposition, the fair patient was treated with pre- sumed hope of success, till after the usual routine of depletion- ary and repletionary exhibitions " in such cases recommend- ed and provided," had proved abortive, with much time and attention lost, and little advantage gained, except from inter- mediate variety of suffering, and occasional imagination of amendment, as the supposed disease, (almost generated into 332 reality) appeared to advance or recede, to or from convales- cence.* About this time, change of situation was suggested, and in conclusion, consigned the case to my inspection, in Febru- ary, 1824. I soon discovered, by the mode herein recommended, th« immediate seat of my little interesting patient's complaint to be in the second bicuspis, or small grinding-tooth, in the left side of the upper jaw, a very small portion of which alone was visible. The disease generated by pressure of the neigh- bouring teeth, having devastated the tooth itself, in propor- tion as the accompanying paroxysms and the remedies pro- posed, had, to a certain extent, been'active in the discompo- sure of her health and comfort. The aborigine diminutive tooth, still more diminished by disease, having been declared neither useful nor ornamental, was quietly and gently (as well with regard to the sufferings of the patient, as to prevent the possibility of fracture) ren- dered incapable of causing further calamity to the fair owner, by removal. On examination, after extraction, the perios- teum, or vascular membrane investing the root, appeared at the extremity swollen to the size of a small pea, which, on being punctured, sent forth on the lancet a quantity of fluid of the colour and consistency of cream, occasioning at once the confirmatory conclusion, that could the pain attendant on the inflammatory action, which had never ceased, and was then going on in this small, but largely excitable substance of * All which may be easily conceived, when it is recollected, that the great sympathetic nerve forms a plexus, or combination with the fifth and sixth pairs, and is thus, through connecting consequence with the trigeme- nus, not only in complete association with the head, heart, and stomach. but also with the teeth, eyes, and ears. 333 bone and membrane, been continued to the fullest extent, the cessation of sensibility would have ended in exostosis; in other words, have produced a bulbous addition of bone, which the alveolar process would have promptly enlarged to the proportion of, rendering all attempts at removal by in- struments, as difficult and abortive as it were to displace a screw from its position, having a nut unassailably attached to the opposite side. * An elderly man of moderate independence, residing at New-Haven, in the county of Sussex, in the summer of 1820, who had been long unknowingly subjected to Tic Douloureux, designated by his medical attendant, "rheu- matic affection of the face," at the anxious instigation of *a friend, desired my assistance. Having announced the day and hour I would attend, I was introduced almost at the door of the person's house, to his medical practitioner, who, on hearing my name, announced himself as such, adding, that he had taken the opportunity of not being immediately wanted at home, to give me the meeting, his friend not yet having made his appearance, to state to me the hopelessness of his case, which he described as being decidedly rheumatic intermittent, which had remained immovable to every effort; concluding his observation by conceiving a mercurial course the only remedy yet untried and most likely to be successful. Before he had quite concluded his observation he was called away, and his absence from the room succeeded by the im- mediate object of my visit, who came out of an adjoining chamber, wrapt about the head with linen cloths, like another resurrectioned Lazarus, meagre in form, pale in face, and feeble from debility. *" By Charles Bew. London, 1824. 334 From himself I learned that he had long been afflicted with this disease, which had not only made inroads on his health, but also on his imagination, having been subject to torment during the day, and interrupted repose during the night, as he in his own words described in a most unaccount- able way, frequently stalling from sleep, with the sensation of loud smacks on his face, as if from sharp irons, sometimes feeling as if they were cold, and sometimes hot; always ap- pearing to have been inflicted by some one who had vanished on his waking. With difficulty repressing the smile, which already agitated my lip, at the tale of terror so gravely told by the truly grotesquely attired invalid, I begged him to* be seated, and after unloading his head of its encumbering coverings, I soon saw the stump of the second bicuspis, pressing on the exterior periosteum or covering membrane of the first molaris, or large grinding-tooth, which, having ex- cited inflammation, had become loosened in its tri-fanged sock- et, so as to occasion its descent to an insolated state of contact with teeth of the the lower jaw, in the grinding mechanism of mastication. The irritating pressure of the stump on the membrane of the molaris, (or perhaps when in full propor* tion before its fracture, which he said had been done by one of his kind friends, anxious to relieve him from pain,) had commenced the calamity which, with its attendant excruci- ations and the then state of excitement, admitted no hope of cure short of extraction. The tooth though formidable from size, was easily and safely removed, just as the medical at- tendant again entered the room, and relief of course afford- ed to a certain extent; but not completed till the expulsion of the stump some few days after, when every disagreeable sensation subsiding, health was established in the usual course, along with the conviction that two teeth, with much intermediate misery, owing to original bad management had 335 been lost, which might otherwise long have remained mem- bers of his masticating system. * A gentleman of spare habit and nervous temperament, holding a situation of trust and consequence in his present Majesty's Carlton House establishment, was long a victim to the distressing Tic Douloureux, originating in the pressure of the first and second bicuspides of the upper jaw; or what are called the two small grinding-teeth, during their uninter- rupted process of pressure on each other's sides, which ulti- mately consigned them to destruction. He told me his mis- ery was most extreme, and that one evening when worn down with the pain on one hand, and the various remedies recommended for his relief on the other, he had sought in repose temporary oblivion from the oppression of the com- plaint, he was on a sudden so attacked as to induce him to believe his life had been assailed by the stroke of an assas- sin. From the respite procured by repose, whether of short or long duration, he was however, soon disturbed, and his family alarmed by his piercing shriek, and demand for light. On his wife arriving at his bed-side with a candle, he eagerly inquired, who went down stairs? and then exclaimed, " some one has struck me on the face with an axe ;" at the same time fearfully, and instinctively carrying his hand to the supposed cut, and then to the candle, as seeking confirmation of what in the first moments of his waking agitation, he had verily believed to have happened. The period of these par- oxysms was previous to my appointment as dentist to. his majesty's household; but subsequent acquaintance with him having enabled me to trace the course, and the consequence of the severe complaint to which he had been subjected ; I could only comment on the peculiar position from whence * By Charles Bew. London, 1824. 336 he had been assailed with pain, upon the philosophic princi- ples of volcanic calculation, the force and data of whose de- structive fires, are only to be ascertained by the situation and extent of its extinguished craters; as by the portions of the teeth remaining in the immediate vicinity of the maxil- lary sinus, I was soon enabled to account for, and explain the extent of the malady, which had so long militated against his health and happiness. I will give a part of the following case:—* The lady'a reply was, " it may be possible, for I have been much sub- jected at times, to the pains you have described in the face, but the tic douloureux with which I suffered was an agitation and throbbing in the fingers, wrist, and arm :" finding my suspicions verified at every step of my patient's descriptive procedure, I begged, " if it lived in her memory," to state the particular progress of the attack, which was kindly thus described. " The approach was always intimated by a numbness, and tingling sensation down the inside of my arm, (describing with her finger the course of the supinator longus muscle,) wrist, and hand, with a violent agitation of my little finger." "And was this of any long duration V " Two or three minutes, and then the agitation of the finger ceased, and the sensations seem- ed to retrace their steps up the arm, in a regular reverse to their approach." " And thus, madam, happily ended your attack of tic douloureux ?" " O yes, certainly, as far as re- garded tic douloureux ! but I cannot say happily, for, most remarkable, the attack I have described, was ever the pre- cursor to a violent pain in the face !" at the same time placing her finger on her cheek, in the situation immediately occu- 2 By Charles Bew. London, 1824. 337 pied by the bicuspis in question, and the first molaris, or large grinding-tooth. I forbear to trouble the reader with any thing more on this subject. Facts enough have been adduced to remind us ever to attend to the teeth in painful affections of the face. SECTION IX. SYMPATHETIC HEAD-ACH, &C. Violent head-achs are occasionally to be excited by dis- eased teeth, so much so as to have been a subject of notice for a great length of time—of which I subjoin a few cases. The first three from the work of Jourdain. *In 1775, Madame de Maubreuil, living at Nantz, was af- flicted with a very severe head-ach, and consulted, on this occasion, her physician and surgeon, who ordered her sever- al remedies. This lady was bled and purged several times ; but as her malady was not, in the least diminished, the gen- tleman ordered her the bath, and the application of leeches to the head: she executed punctually their orders. All the remedies which were applied, did not ease her in the least. This lady had two teeth decayed, which, long since, had giv- en her pain, and hindered her from eating. This made her think that they might be the cause of all the pain she suffer- ed. As I had the honour to be particularly known to her, she was resolved to come to me, at Angers, where I lived then. Having come to me, I examined her mouth, and found 'Fauchard, pages, 413,414, 415,416, 417. 43 338 she had two very carious molar teeth, one on the right side of the lower jaw, and the other on the left side of the same jaw. I judged that these two teeth were the only cause of her head-ach. I was determined, at length, to extract them, which was no sooner done, than this lady found herself en- tirely free of a pain which had tormented her for the space of six months. This lady, whom I have seen often since I have been established at Paris, has assured me she suffers no more with the head-ach." "Madame, the Marquis of Jeans, living in Brittainy, was incommoded for a long time with a pain which occupied the whole head, consulted many regular physicians and surgeons who assured her that her head-ach was a rheumatism. Founded on this opinion, they had recourse to many reme- dies, from which she derived not the slightest ease. Her sorrowful situation made her resolve, four years ago, to visit the waters of Bourbon, which they ordered. In this design this lady came to Paris, where she consulted a celebrated physician, who gave her, at length, the same advice as the first, treating her malady as a rheumatism. The remedies he employed to cure her were useless. The lady always com- plained of the excessive pain she felt in the head and teeth. This physician conjectured at length, that the excessive pain in the head of which she complained, might be caused by the teeth; and upon this conjecture, he advised this lady to see a dentist. As I had the honour of being known to her for many years, I was called upon to see her. Having ex- amined her teeth, I found a large molar tooth on the left side of the lower jaw, and two teeth of the upper jaw of the right side very carious. The gums of these three teeth were swelled, and inflamed. After having sounded these teeth, I told this lady that the caries had arrived at a certain point, which rendered it impossible to save them, and I had not the least 339 doubt this caries was the sole cause of her head-ach: in fine, I thought she ought to have them extracted. She op- posed my advice ; but having observed it was in conformity to that of her physician, she permitted me, inconsequence, to draw two. The pain was not entirely taken away by their extraction. She called upon me five days after to take out the third : this was the last great molar tooth of the upper jaw, which I extracted for her. The pain immediately left her, and since that time this lady has never felt any pain in the head or teeth." Inveterate Head-ach cured by the extraction of several roots of carious teeth* A lady was affected continually with a very cruel pain, which occupied the left side of the head : the violence of the pain being worse principally in cold and wet weather. She had used, by the advice of physicians, many different remedies, internally as well as externally, but always without success. At the last, I was called to her. I examined with care all the causes of her malady. I was apprised by her, that four years before, she had been afflicted for the space of six months, with a very severe pain of the teeth on the left jaw; since then this pain was a little dissipated, but then there was another, remaining of the head of the same side. I conjectured from what was said that the actual head-ach was caused by the roots of spoiled teeth. After having ex- amined her jaw, I really found in the upper jaw, four corrod- ed teeth, wherein the roots were deeply buried. I advised her to have them extracted: she readily consented. Then I prescribed the most convenient remedies. I purged her as much as was necessary. The day following the pur- gation, cupping glasses were applied to the nape of the neck "Jourdain, Tome I, pages, 482, 483. 340 and shoulders; then I directed her an apozeme, which she took, for the space of four days, in the morning; and the fifth day, while she was still fasting, I extirpated these roots. The following day she took pills ; and for the space of some days, there was apphed warm to the painful part, twice a day, a fomentation of the flowers and leaves of bettony, the flowers of rosemary, of chamomile, melilot, of dried red roses, leaves of marjoram, of wormwood, aniseeds, the shav- ings of guaiacum that has been infused with heat in red wine. By these means the patient recovered her health. I did not calculate on the virtues of the ingredients that composed the fomentation, but I believe that the extraction of the teeth, a temperate regimen, some purgatives, and a blister might prove sufficient. Head-ach dependent on the Teeth/ " The late Madame the Princess of Condy, had confided to her physicians a person under her protection, to be cured of a head-ach she had for five years. She was bled twen- ty times, almost successively, both in the arm and foot. Af- ter that, having thought about bleeding her in the throat, the Princess begged M. Petit to do it. But as he had not seen the patient, he questioned her about her malady, and finding nothing which appeared to warrant so much bleeding, he examined her mouth, because the patient spoke of feeling a weight and stiffness of-the lower jaw. M. Petit found some irregularity in the arrangement of the teeth. He counted them, and found eighteen instead of sixteen. The second molar tooth on each side appeared to him to have generated * Jourdain, Tome I, page 483. 341 the others. He extracted these two, which cured this girl in twenty-four hours, of a malady that had continued for five years. Concluding Remarks upon the Sympathy of the General Sys- tem with Diseased Teeth, and the Agency of these in Pro- ducing General Disease. I have already protracted the consideration of this subject much beyond what I at first anticipated, and yet I do not find myself at the end of it. Much more may be said than what has been said upon it, and many more cases might be adduced. As it is my desire to render this work of the first practical utility, and to present to the medical reader all that I have seen in my own practice, or have read upon it in the works of others, which may be useful, I still beg his attention to several observations and cases more. Dr. Rush makes the following observations upon it :* " I have been made happy by discovering that I have only added to the observations of other physicians, in pointing out a con- nexion between the extraction of decayed and diseased teeth, and the cure of general diseases. Several cases of the efficiency of that remedy in relieving head-ach and ver- tigo, are mentioned by Dr. Darwin. Dr. Gater relates, that M. Petit, a celebrated French surgeon, had often cured in- termittent fevers, which had resisted the bark for months, and even years, by this prescription; and he quotes from his work two cases, the one of consumption, the other of ver- tigo, both of long continuance, which were suddenly cured * Koecker, pages 119, 120. 342 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, published in Paris, by Dr. Bluver and Dr. Delaroche, there is an account, by Dr. Sie- bold, 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, at that period, were always deficient in quantity. Upon inspecting the seats of those morbid af- fections, the doctor discovered several of the molares in both jaws to be decayed. He directed them to be drawn; in consequence of which, the woman was relieved of the month- ly disease in her mouth, and afterwards had a regular dis- charge of her catamenia. The dental nerves, as we have before said, are derived from the third branch of the fifth pair; and such is the inti- mate connexion of this pair directly, with many parts of the system, and indirectly, by means of the great pneumo gastric with the lungs, stomach, and several important organs, (as for instance, the uterus, from which cause the improper ex- traction of a pained tooth has produced immediate abortion,) and by means of the different ramifications of this pair, to the ear, tongue, the eye and its integuments, eye-lashes, to the in- teguments of the face, &c. &c. that we cannot for one instant wonder if diseased teeth, by means of these communications and connexions, should produce, under some states of the system, derangements and disease in every one of these organs. * Recherches sur differens points de Pbysiologie, de Pathologie, et de Therapeutique, pp. 353,354. 343 Dr. Darwin has made many useful and accurate observa- tions upon the effects of diseased teeth upon different parts of the system. Speaking of ear-ache, he says, " Ear-ache some- times may continue many days, without apparent inflamma- tion, and is then frequently removed by filling the ear with laudanum, or with ether, or even with warm oil, or warm water. This pain of the ear, like hemicrania, is frequently the consequence of association with a diseased tooth; in that case, the ether shonld be applied to the cheek over the sus- pected tooth, or a grain of opium and as much camphor mixed together, and applied to the suspected tooth."* Hemicrania Sympathetic, sympathetic pain of one side of the head, is often occasioned by a diseased state of the teeth. Dr. Darwin, speaking of this subject, says, "This disease is attended with a cold skin, and hence whatever may be the remote cause, the immediate one seems to be, a want of stimulus, either of heat or distension, or of some other unknown stimulus in the painful part; or in those with which it is associated. The membranes in their natural state are only irritable by disten- sion ; in their diseased state, they are sensible, like muscular fibres. Hence a diseased tooth may render the neighbouring membranes sensible, and is frequently the cause of this dis- ease."! I do not wish to be understood as entering into Dr. Dar- win's theoretical views, but only introduce the subject so far as to have the facts understood He continues, " Mrs.----, is frequently liable to hemicrania, with sickness, which is prob- ably owing to a diseased tooth; the paroxysm occurs irreg- ularly, but always after some previous fatigue, or other cause of debility. When it (the sympathetic head-ach) affects a small ** See Zoonomia, Vol. II. Classes 1, 2, 4,13. t See Zoonomia, Class IV, 2, 2, 8. 344 defined part on the parietal bone, or one side, it is generally termed clavus hystericus, and is always, I believe, owing to a diseased dens molaris. The tendons of the muscles, which serve the office of mastication, have been extended into pain at the same time that the membranous coverings of the roots have been compressed into pain, during the fjiting or mastication of hard bodies. Hence, when the membranes which cover the roots of the teeth become affected with pain, by a beginning decay, or perhaps, by the torpor or coldness of the dying part of the tooth, the tendons and membranous fascia of the muscles about the same side of the head, become affected with violent pain by their sensitive associations; and as soon as this associated pain takes place, the pain of the tooth entirely ceases. The dens sapientia, or last tooth of the upper jaw frequent- ly decays first, and gives hemicrania over on the same side. The first or second grinder in the upper jaw is liable to give violent pain about the middle of the parietal bone, or side of the head, on the same side, which is generally called clavus hystericus." He places hemicrania as a disease of associa- tion, and produced by diseased teeth in many cases. He con- tinues,* " The last tooth, or dens sapientia, of the upper jaw, most frequently decays first, and is liable to produce pain over the eye and temple of that side. The last tooth of the under jaw is also liable to produce a similar hemicrania, when it begins to decay. When a* tooth in the upper jaw is the cause of head-ach, a slighter pain is sometimes perceived on the cheek-bone. And when a tooth in the lower jaw is the canse of head-ach, a pain sometimes affects the muscles of the tendons of the neck, which are attached near the jaws. But the clavus hystericus, or pain about the middle * Zoonomia, Section 36-2-1. 345 of the parietal bone on one side of the head, I have seen produced by the second of the molares, or grinders of the un- der jaw ; of which I shall relate the following case : " Mrs.----, about 30 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 to occasion convulsions. Not being able to detect a decaying tooth, or a tender one, by examination with my eye, or by striking them with a tea-spoon, and fear- ing bad consequences from her tendency to convulsions, I advised her to extract 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 ca- thartic ; 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 medicine by ill advice, and the pain returned with greater violence in the same place; and before I could arrive, as she lived thirty miles from me, 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 after- wards, I was again called to her, on account of a pain as violent as before, exactly on the same part of the other par- ietal bone. On examining her 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 exertion it had caused. On this account I earnestly entreated her to allow the sound molaris of the same jaw opposite to the de- cayed one, to be extracted; which was forthwith done, and the pain of her head immediately ceased, to the astonishment of her attendants. 44 346 Here we have an undeniable case of hemicrania and palsy, produced by diseased teeth, after most violent and protracted suffering. I beg leave to continue a short extract more from Dr. Darwin on this subject. He says,* " Since the above was first published, I have seen two cases, which were very similar, and seem much to confirm the above theory of sym- pathetic hemicrania, being perhaps always owing to the sym- pathy of the membranes about the cranium, with those about diseased teeth. Lord M. and Mr. B. of Edingburgh, 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 inspectng their mouths, I found all the molares were now so decayed 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 of them a hemiplegia, from which they gradually recovered, as much as paralytic affections generally do recover. All the stumps of their teeth, which were useless, were directed to be extracted ; as the swallowing so much putrid matter from decaying bones, seemed to injure their digestion." Here are two more cases of palsy from diseased teeth. It may be asked, why have not other physicians than what I have men- tioned, made observations of this kind ? I believe the correct answer to this question would be, that the great body of physicians, have never paid any attention to the subject. From what cause arise the celebrity and fame of Rush, Hunter, Darwin, and many more I could mention ? It was because they noted with the utmost care, almost every fact connected with both disease and health, and possessed a nice tact in discerning the causes of both. * Zoonomia, Class iv. 2, 2, 8. 347 Dr. Darwin says more upon this subject than I have ex- tracted, as I do not wish to weary the reader, or to protract the subject. I trust I have said enough to induce every medical man to consider the diseases of the teeth as at least worthy of attention; if he still doubts it, let him look at a correct delineation of the ramifications of the fifth pair of nerves, and consider that the dental nerves have at least a nervous association, by being a part of this pair, with almost all the principal organs of the animal system, and conse- quently, their diseases. I would not dwell upon the teeth so long, or with so much earnestness, as to lead any person to suppose, that I consider them the most important organs of the system; still I would be understood as viewing them, as having been form- ed by the wisdom of a Creator, whose hand never swerves from perfection ; and had they not have been necessary to the health, beauty or perfection of the animal, they would never have been formed: and if an all-wise Providence, has formed our systems so, that the teeth under some circum- stances may be dispensed with; or, if he has given us that superior sagacity, by which we are all enabled when our teeth are lost to prepare our food, so as to compensate in some degree for the power of mastication, still this function can be viewed in no other light than of great importance. Man obviates in some degree the consequence of the loss of his teeth, but in most animals, their loss or inability to use them, is followed by death. Nor are we from the same causes to lightly esteem the dis- eases of the teeth, and because we do no every day notice probably injurious or fatal consequences resulting from them, to conclude that there is never any danger. A masked bat- tery is to be dreaded. An insidious foe may plunge a dag- 348 ger in our bosoms when least we expect it. The teeth form a link in a series of organs, whose united healthy functions are necessary to the health of the animal ;—a link which, if struck, the whole chain vibrates—a link which, if weaken- ed, the strength of the whole series is impaired. 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 stam- ina so delicate, as to be affected by the slightest impres- sion. Disease in its steps at first is, at it were, soft and hesi- tating, weak in its powers, and slow in its progress. (Nunc, nunc, monstrum horrendum. Meda advertite.) But every instance of indulgence and each succeeding advantage gain- ed, confirms its steps, increases its powers, and hastens its progress, and what but a moment ago seemed a thing too in- significant to mention, now rises a monster that derides human effort, and whose sting is the arrow of death. Almost unappreciable are the beginnings of many fatal diseases ; and could the grave reveal its secrets, I have not a doubt, when I consider the number of diseases produced by diseased teeth, but 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 him, 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 ; and know for your satisfaction and pleasure, that you will always administer to the well-being and best interests of your patients, and may perhaps occasionally preserve a valuable life. The Indian lightly esteems the rills he bestrides upon the mountains of the cloud-capt Cordilleras ; how little does he 349 Imow that from these small beginnings, there swells the mighty Amazon. I hardly need remind the man of science, from what slight causes in the natural, moral, and physical world, arise those tremendous agencies, which prove at once the fulcrum and the lever of Achimedes. * * PART II. CHAPTER I. OPERATIVE DENTAL SURGERY. It is the object of the writer, in this part of our work, to present to the reader a faithful, and, as far as he Can, in a correct and impartial manner, all that will be useful to him, that he has been able to collect upon this subject, either from his own experience and practice, or from his knowledge of the practice and writings of others ; and he flatters himself that he shall be able to communicate so much, as that the medical man and the student of this art and science, will be fully enabled to understand in what consist the several ope- rations performed by the surgeon-dentist, and how to per- form them, either for the cure of diseased teeth, or for pre- serving the health and beauty of those which are not dis- eased. Also that they may know how to supply by art those which may be lost, and know how to direct the growth and position of the permanent teeth in such a manner, as to insure to their patients, perfect regularity, health and beauty of these organs. He cannot promise his reader any thing more than general principles illustrated by cases, for after all that can be said, still there is such a variety in different cases, that much must necessarily remain to be learned by 352 the experience of the practitioner, and every case will call for the exertion of a correct judgment, to direct the proper course of treatment. Dental Surgery differs in some re- spects from every other kind of surgery. In the first plaee, our operations are mostly confined to organs that are liable to a loss of their substance, but in no instance, except perhaps in the very slightest degree, are they able to repair this loss; unlike the condition of many organs of the human body, which when by disease have lost some of their substance, are able by their own organic powers to restore it. In the second place, such is the small vitality of the teeth, that when a part of their substance is lost, they will allow it to be supplied by the presence of some foreign body, which I be- lieve is not the case with any other bone of the body. In another respect the dental organs are distinct, they are du- plicate, having one set which are deciduous, and when lost, are succeeded by another set. In this respect they differ from all the other organs of* the animal system. It is on these principles, and one or two more I might mention, that dental operations are founded. Dental operations as far as regards the removal of useless, pernicious, or diseased teeth or stumps, and the preservation of the health of those which are or might be useful, may be reduced to the following: First, Extraction. Second, Removal of foreign matter from the teeth. Third, Removal of carious portions from the teeth. Fourth, Separation of crowded teeth. Fifth, Supplying the loss of substance in a tooth, by a me- tallic substance; and, Sixth, Excision of the crowns of the teeth, when we wish to preserve their stumps. Each of these will receive a separate consideration. 353 SECTION I. EXTRACTION OF THE TEETH. This operation naturally divides itself into first, extraction of the infant teeth, and second, extraction of the adult teeth. Extraction of the Infant Teeth. The infant teeth are liable to be affected with caries, and in the progress of this disease to have their nerves exposed, and consequently, at times, are subject to tooth-ache, in the same manner as adults. It is recommended by almost every writer upon this subject, to have them extracted. This is a correct general rule, as regards carious deciduous teeth, when this has progressed to any considerable extent, or when they have become inflamed, so as to produce tooth- ache. A question arises, at what period ought deciduous teeth to be extracted '( should we wait for them to become loose, or not ? I consider these to be practical questions of great importance, because the judicious extraction of the de- ciduous teeth has a great influence in directing the regular growth of the permanent set. Whilst I consider, as a gen- eral rule, that the deciduous teeth, if considerably decayed, ought to be extracted; yet, if not diseased, or the gums, they should never be extracted, until they become loose, or some appearances or symptoms are present which denote the coming of the permanent teeih, I think this ought to be- come an axiom in dental suv^ery. Perhaps an exception may be found in some cases of diseased gums, but then these may become loose, and if they are firm, their extraction, per- 45 354 haps, will rarely be the best mode to adopt in curing the gums. Peculiar circumstances may form other cases of exceptions to this rule: the exception proves the rule. Some- times these teeth become very dirty, and considerably cov- ered with tartar and other foreign and injurious matter; in this case, parents often ask the advice of the dentist, and, in many instances, their extraction is recommended, even if the teeth themselves are sound and firm. In these cases, I recommend to have the teeth carefully cleaned by the den- tist, and direct a brush and some suitable tooth-powder to be used, so as to insure cleanliness of the child's teeth. The following case I will mention to illustrate the position. A lady, in April 1827, sent her little daughter, aged three years and six months, to me, that I might extract her upper incisor teeth, which, the lady supposed, from their being very dark coloured and almost encrusted with tartar, were decay- ed. Upon examining them I found they were sound, and firm in their sockets. Instead of extracting them, I removed the tartar, and rendered her teeth very white and clean, and gave her nurse a soft brush and a box of tooth-powder, composed of myrrh, peruvian bark, &c, with directions to keep the child's teeth perfectly clean with the use of the brush and tooth-powder, and sent her home with her teeth in perfect order, much to the satisfaction of the mother. The child's gums, which were considerably inflamed, soon became very healthy, and she will, no doubt, have the use of her teeth two or three years. Injurious consequences arising from the Premature Extrac- tion of the Deciduous Teeth. In the first place, Jhe pain which attends the extraction of the infant teeth, when they are sound and firm in their sock- 355 ets, is much greater than when they are allowed to remain until they have become spontaneously loose, or until the new teeth begin to appear, and the violence done to the surrounding parts is quadrupled. Nature by a beautiful pro- cess, in almost every instance, loosens the deciduous teeth, and seems to provide with great care for their removal, so as not to produce any injury to the surrounding parts. We generally find, when left to nature, and probably always, when a new tooth is coming in place of the deciduous one, that the fangs of the latter are taken away by a process of absorption, and the gum, which embraced the neck of the tooth, is also absorbed away, so that the tooth drops out; and often, from the absorption of the fangs, the dentist, upon extracting the tooth, thinks he has broken it; and it is only when they have become somewhat loose, or when this pro- cess is so tardy as not to allow the regular descent or ascent „ of the permanent teeth, and the other exceptions I have be- fore mentioned, that we are to extract the deciduous teeth. In some cases, some of the permanent teeth are not formed; and in these cases, the deciduous teeth, which otherwise would have become loose, remain firm, and are of use to the individual for many years. It is but a few days since a lady, ao-ed about twenty-eight, called on me to have some opera- tions performed upon her teeth, and I found that she had never shed her deciduous molar teeth, nor had any of the bicuspids, which usually supply the place of the former, ap- peared. I but lately saw another case, when the individual, a gentleman, aged about twenty-one years, had had the in- fant molar teeth of the lower jaw extracted, but which had never been succeeded by any bicuspid teeth. In these cases we can see how peculiarly correct and proper it is for us to adopt a general rule not to extract these, unless they are dis- eased, or seem to divert the course, or impede the progress 356 of the permanent teeth, or are loose: for when these last are wanting, the deciduous teeth may remain of use for some length of time. The permanent incisors do not, in some cases, appear. I lately saw a case, when one of the per- manent upper lateral incisores had never appeared. Mr. Fox mentions having seen several instances of deficiencies of the permanent teeth. In one case, a lady, who never had but four permanent teeth.* In all these cases we can easily con- ceive how improper it would have been to have extracted the deciduous teeth, which, by being left, would compensate, in some degree, for the deficiency of the permanent teeth. Another injurious consequence resulting from a premature extraction of the deciduous teeth is, the injury which is often done to the permanent teeth. It must be always borne in mind that the permanent teeth are formed upon, or by pulps produced from the deciduous teeth ; and consequently, if ear- ly violence is done to these last, the former are liable to be greatly injured by it: and this is the fact, in many cases. I lately witnessed an instance when a child had one of its mo- lar teeth extracted, and the crown of the permanent tooth beneath it very soon came away. We noticed that the en- amel of the tooth is formed upon a membrane which invests a pulp, and the pulp becomes the form of the bone of the tooth ; and the form of the membrane, consequently, deter- mines the form of the enamel. A knowledge of this ana- tomical and physiological fact enables us to explain the rea- son of a peculiar appearance of the teeth, or some of them, in a few cases, which is noticed by some writers, f They look as if a small round file had been passed across the en- * Fox, Part I, page 41. fHunter on the teeth, Part II, page 155. 357 amel so as to leave a round furrow upon the surface of the tooth: at times we notice several of these furrows on the teeth—sometimes one, two, or three teeth of a set will have this appearance ; in other cases, the whole set with the ex- ception of the dentes sapientia, or wisdom teeth, which I have never seen thus affected ; still, I will not say they are never so situated. Mr. Hunter says it is a peculiar kind of decay, but not caused by any external agency, or, to use his own words, " not to depend on accident, way of life, consti- tution, or any particular management of the teeth," but that it is an original disease of the tooth. Others, I believe, have imputed it to an improper or excessive use of brushes, or tooth-powders, &c. &c; but I think the true cause of this situation of the tooth is owing to some disturbance given to the membrane on which the enamel is deposited. If the membrane is ruffled the enamel will have this appearance. And this is further corroborated from this, that these furrows run either across, or length-ways, or diagonally on the tooth, not confined to any particular direction, although across is the usual direction which these furrows have. The enamel will generally be found as perfectly polished on this irregular surface as on perfectly formed teeth, which would not be the case if it proceeded from caries or the brush. I have seen several cases of it in persons who never used the brush to any extent in their lives. In one case of this kind, Mrs. W. of Frankfort, I saw a whole set of teeth, except the dentes sapientia, thus affected : every tooth appeared other- wise perfectly sound. This lady had never used a tooth- brush more, she assured me, than a dozen times in her life : she could give no account of the extraction of her infant teeth. The following cases seemed to me to amount to a demonstration that this peculiar appearance of the teeth is ow ing to some disturbance of the membrane upon which 358 the enamel is deposited; and the enamel being deposit- ed on the ruffled membrane, had, necessarily, assumed the same shape. The cases occurred in the family of Mr. M—, a respectable mechanic from London. He extracted the teeth of his two oldest children (sons) when they were quite young, and the permanent teeth of both had the appearance I have mentioned. This induced him, at the suggestion of the mother, in the two succeeding children which he had, to leave their teeth to nature ; consequently, he did not extract them until quite loose, and the result was, that the perma- nent teeth of the two last children were perfectly smooth and beautiful. This narration I had from several members of the family, who perfectly concurred in their statements of it. The deciduous teeth seem to serve, in some degree, as a guide to the growth of the permanent set, as these last are apt to be irregular if the first are extracted too soon ; conse- quently, they should not be extracted, unless under the limi- tations before mentioned. It is of the greatest consequence that the person having the care of children should know pre- cisely the order in which the permanent teeth appear, and what deciduous teeth should be removed to give place to the second set. Mr. Fox, speaking upon this subject says, " eve- ry thing depends upon a correct knowledge of the time when a tooth requires to be extracted, and also of the par- ticular tooth; for often more injury is occasioned by the re- moval of a tooth too early, than if it be left a little too long: because a new tooth, which has too much room long before it is required, will sometimes take a direction more difficult to alter, than a slight irregularity occasioned by an obstruc- tion of short duration. If an improper tooth be extracted irreparable mischief will ensue ; as in the case when young permanent teeth have been removed instead of the obstruct- ing temporary ones, which I have several times known to 359 have been done." When the deciduous teeth have been re- moved by accident, or art, too soon, the permanent teeth are apt, in some cases, to be very late in making their appear- ance. I know a young lady, who, by accident, when she was three years old, lost her upper incisor teeth, and the new ones did not appear until her eleventh year. Of this I have noticed several cases. Of the Manner in which the Deciduous Teeth should be extracted. At first sight, one would suppose that no direction upon this part of the subject need be given ; but as from caries of the deciduous teeth, proceeding so far as to expose their nerves, so as at times to produce tooth-ache, we are obliged to extract these teeth while yet quite firm, I deem it proper to give a few hints upon this subject. The instruments prop- er to be used, in almost every case, are the common extract- ing forceps; for these teeth extract much easier than the per- manent ones, because the infant jaw is not so hard and per- fectly ossified as the adult. There is but one rule in regard to the manner of extracting these teeth. They should be extracted with the utmost care: they should rather be solici- ted out, if I may use such an expression, than dragged out with that violence and butchery which is sometimes practised. Mrs. H----, a few months ago, called on me with her daugh- ter, a child about eleven years old, and wished me to clean and perform some operations upon the daughter's teeth. One she wrished extracted; and mentioned to me, that when her daughter was about six years old, she procured a dentist to extract one of her molar teeth, which he did in the most barbarous manner, mangling the gum and breaking the jaw, in the most shocking manner. A violent inflammation en- 360 sued, suppuration took place, a fistulous opening was formed passing outside the cheek, and several pieces of bone were discharged through the external opening, and the child did not recover from this state of her jaw and face, until about nine months had elapsed. An ill looking scar was left ever after upon the side of her lower jaw. If great care in ex- tracting these teeth is not used by the dentist the most per- nicious consequences are the result. The gum is apt to be torn, the jaw shattered in the most dangerous manner, so as often to destroy the rudiments of the young permanent teeth, and to lead to violent inflammation and suppuration. The tooth should be first loosened by carrying it to one side of its socket with some force, so as to break the attachments of the lining membrane, and then by a moderate effort, it is easily lifted out of the socket. If the tooth itself is not loose, the gum in general should be previously separated in the most perfect manner from the tooth by the use of a gum- lancet. If the tooth is loose, the gum need not be sepa- rated. Extraction of the Adult Teeth. This is an operation of very frequent occurrence as we seldom see a person arrived at twenty years of age, who has not been obliged to submit to it at one time or another. It is very important, that its principles be well understood. This operation is performed by almost all country physicians, and many in the cities. It is to be regretted that many per- sons attempt the performance of it, who have not suitable instruments, and have no correct idea of the manner in which it ought to be performed, and consequently are guilty of the greatest mal-practice by their injudicious attempts to extract the teeth. It is very important that the student of 361 this art should have correct views of the subject, before he attempts the operation; for after having imbibed an errone- ous opinion respecting it, he is apt to carry this error into all his future practice. Indications for. Extracting tltese Teeth. It is all-important that the physician or surgeon-dentist should know when he ought, and when he ought not to ex- tract a tooth, for it is often the case that much more skill is shown in curing and preserving a valuable tooth than in extracting it. No practice can be more reprobated than that of the indiscriminate extraction of every tooth, which the physician or surgeon-dentist may be asked to extract; and yet it is a notorious fact, that there are many persons, posses- sing such an insatiable thirst for gain, as to extract every tooth that they might be asked to do, whether the teeth are sound or not, and whether the individuals asking for the operation be sane or not. The following are the usual indications in correct dental surgery, for the extraction of the adult teeth: First, It is proper, and often very necessary, to extract adult teeth, to remove or prevent irregularity, inconvenience, or deformity. If the teeth, especially at the time when they are first appearing, appear to be too much crowded, it is highly necessary to extract some of them ; in this case, the first molar teeth on each side of the jaw, by being extracted, will often give room for all of the other teeth of the jaw to become regular; and if we extract for this purpose one of them, we must extract the other, for if we do not, all the teeth are apt to incline to the side which has lost one of these teeth. This is an important rule, and ought always to be re- membered when operating upon either jaw. The front-teeth 46 362 not only become regular by this means, but the dentes sapi- entia and other molar teeth, which succeed, are apt to be much more perfect and large. In some cases, the canine teeth, or some of the other teeth, protrude either outwards or inwards; and in this case, the deformity or inconve- nience is such, as that we are obliged, in some cases, though not in all, to extract the irregular teeth. Supernumerary teeth generally occasion deformity or inconvenience, and ought, if they do so, to be extracted. Secondly, Those molar teeth which have no opposing teeth on the opposite jaw, and are in a considerable state of decay, or are loose, may with propriety be extracted ; and if so far decayed as to be unable to support a plug in the decayed part, they should always be extracted. Thirdly, When the nerve of an adult molar or bicuspid tooth, wrhich otherwise ought to be preserved, is in a state of inflammation, and all our efforts have failed to relieve the pain, it should be extracted. Fourthly, Teeth which are the cause of gum-boils whether externally decayed or not, should be extracted. Fifthly, Teeth which are decayed, and yet could be pre- served so as to be useful, but are the suspected causes of gen- eral nervous affections, &c. as mentioned when speaking upon that subject, should be extracted. The front teeth, namely, the canine and incisor teeth, if regular, and are not the cause of gum-boils and nervous af- fections, &c. />//, rby l//f //u//r/t>fts /)r////s/'.___ 427 SECTION VIII. OF THE MANNER OF PRESERVING THE HEALTH AND BEAUTY OF THE TEETH. Having now spoken of the several operations for the cure of diseased teeth, the removal of useless and pernicious ones, and for the prevention and obviation of irregularity in them, I now deem it profitable to suggest the proper course to be pursued by the patient, in order to preserve the health and beauty of the teeth, if either in health by nature, or render- ed so by judicious dental operations. It is an impression generally abroad in the minds of medical men and philoso- phers, that the decay and loss of the teeth, is a necessary conse- quence of advanced years, but I humbly conceive that no mistake is greater. The universality of the fact is not a positive proof, that it is a necessary consequence of age, for there are numerous instances of persons who have not at- tained the middle periods of life, and yet have lost all their teeth. It only proves this, that those destructive agents which we have before mentioned, as being the exciting causes of disease in the teeth, gums and alveoli, are impla- cable and persevering foes to the health of these parts, which if not as perseveringly opposed, baffled or removed, will pursue the health and vitality of the teeth, until they have eradicated these noble, useful, and beautiful organs from the mouth. Had the all-wise Author of Nature intended that the teeth of man should be lost in his declining years, and this be a necessary consequence of age, it would be always the case, and an old man with teeth would be a lusus na- tura. But this is not the case, a vast many aged persons go down to the grave, possessing sound and beautiful teeth. It 428 should be always remembered that the teeth fail only in the same ratio as the other organs of the system, and that their local diseases are not the natural consequence of age, but of other causes, and if prevented and perse veringly obviated, that it is in the power of every individual, by an early, judicious, and per- severing attention to his teeth, to preserve them to an advan- ced age, and that their powers will only decline with the de- cline of all the system. The rules for this purpose are few and simple. If irregularity or disease is actually present in the teeth or their appendages, or if foreign matter is lodged upon them which cannot be moved by the use of the brush or dentifrices, then the assistance of the judicious dentist will be required to perform such operations as will remedy and cure all disease or cause of disease in them ; after which the patient may, by the most persevering attention to clean- liness, preserve the health of his teeth, and gums, &c. In order to preserve the health of sound teeth, they should be kept perfectly clean, which is readily effected by cleaning them at least once or more a day with one or more tooth-brushes, so made as to enable the person to clean them on the inside and out, so as to remove all the thickened mucus from them and the gums and from between the teeth. If the brush alone will not do this, he may use some suitable dentifrice, as for example, charcoal and peruvian bark, or some of the bolar earths mixed with a little prepared chalk, or some of the several preparations winch will be found in the pharma- ceutical part of this work, adapting the properties of the powder to the state of his teeth and gums. If the latter are tender, he should use those which have an astringent in their composition. If the dark coloured tartar and greenish mucus are apt to collect on the teeth, let the tooth-powder have more mechanical properties, as for example, the union of prepared chalk, and some of the barks, &c. Some of 429 these he can find in the pharmaceutical part. If the mouth is in rather an unhealthy state, and ready to be loaded with mucus, or the patient's breath is offensive, use some of the alkaline mixtures, or a very weak solution of the argentum nitratum, &c. We should caution the patient never to use any of the acids to remove the tartar, &c. from his teeth, as this practice will most assuredly destroy the enamel of the teeth. I would not recommend using the acids in any state of dilution, or form of exhibition. Nor should he use any me- talic tooth-picks. The best of these are formed from the common goose quill, horn, or turtle shell, ivory, &c. Nor should he be in the habit of scraping his teeth with rough or sharp metallic instruments. And, in fine, he should never use any thing which will, either chemically or mechanically, injure or remove the enamel or substance of the teeth. He should keep the teeth clean, but not injure their substance. In using the brush, he should carry it across the surface of the teeth, and perpendicularly up and down, lengthways of the teeth, so as to remove all mucus from between the gums and teeth ; and he may have such brushes as will enable him to clean his teeth on the inside, and between them. The brush used for cleaning on the inside may be made much harder than that used to clean the outside of the teeth, as the gums on the inside, from the constant action of the tongue upon them, are rendered much harder than those on the outside. In proof of what cleanliness will do in preserving the health and beauty of the teeth, we are only to remark the difference in the different parts of the teeth, in their disposi- tion to decay. The teeth on the outside, between them, and in the pits of the grinding surfaces, from the disposition, in most cases, of the vitiated saliva, and other matters to be retained and to rest long in contact with these parts, decay here, in almost 430 every case, first begins, whilst on the inside of the teeth which is kept clean, or the saliva constantly changed by the action of the tongue, they rarely commence a decay, if regular, so that the tongue constantly acts upon them. Dur- ing a period of sickness, or the exhibition of medicine, espe- cially in inflammatory diseases, these directions become of momentary consequence. No portion of medicine of any consequence should pass through the mouth without after- wards rinsing it with warm water, or cold, as the case may be. The brush should be freely used, so as to remove all the clammy mucus and saliva, which is generally vitiated by disease, or the exhibition of medicine, especially mercurials. It is often proper and necessary to rinse the mouth very fre- quently, and to use the brush, at least, twice a day. In in- flammatory diseases the teeth suffer as much as the other organs, in general, and as the vital powers of the crowns and bodies of the teeth are, perhaps, less than any other organs, consequently they must suffer greatly in disease. It is here that the kind and attentive physician will prove himself truly so by strictly noticing his patient's teeth, and enforcing to- wards them the strictest cleanliness. I once knew a beauti- ful little girl, who, when sick of a typhoid fever and comatose for several days, had a large portion of calomel mixed up with molasses introduced into her mouth as she lay, nearly, or quite insensible, upon her side, in bed, and such was the abominable and unpardonable stupidity and negligence of the physician and nurses, that instead of seeing that the calomel was swallowed, and her mouth rinsed clean with water, they entirely neglected to notice her mouth. The consequence, in this case, was, that the calomel was not swallowed, but passed with the molasses in which it was mixed down upon the inside of the cheek of the side upon which she rested. The calomel lay upon the cheek, teeth, and gums of that side, • pages 430-434 and Plate IV missing 135 these united properties in the degree in which they are pos- sessed by the human teeth. If sound good teeth, they are per- fectly congenial to the remaining teeth and to the gums; thcy rest upon the latter without exciting any irritation in them, or causing them to be absorbed away. Their colour and form arc nature itself; and if the mouth is in order, if kept clean, they retain their colour and form unchanged, either by absor- bing the saliva of the mouth, or by decay, for many ye<.irs. There is a considerable difference in the quality of the nat- ural teeth which the dentist is able to procure ; consequently there will be a difference in the length of time which, they last in the mouth, depending on the quality of the, tooth, and the health of the mouth. I have known artificial natu- ral teeth, which had been worn in a tolerably healthy feiouth for eighteen years, with but a slight change of colour, and which from perfect correspondence with the other teeth, would elude the closest scrutiny of the dentist himself in' de- tecting it. No other substance with which we are at pres- ent acquainted, possesses these united properties in the same degree, and as far as I have been able to learn, the natural artificial teeth at present are preferred to any others, as a \ general principle, both in Eur'ope and this country. But as we are not able, in all cases, to procure natural teeth, and as there are persons who are not able to pay the high price for them, which their scarcity and value demand, other sub- stances are used, some of which approximate in value con- siderably to the natural teeth. The second material we propose to notice is, The Animal Teeth. I wish mv reader will bear in mind those united proper- ties which I have before mentioned as being desirauie. and in 430 part, indispensable to the formation of proper artificial teeth, which were first a congeniality between the living teeth, the gums, and the artificial teeth, so as that the latter shall not injure the two former. In the second place, there should be an exact similarity, as far as may be, in colour and form; and third, that the substance should retain these properties; and fourth, they should not be liable to take up the saliva, and thereby become offensive to the patient. These properties are possessed, to a very eminent degree, by the teeth of old neat cattle, &c. They are very congenial to the living teeth and gums. They can be rendered of a perfectly natural shape. They retain their form and colour unchanged for a great many years in a healthy mouth. They do not absorb the liquors of the mouth but in the slightest degree. There is one point of difference btween them and the natural teeth, which, if obvi- ated; they would be nearly equal to the latter. Their en- amel is very beautiful, and has an animated appearance, which is found in no other substance, except the natural teeth. The point of difference from the latter is, that their enamel is generally of a shade lighter in colour in most cases, and they are not so strong. As they are, they form a very valuable substitute for natural teeth ; when properly prepared and inserted, as will be hereafter directed, and next after the natural, perhaps unite as many advantages and properties, especially for single teeth, which we have before mentioned, as any substance with which we are at present acquainted. The third material for artificial teeth which I propose to mention, is the ivory from the tooth of the Hippopotamus, (sea horse) and also from the Vacca Manina, (sea cow.) This kind of ivory is much more expensive than animal teeth. It can be cut and worked into very elegant artificial teeth; but they are very deficient in those properties which we have 437 mentioned as desirable, and to a degree necessary, for artifi- cial teeth. In the first place, their substance is soft, much more than the human teeth, or animal teeth. They have not the peculiar enamel which is possessed by the two latter. Although their colour is, at first, nearly like the natural teeth, it is very soon lost. They at first become yellow, then of a dark dingy colour: they have nothing like animation in their appearance. Besides losing their colour, in some cases, I have seen them decayed. They are apt to contract, a most offensive, filthy smell. This last is an objection which, if there was no other, is sufficiently weighty to banish this sub- stance forever from the list of materials used for artificial teeth. To those who have never taken notjce of this sub- ject, it would be astonishing to observe how even two, three, or four of these teeth do pollute the mouth and breath of the person wearing them, even when they are kept as clean as circumstances will allow; and when persons are not cleanly with them, they become insufferably offensive, in most cases. Individual exceptions are found, but rarely, to these obser- vations. So much do these facts weigh with me that I never use the sea horse ivory for any purpose about the mouth. And very frequently, I take out these teeth and replace them with natural or animal teeth, and to the great satisfaction of my patients. I need not mention the injurious consequences resulting from the use of such teeth, for every injury result- ing from a vitiated state of the saliva is produced by these. They vitiate the former to a great degree. I could mention numerous instances of the kind, but do not, in the least, think it necessary. If any one doubts it, I would refer them to any person who wears these teeth, and he will find my ob- servations verified in ninety cases out of a hundred. I will not deny if the sea horse ivory is good, and principally the 438 enamel, and the individual particularly cleanly, they may be preserved in a good state for some time. Transplanting of the teeth. The fourth mode of replacing the teeth which I think of mentioning is, by extracting a sound, healthy tooth from the jaw of one person and transplanting it to that of another; at the same time we are to extract the diseased tooth or stump which we wish to replace, and into its socket pass the warm fang of the new and living tooth. In some cases, a dead tooth was put in the socket and allowed to remain, and, as Mr. Hunter asserts, in a great many cases, he had seen these grow.- When a living tooth is thus transplanted, in many cases', it will grow sound and be firm, and continue so for ma- ny years ; in others, there will be no union at all. I have only introduced this subject in order to inform the reader that such a case has occurred, and such a mode of restoring lost teeth has been practiced, but not with a view of ever recom- mending it. This practice was a favourite one with Mr. John Hunter, and had been suggested and practiced a great many years before.* That teeth may be transplanted and grow firm in their new situations, there is not a doubt, as it has been often done. But such are the dangerous conse- quences resulting from this practice, that it is now almost wholly abandoned; and, as Mr. Fox observes, it involves a moral principle, for it seems contrary to the laws of every just principle, to mutilate one person to perfect another. But this is not all; the most dangerous diseases are liable to be propagated along with the new tooth, and, from this rea- ' See Fauchard, vol. I, page 383. 439 son, the practice has fallen into disuse, almost entirely, and vers justly so. Syphilitic, and other most dangerous diseases have been propagated this way, even when the individuals from whom the scion tooth had been extracted wej-e in appa- rently perfect health. I will give one case of this kind, to show the reader what consequences muy arise from this cause, believing that, in this country, this operation will rare- ly, if ever, be performed. This case was dn.wn up by Dr. Watson, and inserted in the Medical Transactions, V ol. Hi. Art. XX. ; Case.* "An incisor tooth of the upper jaw, from an unknown cause becoming carious, in a young unmarried lady about 1 wenty-one years of age, it was extracted, and its place very dexterously supplied by a like tooth from another young wo- man, who, upon examination for the purpose, appeared to be in good health. The scion very rapidly took firm hold, and soon bid fair to be of great service and ornament. In about a month, however, the mouth became painful; the gums inflamed, discoloured and ulcerated. The ulceration spread very fast, the gums of the upper jaw were corroded, and the alveoli left bare. -Before the end of another nioith the ulceration stretched outwardly under the upper lip and nose, and inwardly to the cheeks and thre.t, which were corroded by large, deep, and fetid ulcers. The alveoli s">>n became carious ; several, of the teeth gradually dropped "it, and, at length, the transplanted tooth, which had hiiherto re- mained firm in it.s place. About this time, blotches appeared in "As quoted by J. M. Good, Study of Sh-0.. vol. I. page 44. 440 the face, neck, and various parts of the body; several of which became painful and extensive ulcers ; a considerable degree of fever, apparently hectic, was excited; a copious and fetid discharge flowed from the mouth and throat, which impeded sleep, and the soreness of the fauces prevented a sufficiency of nourishment from being swallowed. An antisceptic course of bark and other tonics were first tried and persevered in, till found to be of no service whatever, and calomel pills, in alterative proportion were then had recourse to in their stead. This plan was found to soften every symptom, and totally to eradicate many; but the bowels were soon affected with severe pain and purging, and the calomel was exchanged for strong mercurial ointment, which, from the present debil- ity of the patient soon produced a like effect, and an effect that could not be corrected by opium. The venomous taint or putrescent tendency, though occasionally driven back, as often rallied, and at length prevailed; and the patient fell a victim to it, in the greatest distress and misery. The person from whom the tooth had been taken, had, in the mean time, continued in perfect health; and upon a minute inspection, as well of the sexual organs as of the mouth, evinced not the slightest syphilitic affection." Many similar cases could be produced, but enough in this one case is told to prove that the performance of this operation is Hlbst fearfully pregnant with bad and fatal consequences. This mode of replacing lost teeth is one which cannot be too much deprecated nor too pertinaciously avoided. It is a truth that the blood of one person, in apparent health, will prove a poison to another; as I have witnessed in cases when a physician has suffered his lancet to become bloody, and, without cleaning it, to bleed another person. I have known two cases of this kind, when the persons barely escaped with their lives ; and how much more, when a warm, living tooth from one person's jaw has 441 been passed in the socket in the jaw of another. I have said enough upon this subject; the practice has fallen into just dis- repute, and probably will never again be revived. Our fifth material for replacing the teeth, or for making ar- tificial ones is, The Porcelain Teeth. In this place, I only wish to discuss the merits of these teeth, and take a short view of their history, whilst a de- tailed method of making them will be found in another place. It is to the ingenuity of the French dentists that we are in- debted for the first intimation of the propriety of using the same substances for making artificial teeth, as are used in the manufacture of porcelain. According to Mr. Audi- bran, who has probably written the best work now extant upon this subject,* the manufacture of these teeth was sug- gested, if not practised by Mr. Fauchard, as early as the year 1728, and it is probable, says Mr. Audibran, that the first suggestion, or at least that in this respect he had profit- ed by the experience of the celebrated Reaumer, who con- tributed so powerfully to the establishment of the royal man- ufactory of porcelain at Sevres, f The suggestions of Fau- chard do not appear to have been much noticed for many years, or were entirely forgotten. An apothecary of St. Germain, says Mr. Audibran, by the name of Duchateau, was the first in modern times who made porcelain teeth. * See Trait6, Historique et pratique sur les Dents artificielles incorrupti- bles, contenant les pror6des de fabrication et d'application, par Joseph Au- dibran, Chirurgien Dentiste, brevite du Ro", Paris 1821. t See Le Chirurgien Dentiste, Tom. II. page 283, et suiv, Chap. XIV. par Fauchard. 5fi 442 Duchateau communicated his discovery to the Academy of Surgery, in the year 1776. Duchateau and his successors kept a knowledge of the mode of fabrication a secret. M. Dubois Chement carried the art to England. The mode of their fabrication was finally made public by M. Dubois Foucou, who contributed powerfully to the propagation of this new mode of making artificial teeth. M. Fonzi made some very handsome improvements upon these teeth, as they had been previously made by M.M. Duchateau, Dubois Chement, and Dubois Foucou, for which the Atheneum of Arts, in Paris, after a strict examination of them, decreed him a medal and crown ; according to the terms of the re- port of a commission appointed for the purpose of examining these teeth, and which was the maximum of their recompen- ses. This was done, March 14, 1808.—(See Audibran, page 47.) M. Fonzi, encouraged by the favourable report of the Athe- neum of Arts, submitted his invention, or rather mode of making these teeth, to the Academy of Medicine, who after after an examination of them, confirmed the report of the Atheneum of Arts. The Society of Medicine of Paris, in the year 1812, decreed a medal to any one who would give cor- rect answers to the five following questions, proposed by the society.* " Question 1st. What are the motives of preference which the porcelain merits over the different animal materials for the construction of teeth. ? * Audibran, page 49, and following. Ire. Question. Quels sont les motifs de preference que la porcelains merite sur les ditferentes raatieres animates pour la construction des dents. 443 " Question 2d. What are the most simple and economi- cal means to employ for the composition and colouring of the paste, and also of the enamel, and for the baking of the materials ? " Question 3d. Is the purple precipitate of cassius (oxide of gold, precipitated by the muriate of tin) preferable to any other substance for colouring the gums when they are re- quired ? What is the manner of using it ? " Question 4th. Platina; does it possess properties which render it more suitable than any other metal, so that when placed in the teeth it readily unites with them in the ba- king? "Question 5th. What are the mechanical means most advantageous for mounting the teeth, and adjusting them in the mouth, without injuring the firmness of the natural teeth?" To resolve these questions, two memoirs were addressed to the Society of Medicine ; one by Meggidro, of Nantz, the other by M. Cornelia, of Turin. The former was honour- ably noticed, but the society decided that the questions had not been clearly resolved ; consequently, the society at that time, found no person upon whom, for a clear elucidation lime Question. Quels sont les moyens les plus simples et les plus econo- raiques a employer pour composer et colorer la pate ainsi que I'email et pour les cuire. Illme. Question. Le precipite pourpre de cassius ("oxide d'or precipite par muriate d'etain^) est-il preferable a toute autre substance pour colorer les gencives au besoin ? Quelle est la maniere de Pemployer. I Vme. Question. Le platine jouit il des proprietes, qui le rendent plus apte que les autres rr.etaux, a disposer les dents de maniere a pouvoir etre faciloment rdunies entrelles apres la cuisson ? Vme. Question Quels sont les moyens mechaniques les plus avantaguex pour monter les dents, et les ajuster dans la bouche, sans nuire a la solidite des dents naturelles. 444 and satisfactory answer to these questions, they could bestow their honourable reward. It appears at this time, that the attention of the learned French societies was directed somewhat to this subject, and as correct answers to the questions proposed by the society of medicine had not been given, so as to affirm them, M. Fonzi again presented to the Atheneum of Arts a specimen of his incorruptible teeth, in order to obtain their approba- tion. At the same time M. Dubois Foucou submitted to the same society a pamphlet, in which he indicated the means of making the composition teeth. Commissioners were named by the society to examine and report upon these teeth, with the manner of their fabrication, as detailed by M. Dubois Foucou. M. Fonzi, and M. Dubois Foucou were at this time unquestionably at the head of those who practised this part of the profession. But the approbation of the society in fa- vour of these teeth could not be obtained. The commission appointed to examine them reported unfavourably of their merits, and declared in their report, that they were defective in those properties which rendered artificial teeth useful, agreeable, and satisfactory to the patient; and in fine, that they did not sufficiently imitate nature.* Afterwards in the year 1821, Mr. Audibran presented to the same society some specimens of these teeth, with a volume detailing the mode of fabrication. They were examined by the society, and received their approbation. I have given this hasty sketch of the history of these teeth in order to give the reader a knowledge of them, and likewise to inform him, that they have had their vicissitudes in public favour. I now wish to present a fair and impartial statement of their good and bad properties. The following are their ad- * See Audibran, page 51. (1) note. 445 vantages which they enjoy, in a greater degree than any other artificial teeth. First, They do not change, except perhaps very slightly, upon being worn in the mouth. Secondly, They do not absorb the saliva or any juices of the mouth, so as thereby to offend the taste or contaminate the breath. These two advantages are very considerable, and they have been and continue to be the only ones which can be urged in their favor over other substances. I will now mention the disadvantages attached to these teeth, and which caused them to be more than once rejected as unworthy of the approbation of the Society of Medi- cine, &c. of Paris : and the reader will bear in mind, that when the Society of Medicine gave their approbation of these teeth, they did not by so doing disapprove of the other substances, but merely that porcelain might be used. The disadvantages of these teeth are the following. First, There is no congeniality between them and the gums, against which they are placed. They are a complete foreign body. Animal or natural teeth when properly mount- ed and inserted in the mouth, will repose upon the gums for years, without much change taking place in them after being worn a few weeks ; and in all cases the alveoli, after a tooth is extracted, are absorbed away, and if any teeth are inserted previously to this time, the jaw will change in some degree its shape. But putting these exceptions out of the way, the animal and natural teeth may be worn for years with little or no change taking place. It is otherwise with porcelain teeth ; there is no fellowship betwreen them and the gums, the remaining teeth, the Ups or the tongue. The gums are constantly disposed to retire from the contact of these teeth, and in this respect we may notice that one of their great 446 advantages, which is of not changing, is immediately render- ed of little avail; because if they do not change themselves, the gums upon which they repose change, and consequently these teeth must be renewed in a few years, in order to be adapted to the situation and condition of the gums. The second disadvantage of these teeth is, that they are far greater conductors of caloric than natural or animal teeth. They immediately become cold when exposed to cold air, as when a person is conversing with another when the air is cold, or upon walking in the cold wind, or upon taking them out to clean them, if done in a cold room or with cold water, they become very cold, and communicate a very cold sensation to the patient upon replacing them. To such a degree do they have this effect more than animal sub- stances, that if there are many of them, a chill will be felt by the patient upon their being exposed to cold, and from this cause they are liable to produce pain in the living teeth which they touch. We very often experience pain in our teeth, upon taking a glass of very cold water in our mouths, and in this way porcelain teeth often affect the living teeth when they become cold, as we have before mentioned. This objection may seem somewhat trivial but it is not so. It should be a prime object with every dentist to place such ar- tificial teeth in the mouth, and so insert them that they shall be perfectly comfortable and agreeable to the patient; and if so, after a very short time, he will be hardly conscious of having any thing like artificial teeth in his mouth ; and if con- vinced that they cannot be detected by the common observer, he will be perfectly satisfied with them, will open his mouth without being abashed at the thought of his artificial teeth's being detected ; and indeed he will rarely think of them : but if every time he opens his mouth, his teeth become cold and thereby disagreeable to him, he will be constantly 447 reminded of them. He will not only think of them himself, but will be constantly harassed with the idea, that every body else notices them, which to say the least is a disagree- able state of things. The third objection which I notice as applicable to these teeth, is their weight. They are much heavier than animal or natural teeth of the same size, thickness, &c. ; so much so, that they are ready upon every occasion to fall down. If several of them are placed upon a gold spring or plate, which is the only way any tooth should ever be inserted, ex- cept upon the stump, unless the spring is very strong, and the living teeth to which it is attached very firm in their sockets, they will in most cases fall down, and the disposition to fall down is still farther increased by their having no fel- lowship with the gums. The fourth objection is, that they are very brittle, and ready to be broken upon any slight cause. If made thick to prevent this, then they are two heavy; so then there are four objections to these teeth, which art cannot remedy. Their want of congenialty to the tongue, gums, lips and the other teeth ; secondly, their»disposition to become cold and un- pleasant in the mouth of the patient; thirdly, their weight; and fourthly their fragility, brittleness, &c. These objections arise from the nature of the substance, and I cannot believe that they can ever be obviated. Another objection to these teeth, is their aspect and colour. Mr. Audibran who ap- pears to possess the greatest partiality to the porcelain teeth, acknowledges himself, that in colour, the natural teeth far sur- pass the porcelain teeth.* He says, " The true superiority of * La veritable superiorite des dents naturelles consiste principalement dans leur couleur qui se marie parfaitement avec celle des autres dents aux- qurlles on les a aggregees, lorsque toulefois on les a bien cboisies. Page, 66. 448 the natural teeth consists principally in their colour, by which they perfectly join themselves to those living teeth with which they are aggregated, when nevertheless, they have been well selected." Page, 56. This frank declaration of Mr. Audibran, I believe will be reciprocated by every per- son, who has ever noticed porcelain teeth. Their aspect is perfectly dead. There is a certain animation in the aspect and appearance of the living tooth, which is not seen in any dead substance used to replace them. A dead natural tooth when artificially inserted possesses, especially if a good tooth, a considerable of this animation. Animal teeth in conse- quence of their beautiful enamel, possess a considerable of it, but the porcelain teeth when in the mouth, have not the least animation in their aspect, but appeal- perfectly dull and dead. I have never seen any porcelain teeth, which pos- sessed to any great extent a natural colour and aspect like the natural teeth, or as much so as the animal teeth. Mr. Audibran dwells with considerable emphasis upon the im- penetrability of these teeth, and their not taking up any of the juices of the mouth, food, &c. This is indeed a very valuable property, and one which gives a principal value to these teeth. We have before noticed that no artificial tooth whatever, should be inserted, until the mouth and all the other teeth, if any remain, had been rendered perfectly healthy. Because if inserted in a diseased mouth, or when any of the teeth are diseased, it aggravates all the other com- plaints. If this rule is adopted, (and any thing short of it is incompatable to every principle of correct practice,) then we may insert the animal and natural teeth in the mouth so as to be very useful, comfortable, natural and agreeable to the patient; and if strict cleanliness is observed, they will remain clean and without contracting any bad smell for many years, and also retain their colour and good appearance. When we 449 take into consideration how much the gums and alveoli are apt to change, and especially the former, upon the contact of porcelain teeth, our own reason and observation will at once teach us, that the latter will, before any great length of time, from the change in the jaw and the teeth to which they are attached, become out of fit, or not adapted to the shape of the jaw ; and consequently become useless, and new ones will have to be substituted; so that natural and ani- mal teeth if good, and properly inserted, and rigid cleanli- ness is observed by the patient,, will, besides all their other advantages over porcelain teeth, add this, of being useful to the patient nearly as long as the latter. When porcelain teeth are inserted upon the stump, the objection, as regards the retiring of the gums, is mostly ob- viated. But another difficulty arises : the porcelain teeth are so brittle and ready to break, that they cannot be fastened with that firmness whieh animal or natural teeth may be. I have now several sets of porcelain teeth, which I have taken out, and inserted either animal or natural teeth in their pla- ces. I do not wish to deviate from the strictest candor in the discussion of this matter, knowing that truth will ever remain, whilst every deviation from it will, like the darkness of night, be dispelled by the rise and progress of the sun of science and observation. It is too often the case that views of interest, will often prevent us from taking a comprehen- sive view of any subject. This appears to me to be the case with many of the advocates of porcelain teeth; who in many instances stoutly assert that they are superior to every other substance whatever for the construction of artificial teeth. When we consider that almost coeval with the first dawning of Dental Surgery as a science or an art, these teeth were known, that they have been known about one hundred years, (for Fauchard at least hinted at them in the 57 460 year 1728,) and as yet, they have made but very little pro- gress in public favour, either in Europe or this country, which they most assuredly would have done, had they pos- sessed those advantages which some interested individuals have ascribed to them, we must infer some bad properties at- tached to them ,whilst the use of the natural, and animal, and ivory teeth has been extended to almost every part of Europe and this country. In concluding the subject of porcelain teeth I will remark, that having some insurmountable objections in the nature of their substance, their reputation has ever depended, in a great degree, upon the ingenuity of their fabricators. My own individual opinion of them is, that for single teeth, or a few in contact with others, they are much surpassed by natural teeth; but for whole sets, if well and ingeniously executed, and perfectly adapted to the mouth, they possess high advan- tages, and are nearly, if not quite equal, to those formed of other substances, natural teeth, &c. I will conclude the sub- ject by giving the opinion of M. Delabarre, one of the most ingenious mechanical dentists in Paris. He remarks,* " The composition teeth, placed in the mouth, along side of the others, are nearly always illy matched with the other teeth; there is something about them that does not appear natural, that shocks a delicate eye, and which at length detects the mystery. " In the mean while, until making them is brought to per- fection, I think the preference ought to be given to natural teeth, where one is to be replaced here and there ; but if a complete set of teeth is wanted, porcelain is preferable, be- cause the person being without teeth, there can exist nothing by which a comparison can be made." * Odontologie sur les Dents Humaines, par M. Delabarre, page 67. Paris. 451 SECTION II. MANNER OF PREPARING ARTIFICIAL TEETH PREVIOUSLY TO THEIR BEING MOUNTED FOR INSERTION IN THE MOUTH. We have now considered the several materials of which artificial teeth are made. I now wish to detail the mode of preparing these materials previously to their being mounted upon springs or pivots for insertion in the mouth. Natural teeth are extremely liable to crack and split, when they are, or have become dry; consequently, to remedy this, and to render them perfectly clean, they should be constant- ly kept in alcohol or water, and should be rendered perfectly clean by scraping them, and often renewing the water in which they are macerated. It should be a general rule nev- er to insert one in the mouth, unless perfectly clean and free from every impurity. There is a great difference in the quality of natural teeth, as regards their colour, shape, and exemption from defects, which always modifies the price of them, and should be un- derstood by the dentist. Animal teeth should be selected of a handsome shape, with a fine, smooth enamel, free from any inequalities on their sur- face, &c. The teeth of neat cattle I prefer to any I have ever used. They should be boiled in water, or soaked for a long time: their fangs should be sawed off, and their crowns kept in water, in the same way as we remarked of natural teeth, as they are equally as liable to split upon becoming dry for any time. As their principal objection is of being of too white a colour, we should select those which are as yellow as we can find them. 452 Ivory from the Tooth of the Hippopotamus. We should select this, if we intend to use it, which has a large proportion of enamel, and is of a fine clear colour, and of a close, dense, compact structure, with a fine grain, not coarse or cracked, and checked through its substance. It does not require any particular preparation before working it, nor is it necessary to put it in water, as it is not apt to split when dry, or upon working it, if carefully managed. Transplanting Teeth, fyc. I have already said all that I wish to say upon this subject. Those who wish for directions upon it, can consult Mr. Hun- ter's remarks and directions upon transplanting teeth, &c* section m. OF THE MANNER IN WHICH ARTIFICIAL TEETH SHOULD BE INSERTED IN THE MOUTH. There are various modes of inserting artificial teeth in the mouth; some of which are very pernicious, and others very useful and proper. Of these I shall mention but four, to wit: Firstly, with Ligatures. Secondly, with Springs and Clasps. Thirdly, with Pivots. Fourthly, with Clasps alone. * See Hunter, Part II. pages 217 to 232. 453 Ligatures. These are made of silk, or fine gold or silver wire, and are passed through the tooth or teeth which we wish to fasten in the mouth. When the artificial tooth or teeth are placed in the situation we wish them, the ligatures are carried around the two adjoining living teeth and tied so as to be firm in their places. The following are the inconveniences which result from dependence upon this mode of fastening the teeth. In the first place we cannot always use ligatures; for very often we wish to insert six or eight teeth in the front of the mouth, and perhaps are obliged to fasten them to the posterior grind- ers, in consequence of there being no other nearer. In this case, we should have to continue our block of teeth to the last molar tooth, or not be able to use a ligature, and should we do so, a ligature would not confine such a large block of teeth as firmly as they ought to be. In the next place, if made of silk, &c. they are extremely apt to contract an un- pleasant taste and smell, become dirty, and the patient is obliged to change them very often. If made of gold or sil- ver wire, then the patient will be troubled to untie them, so as to take out the teeth to clean them, as he will desire to do occasionally, and he will be troubled to tie them in again. In the third place, they never give that firmness to the new teeth which we desire, and the teeth are constantly moved by the tongue. The fourth and last objection I would men- tion to ligatures, and one which, if we could pass by all the others, would for ever, in most cases, forbid their use alto- gether, is the injurious effects which the ligatures suspending the teeth have upon those living teeth to which they are tied. Their first bad effect is to pull those teeth out to which they 454 are tied ; which they generally do, sooner or later, or else they cut the tooth off, as I have seen done in repeated instan- ces. I could mention a most numerous list of cases in illus- tration of these positions and facts. These effects are most noticed when applied to the upper teeth. If to the under, our three first objections come in with force. I will men- tion but two cases of the injurious effects of ligatures, when applied to the upper jaw, and these cases will be found to be a common effect. Case I. Mrs. A-----, residing in the south part of this city, lost One of the front upper incisores, which was extracted. She applied to a dentist, who inserted a tooth in place of the lost incisor, and confined it to the lateral and remaining front in- cisor. In the course of four or five years, the other front incisor tooth, otherwise perfectly sound, was loosened and pulled out by the ligature and weight of the inserted tooth. She then had two artificial teeth inserted in the same way, and fastened with the ligature. Then the lateral incisor, to which the first tooth was fastened, became loose and came out. Then she had three inserted, in the same way, tied to the eye tooth and the remaining lateral incisor, which soon caused the other lateral incisor to drop out. She then had four inserted, and tied to the two canine teeth, which was followed by the loss of the canine tooth to which the last set, having three teeth, was tied. Then she had lost four front upper teeth by the use of the ligatures, to wit, the three front incisores, and one canine tooth, and the other canine tooth was useless by being almost drawn out, and very loose, so as to appear, from its unnatural length, very disgusting. In consequence of disease, no doubt, in a great measure, in- 455 duced by these bad artificial teeth, which were of sea horse ivory, she had now lost both of the bicuspids and the first molar tooth of the side upon which she had lost the canine tooth, so that she was placed in precisely the predicament which I mentioned in my first objection to ligatures. See the preceding objection to these, &c. As her dentist's skill seemed to be somewhat at an end, as there were no more teeth to which a ligature might be tied, he applied to me to know what could be done to replace her teeth. I found her last set of four teeth tied to the remaining canine ; of course on one side only, whilst the other was not fastened at all; consequently, whenever she spoke, her teeth moved as well as her tongue ; which, to say the least, was a most unpleasant state of things, and rather bordering on the ludicrous. I took out this last set of teeth, which were tied in, and replaced six elegant animal teeth, mounted upon a fine gold plate, with gold springs and clasps, carried back so as to embrace the molar teeth, which the lady has since worn with the ut- most pleasure and satisfaction. Cases when ligatures tied to the upper teeth, and having this effect, are seen every day. I will mention a part of the following case. Case II. Mrs. O----, living in the south part of this city, called upon me last spring, in great trouble. She had had several sets of teeth placed in her mouth at different times, as in the case of Mrs. A----, and like her, disease, probably induced or aggravated by her artificial teeth, had destroyed nearly all her back teeth, and the artificial ones had done the same for most of her front teeth, nearly as in case of Mrs. A----. But in that of Mrs. O----, the canine teeth were very firmly placed in their sockets, so as not to be readily moved 456 by the weight of the other teeth ; and the ligatures, instead of pulling them out, cut them off. At the time when her last set of artificial teeth wrere inserted, she had lost all of her upper teeth except the right canine tooth. The left ca- nine tooth had been cut off by the ligatures of the set pre- ceding these last, and to the stump of this tooth a silver screw was fastened, and to this screw and the right canine tooth the last set of artificials was fastened by ligatures. When she called on me, the ligature had cut off the right ca- nine tooth, and the set dropped out. This is a brief history of objections to ligatures, and of their bad effects. We are obliged to carry them up close to the gum where the enamel of the tooth becomes attenuated; and, in almost every in- stance, they cut upon, and through the enamel, inducing pain in the tooth, and frequently exposing the nerve, if the tooth does not soon fall out. We can easily conceive how muc^ this effect is increased when porcelain teeth are inserted in this manner, on account of their being heavier than other teeth. 1 think the objections to ligatures and the bad con- sequences resulting from their use, are sufficient reasons to forbid their being used in any case whatever to fasten artifi- cial teeth to the upper living teeth. ' I could dwell much lon- ger upon this subject, but I think I have said enough to in- duce the judicious practitioner, as a general rule, never to use ligatures to fasten artificial teeth. Of Clasps for Fastening Artificial Teeth. This mode of fastening artificial teeth is often adopted. The tooth, or, if more than one, they are united so as to form an entire block, which are placed in the mouth so as to perfect- ly fill the space of the lost teeth, and having a clasp on each side, which are carried around the two teeth adjoining, one on each 457 side. This mode is preferable to the use of ligatures, inasmuch that the flat surface of the clasps does not cut or injure the teeth to which they are attached, and they may be taken out at pleasure. But the inconvenience aris- ing from them is, that they in some degree pull down the other teeth, and they cannot be used in all cases. And if only one, two, or three teeth are inserted, as for in- stance the front incisores, they are apt to be exposed to view. As the clasp m grains. 1-4 gram, very exact. Enamel No. 18. Petunze, Kaolin, Oxide of manganese, Oxide of titanium, Oxide of gold, Grind, &c. 4 ounces. 1 drachm. 34 grains. 34 grains. 1-4 grain, very exact. Paste No. 19. Kaolin, Earth of Vanvres, Oxide of titanium, Filings of standard gold, Filings of platina, Grind, &c. 1 ounce, 4 drachms. 2 drachms. 1-2 drachm, 9 grains. 2 1-2 grams. 3 grains. Enamel, No. 19. Petunze, Kaolin, Oxide of titanium, Filings of standard gold, Grind, &c. 2 ounces. 24 grains. 1-2 drachm, 9 grains. 2 1-2 grains. 495 Paste No. 20. Kaolin, - . . 6 ounces. Earth of Vanvres, - 1 ounce, 4 drachms. Oxide of titanium, - 2 1-2 drachms, 2C grs. Oxile of gold, - - 1-2grain; very exact. Filings of platina, - 2 grains. Oh-ev alio. t.—The paste No. 20, is inserted with the ena- mels, Nos. 20 and 21. Enamel, No. 20. Petunze, . . . 7 ounces. K*.oi>n, 3 drachms. Oxide of titanium, - 2 1-2 drachms, 20 grs. Oxide of gold, - - 1-2 grain, very exact. Grind, &c. Enamel, No. 21. Petunze, - - - 7 ounces. Kaolin. - - . 11-2 drachms. Earth of Vanvres, - 11-2 drachms. Oxide of titanium, - 3 drachms. Oxide of gold, - - 1-2 grain, good weight. Grind, &c. Paste, No. 22. Kaolin, ... l ounce, 4 drachms. Earth of Vanvres, - 2 drachms. Ox:de of titanium, - 1>J drachm, 19 grains. Filings of standard gold, 3 grains. 496 Filings of platina, - 2 1-2 grains. Grind, &c. Enamel, No. 22. Petunze, Kaolin, Oxide of titanium, Filings of standard gold, Grind, &c. Paste, No 23. Kaolin, ... 6 ounces. Earth of Vanvres - - 1 ounce, 4 drachms. Oxide of titanium, - 3 drachms. Oxide of gold, - - 1-4 grain, good weight. Filings of platina, - 2 grains. Grind, &c. Enamel No. 23. Petunze, - - - 7 ounces, Kaolin, - - - 3 drachms, Oxide of titanium, - 3 drachms, Oxide of Gold, - - 1-4 of a grain, good weight, Grind, &c. Paste No. 24. Kaolin, - - - 3 ounces, Earth of Vanvres, - 6 drachms, Oxide of titanium, - 1 1-2 drachms, Oxide of Gold, - - 1-2 a grain, very exact, Filings of Platina, - 1 grain. Grind, &c. 2 ounces. 24 grains. 35 grains. 3 grains. 497 Enamel No. 24. Petunze, - . .4 ounces 2 drachms, Kaolin, - . .11-2 drachms, Oxide of Titanium, - - 1 1-2 drachms 10 grains, Oxide of Gold, - - 3*4 of a grain, very exact, Grind, &c. Paste No. 25. Kaolin, * - - 8 ounces, Earth of Vanvres, - 1 ounce 4 drachms, Oxide of Titanium, - 2 drachms 12 grains, Ammoniated muriate of platina, ... 1-4 ofa grain, very exact, Oxide of Gold, - ~ 1-4 of a grain, good weight, Grind, &c. Observation.—The paste No. 25 is inserted with those of the enamels Nos. 25 and 26. Enamel No. 25. Petunze, - - . s ounces 4 drachms, Kaolin, - - .4 drachms, Oxide of Titanium, - 2 drachms 12 grains* Ammoniated muriate of platina, - - - 1-4 of a grain, very exac! Oxide of Gold, - - 1-4 of a grain, Grind, &c. Enamel No. 26. Petunze, - ► - 8 ounces 4 drachma Kaolin, * - - 4 drachms, 63 498 Oxide of Titanium, - 2 1-2 drachms, Ammoniated muriate of platina, - - - 1-4 of a grain, Oxide of Gold, - - 1-2 a grain, Grind, &c. Paste No.. 27. To make sets of a single piece, after the first process: Kaolin, ... 1 ounce 4 drachms, Kaolin having been once put ) . . , ° . . r [4 drachms, into a porcelain furnace, ) Earth of Vanvres, - 4 drachms, Earth d'encollage,* 4 drachms, Oxide of Gold, - - 21-2 grains, Grind, &c. I thought it convenient to make the paste of a rose colour, that the gums might have their proper colour. The only precaution which one must take after the piece is moulded, is, to keep back a little of the paste, having the number of the enamel which we wish to employ, and to lightly mark the teeth by means of a pencil. This coat, once dried, is enamelled in the way we spoke of in paragraph 18 of this section. Enamel No. 27. Used for enamelling the parts of pieces with which the gums are figured. Petwue, - - - 2 ounces, * This earth, called d'encollage, is to be had from the manufacturers of porcelain; itincorporatesitself into the pastes which they make use of to execute the most diflBcult flowers, without which would break their extreme delicacy. This earth is nothing more than Kaolin mixed with a little gum Arabic. 499 Kaolin, - - -3 drachms, Oxide of Gold, - - 3 grains, Grind, &c. See the manner of using this enamel, Section V. para- graphs 1 and 2. Paste No. 28. Proper for making single pieces, but without gums. Kaolin, - - - 2 ounces, Kaolin once put into the pot- ) . , i ■ /• [2 ounces, ters porcelain furnace, ) Earth of Vanvres, - 2 ounces, Earth d'encollage, - 1 ounce 4 drachms, Oxide of Titanium, - 2 1-2 drachms, Oxide of Gold, - - 3-8 of a grain, Filings of Platina, - - 3 grains, Grind, &c. This paste can be enamelled with all the enamels indis- tinctly, that is, at the option of the artist; but he ought to be acquainted with all the tints, to be able to make a proper use of the enamel which he wants. Without this particular knowledge, he will be liable to make wrong tints of pieces, which will not be like those of the natural teeth. All the formulas of pastes and enamels which we use, are known by a number; in using, the number of the enamel which corresponds with that of the paste, and that which is used for enamelling the teeth made with the paste, having the same number. This plan has appeared necessary to us to establish order in our work. But we ought to observe, also, that, for increasing the number of the tints, the pastes 500, mav be enamelled with the enamels in which the numbers do not correspond. It is by this, means we obtain a vast number of shades, which would be difficult to obtain by other means. Having, at length, given various formulas for the composi- tion of the pastes and enamels which serve to establish the different shades of the teeth, and to actually suit every mouth, we shall now speak of the manner in which the moulds are made intended for modelling the teeth. § xii.—Manner of Making the Moulds that are used for Incorruptible Teeth. We have observed in the second section of this work, that the teeth made of porcelain, are wanting, generally, in shape, which is never natural; for we cannot repeat it too much, the exact imitation depends upon three indispensable condi- tions : 1st. the shape ; 2d. the position ; 3d. the colour. And it is certain, if the artificial teeth want any of these con- ditions, they will not completely imitate the natural ones: but if, on the contrary, they come up to it, they approach the natural ones as much as possible. To arrive at this point, it is necessary to have moulds that faithfully represent the natural teeth. For that purpose, punches of iron must be made, imitating in fineness of shape, the true teeth, and augmenting their diameter at least one ihird more than is natural, which admits of their retracting when submitted to the baking process. These punches serve to stamp the little moulds of copper which are soldered to a band of white iron, after having been first prepared and stamped. 501 § xin.—Manner of Making the Cramps of Incorruptible Teeth* The cramps which are introduced into incorruptible teeth, are of such importance for solidly mounting them on the backs, that the way to fix these cramps is not altogether a matter of indifference. All the dentists are so well aware of the necessity of fixing them firmly, that each one prepares them in the manner which appears to him the most advantageous; but he has certain difficulties to overcome which are not always crowned with success. We have seen, on many occasions, teeth made by them, w herein the cramps were not solid, and where the teeth were easily separated. This remark is made by all those who use the incorruptible teeth, which has varied them into numberless shapes by the introduction of cramps ; for our part, we think it useless to single out here those that are good for nothing, and we will limit ourselves to speaking of those which we use, and which we have adopted after hav- ing been convinced they are better than all the others. To make cramps, take platina wire of a middling thick- ness, pass it through the screw hole of a vice, then plate it lightly : at length, being flattened sufficiently, without taking it out of the vice, which ought to rest upon its sides, cut the cramps of a sufficient length, and if you do not find the notch of the vice sharp enough, cut it more with the file ; the cramps made in this manner can be well fixed in the tooth, and will never come out without breaking. See at length the manner of modelling incorruptible teeth. * These are little pivots of metal, placed in the tooth before baking, which, after the baking, allow of being soldered to plates for insertion in the tooth. 502 We may, if we will, make cramps more simple than those we have spoken of. Draw out a platina wire to a middling thickness, after which it must be flattened ; cut the cramps of a sufficient length, before cutting out each piece, with a eutting pincers. There is another excellent way of making cramps, to which no objection can be made; it well fills up all the conditions; it is a misfortune it can only be employed for teeth furnished with talons or pivots. It consists in making screws of platina wire of a convenient size, then cut each vice about two lines in length ; then prepare, with a file, the end which corres- ponds to the summit of the talon, and a hole is pierced in the middle. This hole is made for receiving a pin which is also soldered to the plate. See the manner of mounting teeth with talons, Section V. paragraph 8. This same hole which I have carefully bored through, serves again to pass through a screw, which permits me to mount, sometimes, incorruptible teeth on gold bases. § xiv.—Manner of Modelling Incorruptible Teeth. The operation which has for its consideration the model- ling of the teeth, appears to be, at first sight, of the least im- portance, and of no moment; it is, nevertheless, very essen- tial, and requires to be well done. We shall give different precautions, and to which much attention should be given. Before modelling the teeth, the paste should be made very unctuous, well kneaded with the fingers; and, that it may not become too liquid, it is necessary to put a certain quantity on a dry plate, that all the humidity may be ab- sorbed ; then they fill all the moulds or matrices with one of the pastes which we have prescribed. It is a practice, by means of a little square piece of platina, to give to the poste- 503 rior part of the tooth, a verticle groove, on the sides of which are sunk (while the paste remains soft) two cramps, made with platina wire prepared for this purpose. It'is also neces- sary, that the tooth may be more susceptible of being firmly soldered, to implant a third cramp a little lower than the two first, and in the middle of the groove upon the side of the triturating surface. After this manner as many teeth may be moulded as are wished. They are left to dry in their moulds: they may then be detached very easily; it is sufficient to unfold the band that the teeth may fall out. § xv.—Of Incorruptible Teeth uith Talons. Ever since the making of incorruptible teeth has been thought of, the necessity of making them with talons has al- ways been felt; that is to say, equal, in all respects, to natural teeth. If the dentists who have adopted them, had not made any to the teeth they fabricate, and contented themselves only with imitating the exterior surface, which is what they pre- tend to, than in making the incorruptible teeth thus, there would be more facility in mounting; and altogether less trouble in adjusting them to the mouth, because the teeth which are opposed to the artificial piece, finding less obstacle in the way, would not misplace, and consequently derange them. But the artist who, in his labours, would equal nature as much as possible, ought he to give up the work, because he meets with obstacles ? No, certainly not; he ought, on the contrary, to redouble his efforts and his patience. The subject with which we are occupied is well worth the trouble ; and having also given it all our application, it is with 504 some satisfaction that we communicate the means we have employed for making teeth with talons, susceptible of being mounted on plates like natural teeth, not on riveted pins, but on soldered pins; also by means of the screws, which we were one of the first to adopt, for mounting natural teeth, be- cause this process is the best and most firm, although differ- ing from the opinions of certain dentists. To arrange teeth with talons, take a piece of paste, knead it between the fingers, and give it the shape of a crown of the tooth ; put this tooth in a matrice,* in order that it may imitate nature. Introduce, in the mean time, in the middle of the talon and near the top, a screw of small dimensions, and about a line and a half long; this screw having been previously pierced in its centre, is intended to simulate the dental canal in the incorruptible tooth. It is in the hole of this screw that the pin is soldered, after the tooth has been adjusted on the plate or on the screw, for it is on the screw the teeth ought to be mounted. § xvi.—Manner of Making Incorruptible Grinding Teeth. If the perfect imitation of incisor and canine teeth was dif- ficult, those of the grinders was yet more so. It is not to be wondered at that these last have not been imitated, and that the dentists have been limited to making the square plates with which they replace the grinding teeth ; but this way of supplying them is inconvenient and arbitrary. Our first care has been to find out a way of imitation that approaches near- est to nature: to attain which, see here, what we have done. In one of the preceding paragraphs, we recommended the * I call matrice the moulds in which I model the teeth. 505 steel punches which exactly represent the shape of the nat- ural teeth. We have made them that imitated grinding teeth of ail sizes. We used the precaution to make them of an equal diameter at the top of their crowns, as well as at their collars, in order that the teeth moulded in the matrices made with these strong punches, when they became dried, might be easily taken out. We have introduced into their interior, and by the part that Ought to rest on the plate, a single cramp of the small- est screw, and two to the largest. We have again made to those we have implanted, a third cramp, on their exterior sur- face, to supply the vacancy, and adapt it to proper levers for" fixing sets of teeth : in one word, we have made, and we are sure they can be made of all sorts of shapes, before they have undergone the baking process. In modelling they are straightened, and given the finest proportions, in order that they may have a most^erfect imitation. In fine, nothing is impossible for an intelligent artist to do. § xvn.—Manner of Hardening Incorruptible Teeth. What is called hardening, is performed by first exposing the teeth to a strong charcoal fire: after that, having put them in a crucible placed in a mass of live charcoal, which is left to entirely consume, and when the crucible is cold, the teeth are taken out, which must be carefully scraped. By this preliminary baking, the cramps have already ac- quired by this means a certain solidity, which permits theirs being handled without fear of breaking them. 64 506 § xviii.—Manner of Enamelling Incorruptible Teeth. The beauty of our teeth consists principally in the manner in which they are enamelled. The precise plastering of the enamel is no less necessary to their preservation, and is what protects them from exterior causes; for which reason one cannot bestow too much care in its preparation. If the paste has not been well ground, .the enamel ought to be the more attended to. We have already made known the manner of preparing it; it now remains for us to speak of the manner of applying it to incorruptible teeth. Presuming it to be in a state of extreme division, it may be applied to the exterior surface of the teeth, by means of a feather pencil. Each tooth is fixed on the end of a match furnished with wax for modelling it; this wax is to hold the tooth by means of the cramps which penetrate; then there is laid on the surface of the tooth a sufficient quantity of enamel; care must be taken that the enamel is neither too thick nor too thin, for in either case the enamelling will be badly done. The teeth are placed, one by one, on a platina grate, made expressly to facilitate their drying. After being sufficiently dried, and the enamel adhered to the paste, they are put with care in a box, to be taken to the potter's porcelain furnace ; they are shut up again in a cas- ket sprinkled with sand, and in placing one along side of the other, they must not touch one another, for fear that during the baking, they will adhere together during the fusion of the enamel, which may happen in despite of all our pains. It is here we repeat, it must be recommended to the pot- 507 ter to put the casket to the charge, for the reasons which we have assigned in the preceding paragraph.* In the application of enamel, there exists another method, which we have equally employed. It is this: make enamel of the same consistence as that one the paste ; put a certain portion in the bottom of the mould; put again upon the en- amel a sufficient quantity of paste ; fill up the mould as usu- al ; make the grooves of which we have spoken, and put on the cramps. The teeth moulded thus, need not undergo the operation of hardening ; they are then put in a porcelain furnace, with- out having previously undergone a preparatory baking. In the mean while, having spoken of the processes in the manipulation of divers pastes, and of enamels to suit them, as well as the manner of modelling the teeth, we believe it will be useful to give here the formulas proposed by M. Delabarre, in order to present, in the same compass, all that belongs to the confection of incorruptible teeth, and let every one judge to what extent we have simplified the processes. Pastes proper for making the bases, according to M. Delabarre. " The amalgams following," says this practician," fill up all the desirable conditions." White Paste. Paste of the manufactories of porcelain, 20 parts, Sand, grey or white silex, - - 1 part. *At Paris they are baked with advantage at the manufactory of Mad. Cremiere, Menil-Montant 6treet, PJo. 48. 508 Coloured Paste. Paste of Porcelain, 20 parts, Sand,......1 part, Alumine or infusible earth, - - 1-2 a part, Whatever oxide you will, 150 decigrammes by 1-2 kilogrammes. Sprinkle it with water and mix it well on glass with a muller, or on a porcelain plate, or, finally, in a mill. Mass of white Enamel used for the Composition of Colouring Enamels. Glazing of porcelain makers, - - 5 to 6 parts, Porcelain earth, - - - - 3 parts. This mixture is not more, in its present state, than half fused, but the oxides which are put in to colour it, give it that colour which it ought to have. " Take any portion you will of this amalgam, join with it some centigrammes of metallic oxide with thirty grammes, and in order to vary the shades to advantage, make a re- union of the different oxides. Grind on glass for some time, in order that the colouring matter may well mix. " Among the oxides that resist the heat of the porcelain fire, the best, says M. Delabarre, (and are, in consequence, less got at in the fabrication of calliodontes,*) the following may be mentioned, which are used on account of their col- ouring properties." *This denomination was proposed by Ricci: M. Delabarre has adopted it; in mean while it appears to us wrong, because it does not designate clearly enough artificial incorruptible teeth; and why introduce a new de- nomination, while that which is most generally known is so precise. 509 CD * 03 ** n> H I s,a O D- © f Cobalt to ct> 02 5 g 3*2 ►r 3 CD CO < Platina Gold Bismuth Mercury Silver Iron Manganese Uranium Titanium .Antimony For 4 grammes. 0 grammes 0 grammes 0 grammes 0 grammes 0 grammes 0 grammes 0 grammes 0 grammes 0 grammes 0 grammes 0 grammes 0000535 0000535 00134 00268 00268 00268 00669 01338 05350 10700 21400 Colours in. blue. dark blue. violet and red. blue gray. gray. yellow-white. yellow-red. gray. pale yellow. pale yellow. yellow. "As to the remainder, there is nothing absolute in the table which I have just presented," says M. Delabarre, " it is for the artist to make trials. " In making the application, as above, I present some ex- amples of the composition of coloured enamels." Enamel composed after the manner which I have spo- ken of: 4 grammes. Oxide of titanium - 0 Enamel composition 4 Red oxide of iron - 0 Enamel composition - 4 Black oxide of iron - 0 Oxide of manganese 0 White oxide of lead - 0 Millim. ' 32100 03560 01338 05350 02675 CO ^ CO 3 iij. Precious Stone,aa - ) Calcined Alum, ... 3i, Reduce them all to an impalpable powder, and incorporate with them a sufficient quantity of clarified honey of roses, and make an opiate of a soft consistence; taking care that this mixture is made in a vessel twice as large as it ought to be to contain the whole, on account of the fermentation of the ingredients, which takes place much more in summer than in winter; and during the fermentation, care should be taken to stir this composition once or twice a day with a wooden spatula." Four or five drops of the oil of cinnamon, and as much of cloves may be put in it, which give it a good odour and increases its virtues also." " This opiate is admirable for cleansing and whitening the teeth, strengthening and constringing the gums, too often re- * Fauchard, pages 75 to 82, 544 laxed by scorbutic affections or by other acrid humours, into whieh they are often infiltrated; besides which, this opiate can never cause any bad effects to the enamel of the teeth. To keep and preserve the teeth and gums, about the size of a pea of this opiate is put on a piece of fine sponge, and the teeth rubbed up and down, and down and up, outside and inside, once or twice a week. If the gums require to be the more strengthened, the same opiate is used on the end of the fingers, with which they are rubbed two or three times a day, and so for eight or ten days in succession. The two fol- lowing opiates may also be used for whitening the teeth; they are very good for this purpose." Another Opiate for the Teeth. Take Prepared Coral, Gum Shell Lac, Dragon's Blood, Catechu or Japan earth, a a Cinnamon, Cloves, Root of Py- rethrum, a a - Red Saunders, Cuttle Fish-bone, Calcined Egg-shells, a a Decripitated Salt, Reduce them all to powder, and sift them through a linen sieve, as fine as silk, then mix them in a marble mortar, with a sufficient quantity of the honey of roses. Another Opiate for the Teeth. To make the other opiate, take Hartshorn, Ivory, the bones of the feet of sheep, the wood of rosemary, of crusts of bread, a a 3ij; burn them separately, and reduce them to charcoal; of red earth, the dry rind of pomegranate, tar- 3ij. - 3i- 3vi. - 3ss. 3i. 545 tar of Montpellier, a a 3ss. cinnamon, 3ij. Reduce all to a fine powder, sift and incorporate it with a sufficient quantity of the honey of roses. These opiates are enclosed in fine earthen-ware glazed pots, to be used as occasion may re- quire." " The powders, may be, more convenient for some persons. I will give here two of excellent composition. Powder for Cleansing and Whitening the Teeth. " Calcine, or reden by the fire twelve ounces of pumice- stone ; reduce it to powder in a mortar, and prepare it on the porphyry st< ne. Take again, Fine or common lake, 3vi; Cuttle-fish-bone, 3 iv; Bole Armenic, Red earth, and Calcined Alum, of each, 3ij; Cinnamon, 3ij; Cloves, 3i. Reduce these drugs to powder in a covered mortar, and pass them through a very fine and covered sieve. When this powder is sifted, you join that of the pumice-stone, por- phyrized; and in order that all may be well mixed together, and that this powder be extremely fine, pass again once through the sieve ; then you put it up. " It is used by means of a small sponge a little moistened, " It may also be made into an opiate by mixing it with a sufficient quantity of the clarified honey of roses." Antiscorbutic Gargle.* Take sarsaparilla, esquine, and shavings of guaiacum, of each, 3ij. Infuse them as described before, for the space of twenty-four hours, in a half septier of myrtle-water, with 1 M. Bourdet, Tom II, pas;es 319, 320, on 546 as much distilled plantain-water. Strain then the liquor; put in 3viij. cinnamon-water, 3iv. of the strong spirit of scurvy-grass, wherein is dissolved, 3i. sal ammoniac, 3ij. tincture of myrrh, 3ij. tincture of aloes, and 3i tincture of cloves. Incorporate them well together, and make the patient rinse his mouth with it. When the scorbutic ulcers are deep, and the sphacelus and gangrene have affected the g .ras, and the jaw carious, at the same time the operations are performed which I have de- scribed, the ulcers are opened at the same time, after having let out the pus, and the contiguous parts are bathed with the following composition." Spirituous Water for Scorbutic and Gangrenous Ulcers. Take strong spirit of scurvy-grass and tincture of guaia- cum, aa 3iv; wherein is dissolved 3i. sal. ammoniac, 3L camphor, and 3ij. of good theriac diluted in 3ij. tincture of myrrh, 3ij. tincture of aloes, and 3ij. tincture of cloves, all well mixed together. It is not sufficient to touch the ulcers very often with a linen rao- or sponge: a tent must be dipped in it, and kept there, if the ulcer is deep, or little compresses or pledgets, which are kept in continually. Another Opiate for soft Gums: spongy, relaxed, swelled, SfC.* " Take red coral, tartar of wine, dried bone, a a 3ij. ** M. Bourdet, Tome II, page 30S. 54T Thyme, rosemary, and marjoram, very dry, and in powder, a 3i. Cloves and cinnamon, a a 3ij. Sal. ammoniac, rock alum, a 3i. Dissolved in a little of the tincture of guaiacum made with spirits of wine. The whole being well incorporated together, with a suffi- cient quantity of clarified honey of roses, and put in a proper vessel for the space of twelve or fifteen days, and preserved m fine earthen ware pots. It is used in the same way as the preceding, every morning, until the gums are restored ; then every third or fourth day, in order to keep them in a good state." Paste for Easing Pains of the Teeth* Persons to whom all the ordinary remedies cannot give ease to spoiled teeth should have them extracted ; or, if they are not willing to support the operation for curing them, may use with confidence the following paste, which will almost always succeed in easing severe pains caused by exposure of the nerve. " Take Opium, fij grains, Cloves in powder, - x grains, Gall nuts, do. do. - x grains, Red earth, - - xv grains, Camphor, - - x grains, and of Anodyne drops as much as may be necessary to make these powders of the consistence of a thick paste. The hole in the tooth is well filled up with it on going to bed, the night is generally passed without pain, and it is banished for a greater or less time by this palliative." * M. Bourdet, Tome II, page 312, 548 Lalande's Odontalgic Elixir.'7 Take Essential oil of cloves, - - 3i. Do. do. of thyme, - - 3ss. Thebaic extract, - - 3 ii- Alcohol of roses, ... 3 ij. Frontignan wine, - 3hj. Digest for the space of eight days, and filter for use. A few drops are put into the mouth, which is held on the pain- ful side, which is rejected immediately when the pain has ceased." Ether Dentifrice of the samcf " Take Sulphuric ether, - - 3ij. Laudanum, - - - - 3ss. Camphor, - - - - 3i. Oil of thyme, - - - - 3ss. Oil of rosemary, - - - 3ss. Mix. A small piece of cotton is dipped in this mixture, and is placed directly in or on the side of the painful tooth." Dentifrice Electuary of the same.'l " Take Pumice stone, - Dried bone, Red coral, Florentine orris, Calcined alum, Pulverised cinnamon - 3ij. - 3h. - 3ij. - Bij. " Bij- - Bij. * Le Maire, page 195, t Le Maire, page 195. J Le Maire, page 196. 519 Rock alum, - - - -Si. Cochineal, - - - - 3i. Pulverise and porphyrise all these substances, each sepa- rately : then make according to art an electuary, with a suf- ficient quantity of Narbonne honey, with which you have pre- viously made a syrup. Let it ierment for the space of forty- eight hours, taking care to stir it from time to time, and put in Alcohol of cloves, - - xxiv drops, Alcohol of musk, - - x drops. Triturate the mixture again, and put it in tin boxes, or pots of fine earthen-ware convenient for use." Cologne Water.* " Take Rect. spirits of wine, - - lbs. vi. Spirit of rosemary, - - Ib.i 3. x. Compound water of balm, - lbs. i. Essential oil of bergamotte, - 3 i. liv grains, Essential oil of cedrat, - 3i. Essential oil of lemons, - 3 ij. These ingredients are all put into a large bottle; the mix- ture is shaken, and the water is made. If it is wanted in a more delicate state, it must be rectified in a water bath, with a gentle heat to draw it nearly all off, within about half a pint. This water is used for the toilette, and not as a medi- cament. Madame de la Veilliere's Water for the Teeth.\ " Take cinnamon, - - - 3 ij. Cloves, - - - 3vi. * Le Maire, Dentiste des dames, page 192. t Ibid. 556 Recent rinds of lemons, - 3xii. Red roses, dried, 3i. Scurvy grass, - Sviij. Alcohol, - lbs. iij. Pound the cinnamon and cloves, divide the roses and rind« of lemons, bruise the scurvy grass; they are then macerated in the alcohol for the space of twenty-four hours; and dis- tilled in a water bath." Vulnerary and Spirituous Water, or Water of Uarquebusade.* " Take fresh leaves of sage, - Do. do. of angelica, - Do. do. of absinthium,- Do. do. ofsariette, Do. do. of fennel, Do. do. of mentastrum, Do. do. ofhysop, Do. do. of balm, Do. do. of basilic, - ^ a a 3 iv. Do. do. of rue, - Do. do. of thyme, Do. do. of marjoram, - Do. do. of rosemary, - Do. do. of origanum, - Do. do. of calamus, Do. do. ofserpolet, Do. do. of lavender, - Rectified spirit of wine, - lbs. viij. These plants are all first grossly cut in pieces : they are then infused for ten or twelve hours in the spirit of wine, Le Maire, page 198. 551 followed by distillation in a water bath, to draw of all the spirituous liquor. It is preserved in a well stopped bottle. It is called by this name, Vulnerary Spirituous and D'arquebu- sade Water. It is very agreeable : It is used internally to prevent the bad consequences which sometimes follow from bruises and falls." Cadets Odontalgic Mixture.* Take sulphuric ether, - - - 3i. Liquid laudanum, - - 3i. Turlington's balsam, - - 3i. Essential oil of cloves, - ij drops, Mix together. " Some cotton is dipp*ed in this mixture, and applied to the paintul tooth." Opiate of M. Gariot, Surgeon to the king of Spain. Take rock alum, - - - 3 ss. Dragon's Blood, - - 3iij. Cinnamon, - - - 3L Mastic, - - - - 31. " Reduce all to a fine powder, and take a sufficient quantity of the honey of roses, to make an opiate, which is used with success, after the mouth has been washed in water, of which a few drops of Le Maire's Elixir has been put in." L» Maire, pages, 204, 306. 552 Opiate for the Teeth. Take of the above powder, (Baume) 3i. Painters'red lake,' - - 3ij. Narbonne honey, - - 3iv. Mulberry syrup, - - 3 ij- Essential oil of cloves, - ij drops. Make an opiate, and make use of it like the powder with the brush I have described above. Vogler's Odontalgic Remedy.* Take mastic, - 3ij. vij grains. Sandarac,- - - 3ij. vij grains. Choice dragon's blood, • xxxvi grains. Dried opium, - - 3i. Volatile oil of rosemary, viij. drops. Spirit of scurvy grass,- a sufficient quantity. After having separately pulverised the mastic, the sandarac, the dragon's blood, and the opium, they are mixed, and mois- tened with the volatile oil of rosemary, and are ground in a marble mortar; then the spirit of scurvy grass is put in by little and little, and in sufficient quantity to form a uniform mass of a soft consistence, both plastic and semi-ductile. It is used against pains of the teeth, by applying and spreading on the gum a portion of this emplastic mass of the size of a pea. Lalande's Dentifrice Elixir.^ Take root of pyrethrum, - 3i 3ij. Cloves, - - - 3ss. * Le Maire, page 210. t Le Maire, page 197. 553 Flowers of lavender, - gij. Cochineal, - - - 3ij. Rock alum,- - - 3ij. Brandy of 22 degrees,- lbs. iv. 3iv. Make an elixir according to art, of which put in a few drops in water when made use of. Elixir for the Teeth. By Abbe Argelat. Take spirit of rosemary, - 3viij. Root of pyrethrum, - 3 i. "Put these two ingredients into a matras, and let them infuse for the space of some days, and filter the liquori The mouth is rinsed with a spoonful of this elixir mixed with twice as much water. It is proper to excite the saliva a little, and to remove from the gums little humours which collect about them, which might occasion some slight pains of the teeth." Parmentier's Astringent Gargle." Take oak bark, - 3i. River water, lb. i. Sulphate of alumine, 3i. Honey of roses, - 3i. This gargle is particularly used when the gums are swelled and spongy. The gums shou'd be made to bleed well by means of a quill tooth pick before using it. Le Maire, pages 198,202. 70 554 Plench Odontalgic Lotion. Take root of pyrethrum, - 3ij. Muriate of ammonia, - 3i. Extract of opium,- - grains ij. Distilled water of lavender, 3 ij. Distilled vinegar, - - 3ij. Digest this mixture for the space of som^ days, and filter. In pains of the teeth, a spoonful of this lotion is held in the mouth from time to time, and care taken not to swallow it. * " If the gums are found ulcerated, without being excres- cenced, there is no other operation to practice but the appli cation of the following remedies : Take two drachms of rock alum in powder, one ounce of tincture of myrrh and aloes, with one drachm of camphor; put all into a half pint of brandy, and let the affected person frequently rinse his mouth with it, or by injecting it upon the ulcers only, by means of a syringe: these ulcers are again rubbed by means of a piece of linen rag rolled around a small stick, which is dipped in the lotion, and with which the gums are rubbed : this is the practice in the Hotel Dieu at Paris, in which most of the diseases of the mouth are treated ; it should be remembered also, that when the disease is prolonged by any excrescences of the gums, they are extirpated, It should be remarked that these rubbings should be repeated very frequently, to derive any utility from them." Detersive Opiate^ " I here give the formulary of an opiate, because there are persons who prefer this kind of preparation. * Le Dentiste Observateur, pages 93, 99. fMaury, pages 82,83. 555 Take fine honey, - - . lbs. ij. Calcined alum, - - 3ij. Extract of bark, - - 3i. Essential oil of peppermint, 3 iss. Do. do. of cinnamon, 3 ss. Spirit of amber, musk rose, 3ij. " Reduce the honey by boiling down to one third ; colour it with a little orcanet; mix into it the bark, and strain it through a fine cloth; when it is almost cold, incorporate the alum with it, but do not put in the essences until it is entirely cold. Use. It has the same properties as the detersive powder, and it may be used in the same manner. Liquors.* " Since a long time, waters, liquors, spirits and elixirs of all those which have been discovered, the principal merit consist in those that keep the mouth fresh, and give it an agreeable smell. The following formula has enjoyed, until the present time, in the hands of its inventors, a merited rep- utation. Some changes may be observed, which I thought ought to be made, and I hope they will be of advantage." Philodontic and Antispasmodic Liquor. Take alcohol of 38 degrees, - 2 litres. Essential oil of English mint, 3 i- * Maury, pages, 83,84. 556 Neroli, - - - 3iij. Essence of cinnamon, - 3ij. Spirit of amber, musk rose, 3ij. Sulphuric ether, - • 3ss. This liquor is coloured at pleasure, either with the tinctures of orcanet, of orcel, or of saffron: it is filtered then, and the ether is not put in until about the time it is put in flasks." Use. " People who take a particular care of their teeth, go in quest of this liquor, because it gives a very agreeable smell to the mouth. From eight to ten drops is put into a glass of water one third full, and a brush dipped in, with which the teeth and gums are rubbed. It removes the bad smell of the mouth, restores and hardens the gums, prevents caries of the teeth, and stops its beginning, if used with care." Elixir* Take Root of ratania, - • 3 viii. Vulnerary alcohol, - 4 litres. Essential oil of English mint, 3 iv. Do. do. of orange rind, 3i- Put the bruised root in a matras; pour over it the vulne- rary alcohol, and let it digest for the space of eigheeen days; filter it, and then put in the essences, which you will have previously dissolved in alcohol, 3iv. * Maury, pages 85, 86. 557 Use. This elixir cures many diseases of the mouth ; among oth- ers, the beginning of scurvy, apthos, spongy gums, which it prevents from bleeding. From 15 to 20 drops of this elixir may be put in a glass of water one third full, held for some time in the mouth, and the teeth and gums rubbed with a brush. If this wash is re- peated two or three times a day, the ulcers soon deterge, and cicatrize, the swelling and the dropping ceases; the bad smell of the mouth, and the teeth that are not very firm, are tightened, or if they not sheltered, as well as those which re- quire a certain treatment, that give much disorder to the mouth, Calming Drops.* Take Alcohol of 40 degrees, - 3iij. Sulphuric Ether, } Liquid Laudanum, > - a 3i. Turlington's Balsam, ) Essence of Cloves, - 3iij. This liquor must be kept in flasks hermetically sealed. Use. I believe I can give the calming drops as one of the most efficacious remedies against the mischief produced by caries, or any other affections of the mouth. When the carious part has been cleaned as much as possible with cotton, ano- ther piece of cotton is introduced into it, wetted with one " Maury, pages 86, 87, 88. 558 or two of these drops, taking care to touch only the carious part. If the pains proceed from the caries, or from another cause, and have already produced a defiuxion, a cataplasm is applied to the affected cheek, prepared with linseed and a decoction of poppy heads, to which is added fifteen or twen- ty of these drops; this application is renewed every three hours. If the gums are only affected, a gargle composed of six or eight of these drops, and of two spoonfuls of barley- water, will produce a sensible effect; but it must be repeat- ed many times during the day, and kept for three or four min- utes in the mouth. Calming Ghrains. Take Resinous extract of opium, - 3 vi. Frankincense, - - - 3iv. Camphor, - - - - 3hj. Essence of cloves, - - 3iss. Virgin wax, - - - 3vi. " Prepare according to art, small grains, the size of the head of a pin, which are introduced into the carious part. Tooth-Brushes, Tooth-Picks, Sec. Tooth-brushes are perhaps indispensable in keeping the mouth and teeth in a healthy and clean state. By a judicious use of them, the gums are preserved in a healthy condition, and the teeth are rendered free from foreign matters, and preserved in a cleanly and neat condition. They are made of different shapes and different degrees of harsh- ness. Hard and stiff brushes if the teeth are firm and sound, and applied to the teeth alone, may be used with ad- vantage. But soft and limber brushes are applied to the 559 gums, and teeth in an irritable, loose, and diseased state. The gums may be rubbed with a sponge to advantage, either dipped in pure water, or in some medicated liqour. Soft brushes are alone admissible for the teeth and gums of chil- dren. Tooth-brushes may be made of different sizes and cut into different shapes, so as to clean the teeth inside and out, and adapted not only to regular teeth, but those which are irregular. Tooth-Picks. These are made of gold, silver, &c, and of tortoise-shell, ivory, quill, &c. The metallic tooth-picks are generally re- jected. Those from the quill, &c. are prefered and recom- mended by nearly all dentists. The oldest dentists and writers on the teeth, affirm the utility of tooth-picks. They should have a place in every gentleman's pocket, and every lady's toilet; and should be always used after every meal, to remove every particle of food from between the teeth. They may at first make the gums bleed, but they will finally do for the gums between the teeth, what the brush does for them on the outside, that is, make them firm and healthy. I cannot dismiss the subject, without urging the use of tooth-picks, as well as tooth-brushes; as w ithout them, bits of food, mucus, tartar, &c, collect between the teeth, irritate the gums, and cause them to assume a spongy, inflamed, and swollen state, whilst their use obviates these unpleasant ef- fects, and becomes an efficient adjuvant in producing a pleas" ant. sweet, and healthy state of the mouth. FINIS. A LIST OF BOOKS, With the Names of Authors who have written upon the Science of Odontotechny, from the Latin, German, Danish, Swedish, French, and English Languages. Jlrenius. Dissertation on catarrh and its descents, such as odontalgia, epiph- ora, and otalgia. Rostock, 1663. Andree. Dissertation on diseases of the teeth rendering extraction necessary, and on their mechanical force and use. Leipsic, 1784. do. on the first teething of children. Leipsic, 1790. Alhey, do. on teething, and diseases attending it. Edinburgh, 1788. Aurivillius. do. on difficulty of teething. Upsal, 1757. Mberti. do. on the lateness of wisdom teeth. Halle, 1737. Auzebi. Treatise on odontalgia. Lyons, 1771. Jiudibran, Chambly. Essay on the art of the dentist. Paris, 1808. Letters to dentists on porcelain teeth. Paris, 1808. Joseph. A treatise, historical and practical, on the artificial incorruptible teeth. Paris, 8 vo. 1821. Arnemann. System of surgery, 2d part, 3d division, on the diseases of the teeth. Gottingen, 1802. Assur. Undervatelse om de mait vanliger tansguk domar. Stockholm, 1799. Buchner. Dissertation on the care of the teeth, and keeping them sound, Halle, 1752. Bauhinus. do. on odontalgia. Bas. 1660. Brendel. do. on tooth-ach. Erf. 1697. Branver. do. on do. Leid. 1692. Beurliz. do. on difficulty of teething. Altd. 1720. Blake. Treatise on the formation and structure of the teeth in man and in various animals. Edinb. 1798. Bring. Observations on the modern doctrine of the teeth, especially those of man. Lond. 1793. Beaupreau. Dissertation on the properties and preservation of the teeth. Paris, 1764. Letter to Mr. Cachais on the diseases of the maxillary sinus. Paris, 1769. Bourdet. Letter to Mr. D----. Paris, 1754. Researches and observations on every branch of the art of the dentist. Paris, 1757. Easy means for the care of the mouth and the preservation of the teeth. Paris, 1759. Dissertation on the depositions of the maxillary sinus. Paris, 1764. Easy methods to keep the mouth clean and the teeth healthy. Leips. 1766. Bunon. Dissertation on the prejudices concerning the diseases of the teeth of pregnant women. Paris, 1759. Essay on the diseases of the teeth, do. 1743. Experience and demonstrations, do. 1746. Botot. Advice to the people. Paris, 1789. Baumes. Treatise on the first dentition, do. 1800. Bucking. Complete directions for the extraction of teeth. Hernial, 1782. Bodenstein. Medicine for the teeth. Franckf. 1576. Brunner. Introduction to the necessary science of a dentist. Vienna and Leipzig, 1766. On the cutting of the milk teeth, do. 1771. 71 502 Blumenthal. Short views on the natural history of the teeth. Stcndal, 1800. Becker. On the teeth and the surest remedies, &c. &c. Leipsig, 1807 & 1810. Bennet. A dissertation on the teeth and gums. Lond. 1779. Berdmore. do. on the disorders and deformities! of the teeth and gums. Lond. 1770. Bew+ A popular treatise on the teeth, with an account of the cause fit caries. •••*■' "6 vb. Lond. 1819. Qn tic douloureux. 8vo. London. ' Couring. Dissertation on the nature and pain of the teeth. Thelmst. 1672. Crausiusi do. on the tooth-ache. Jena. 1681. Crause. do. on the sensibility of the teeth, do. 1704. Gumme. Dissertation on the history of the teeth, treated pathologically'ancf therapeutically. Thelmst 1716. ; Courtois. The observing dentist. Paris 1775. Caigne. Dissertation on the teething of infants of the first year. Paris, 1802. Collinbush. Advice for all classes. 1789. Courtois. Examination on the nature and diseases of the teeth. Gothca, :1778. Campani. Odontalgia, ossia trattato sopra i denti de denti ecloro cura e la maniera di estragli. Florenza, 1789. Chamont. Dissertation on artificial teeth. London, 1797. Curtis. Treatise on the structure and formation of the teeth. London, 1769. Curious observations on that part of chirurgery relating to the teeth. Lon- don, 1687. Decastrillo. Colloquy on teething. Valladolid, 1557, and Madrid, 1570. Defritsch. Dissertation on the teeth. Vienna, 1772. Depre. do. on difficulty of teething. Erf. 1720. Dubois-Dechemant. do. on the advantages of the new incorruptible teeth. Paris, 1788. Drouin. On the diseases of the teeth. Strasburgh, 1761. Dvpont. Remedy for the tooth-ache. Paris, 1633. Duval. Of accidents in the extraction of teeth. Paris, 1802. Reflections on the tooth-ache. do. 1803. The youth's dentist. do. 1805. Historical researches on the art of the dentist among the an- cients. Paris, 1808. On fistulas of the teeth. Paris, 1812. Dubois-Foucou. Exposition of new methods for the manufacture of compo- sition teeth. Paris, 1808. Letter addressed to the gentlemen dentists. Paris, 1808. Duchemant. Dissertation on artificial teeth in general. London, 1797. Deschamps. The younger, treatise on the diseases of the nasal fauces and of their sinus. Paris, An XI. Delabarre, C. F. Odontology, or observations on the human teeth. Paris, 1815, in 8vo. 4 plates. A treatise on the second dentition and a natural method of di- recting it, &c. Paris, 1819. 22 plates. do. on the mechanical part of the art of the surgeon- dentist. 2 vols. 8vo. Paris, 1816. 42 plates. Natural method of directing the second dentition with proofs of the growth of the jaw in all parts. 8vo.- 5 plates. Paris 1826. The sincere dentist. Bayreuth. The careful do. Vienna, 1798. Tooth-ache or certain remedies to cure it. Pirna, 1805. 563 Erastus. Tract on the teeth. Figuri, 1595. Eustachius. Smallbook on the teeth. Venice, 1574. Ehinger. Dissertation on the tooth-ache. Altd. 1718. Eloy. do. on anti-tooth-ache remedies. Vienna, 1772. ' Ethmuller. Medical, and surgical treatise on the diseases of the teeth, Leipsig, 1798. Esswnn. Observations on the teeth, &c. Charleston, S. C. 1820. do. at the Havanna, in Spanish. 1827. Frank. On restoring teeth to soundness. Heidelb, 1672. Dissertation on the tooth-ache. Jena, 1692. Fauchon. Tracts on vicious positions of the teeth. Paris, 1775. Fleurimon. Methods for preserving the teeth sound and good. Paris, 1682. Fauchard. The Surgeon-Dentist. Paris, 1728.-46,-86. -\ . Treatise on the teeth. A. D. French translated by Buddeus. Berlin, 1733. Fischer. On the different forms of the interior maxillary bone in different animals. Leipsic, 1800. ti Fox. Account of the diseases, which affect children during the first denti- tion. Append. Natural history of the human teeth. Lond. 1803. > History of the diseases of the teeth and gums. London, 1806. Fuller: A popular essay on the structure, formation and management of the teeth, illustrated by engravings. Lond. 1810. Flagg. Observations on the teeth. Boston. Fitch, Samuel S. Observations upon the importance of the teeth. 8vo. Philad. 1828. Glaubrecht. Analectic dissertation on the tooth-ache, and its various reme> dies, especially the magnetic. Argent. 1766. Goeckel. Epitome of the theory and practice of odontalgia. Nordl. 1688. Griin. Dissertation on the tooth-ache. Jena, 1795. ;„ Giinz. do. on fetor of the gums, and observations on ulcerated teeth. Leips. 1753. Gehler. Observations on the third teeth. Leips. 1786. ..-.. \, Gerauldy. The art of preserving the teeth. Pans, 1737. Gilles, the flower of; remedies against the tooth-ache. Paris, 1622. Grousset. Dissertation on dentition or the developement of the teeth in, man. Paris, 1803. Gariot. Treatise on the diseases of the mouth. Paris, 1805. Gallette. On the art of the dentist. Mayence, 1803. Present for persons of both sexes, to keep the teeth healthy and clean. Franckf. 1796. Gardette, James. Transplanting of the teeth. Philad. 1821. Guilleman and Schmiz. Eye and tooth doctor. Dresden, 1710. Gerbi. Storia naturale de un puoro insitto. Florent. 1794. Giraud. The good mother, or a treatise on the means of procuring fbft. children a strong and lasting constitution, particularly by a happy teething. Brunswick 1790. Gariot. System of the Physiology, Pathology, and Therapeutics of the mouth, with remarks by Angermann. Leips. 1806. Gallette. Glances into the provinces of the science of a dentist. Maing, 1810. Horstius. On the golden tooth. Leips. 1595. Heister. Dissertation on the pain of the teeth. Altd. 1711. Epistle on bones and teeth, found in different parts of the human body. Thelmst. 1743. Heye. Dissertation on pain of the teeth, do. 1672. 564 Hauffmann. Dissertation on the teeth, their diseases and cure. Halle. 1698 and 1714. Hilscher. do. on the tooth-ache. Jena, 1748. Hauffmann. do. on anti-tooth-ache remedies. Halle, 1700. Hubner. do. on supper taking. (Coenaesthesi.) do. 1794. Hurhius. Tract on diseases of the eye, ear, and teeth. Leid. 1602. Heeslop. Dissertation on the difficult and laborious teething of infants. Leid. 1702. 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Dissertation on pain of the teeth. ^Leips. 1631. Zirgler. On the chief diseases in the caviti*es, of^.the bones of the forehead, also those of the upper and lower mandible. Rinteln, 1750. Trenor. Tic douloureux. New York, 1824. Structure, organization, and nourishment of. the teeth. New York, 1826. Zabarnagen. Councils how to preserve the teeth,. Ewf. 1614. Zakbockjen. Bevattende de middelen om de Gozondeit der tamden to bewa- ven. Arnheim, 1804. DIRECTIONS FOR PLACING THE PLATES. Plate I. to be placed between pages 24 and 25. II. " " « 350 and 351. III. " " " 426 and 427. IV. " « " 432 and 433. Synoptical Tables " " " 48 and 49. EXPLANATION OF THE PLATES. Plate I. Fig. 1. A part of each maxilla showing a perfect set of teeth in their appropriate situation. 1. a. b. c. e. e. superior row of infant teeth. 2. a. b. c. e. e. inferior row of infant teeth. 3. a. b. c. e. e. e. superior row of adult teeth. 4.' a. b. c. e. e. e. inferior row of adult teeth. Plate II. Different specimens of cleansing, plugging, and extracting instru- ments. ■ Plate IV. Different forms of artificial teeth, prepared for insertion in the mouth. ERRATA. Page 70, seventh line from top, after " membranous," read " sacs." 129, seventh do. for " sawing," read " sowing." 149, twenty-second line from top, for "eroded," read " corroded." 185, fifth do. after" face," add " continued " 213, ninth do. for "cancroris," read "cancrum oris." 2.1, twenty-seventh do. for " ii or iii,"read "ij or iij." 248, fifth from the bottom, for " their," read " them." 260, fifth from top, for " have," read " prove." 301, eleventh from top, for " an." read " art." 312, ninth do. for " Philadelphia," read " Pennsylvania " 324, fourteenth do. for " him," read " Mr. Koecker." 347, fifteenth do. for "by," read" in." thirtieth do. for " probably," read " palpably." twenty-first do omit the word " all.1' 348, twelfth do for " Medor," read " preda," and omit 'he period before it. 365, Note. Mr. Fox is referred to by mistake. 374, fifth line from bottom, for " Zufa," read " Tufa." 383, fifth line from top, for " abandoned," read " abraded." 390, sixteenth do. after '• bicuspid," add " or." 408, sixteenth do. for " natures," read " matters." 436, fourth line from bottom, for '' manina," read " marina." 455, eighth line from top. for " he," read " she." 463, sixteenth do. for " pestiors," read " portions." 487, first from bottom, for " like it is," read " as." Some other mistakes; as the occasional use of the word " when," that should have been " where." They are left to the indulgence of the reader. / ;:;*?: *£■-■, ... -:^a i* ■._ '*^p will >#i *» ' il&: m m* is 8 ■fip-.^ « *:■?■ \ '<. A lite/ JLm JriPSfc, r