*a uuaaMaaaaHnanB 
 
 JEWRY :-iE W 1 L L. 
 
UNC 
 
 HEALTH SCIENCES LIBRARY 
 
 The Sheldon Peck Collection 
 on the History of Orthodontics 
 and Dental Medicine 
 
 Gift of 
 
 Sheldon Peck, DDS 1966 
 
 and 
 
 Leena Peck, DMD 
 

 
 / 
 
 
 
 
 
 » 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 'v 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 * 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 

 
 IRREGULARITIES 
 
 AND 
 
 DISEASES OF THE TEETH. 
 
 A SERIES OF PAPERS FROM THE 
 LANCET AND BRITISH JOURNAL OF DENTAL SCIENCE. 
 
 BY 
 
 HENRY SEWILL, 
 
 MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN DENTAL SURGERY; MEMBER 
 OF THE ODONTOLOGICAL SOCIETY OF GREAT BRITAIN : FELLOW OF THE MEDICAL 
 SOCIETY OF LONDON J DENTIST TO THE WEST LONDON' HOSPITAL, ETC. 
 
 LONDON: 
 
 JOHN CHURCHILL & SONS, 11, NEW BURLINGTON ST. 
 
 1870. 
 
?0\ t Pc 
 
 / tfO 
 
 Sstn; 
 
 \ % r )o 
 
 
 
PREFACE. 
 
 Of the following papers, the first two were pub¬ 
 lished in the “ Lancet.” They were written, at 
 the request of one of the staff of that paper, with 
 the object of concisely explaining the causes, 
 nature, and treatment of irregularities of the 
 teeth—a class of affections with which many 
 Medical Practitioners, in the absence of a Dentist, 
 are called upon to deal, and with which they are 
 consequently required to be properly acquainted. 
 The requisite knowledge could previously be ob¬ 
 tained on]y by a considerable study of Dentistry, 
 and these papers were therefore designed to make 
 the points of real importance clear, without the 
 necessity of wading through a mass of uninterest¬ 
 ing matter. 
 
 The remaining papers were contributed to the 
 “ British Journal of Dental Science.” They con¬ 
 sist of reports of cases from my note-book, with 
 passing comments on their pathology and treat¬ 
 ment. They comprise in a small space an account 
 
 A 2 
 
IV 
 
 PREFACE. 
 
 of most of the constitutional and local affections 
 associated with diseased teeth, of which a descrip¬ 
 tion is not to be found except in fragments scat¬ 
 tered through physiological and medical works. 
 
 These several papers are now necessarily out of 
 print, and I have thought that their republication 
 might be acceptable to those who, while anxious 
 to obtain a general knowledge of the more im¬ 
 portant topics of Dentistry, are unable to enter 
 fully into the special technicalities of the subject. 
 
 6, Wimpole Street, 
 
 Cavendish Square, 
 
 December , 1869. 
 
IRREGULARITIES AND DISEASES OE 
 
 THE TEETH. 
 
 IRREGULARITIES OF THE TEETH. 
 
 Many subjects connected with dentistry are 
 necessarily of great interest to general prac¬ 
 titioners, and more especially to those who, living 
 at a distance from London, are compelled to act 
 on emergency as dentists. Irregularities of the 
 teeth constitute one of the most important of 
 these subjects, and one upon which the advice of 
 the practitioner is most constantly sought. At 
 the period of second dentition the child's mouth 
 usually presents an unsightly appearance, owing 
 to the absence of temporary teeth and the slow 
 advance of the permanent set. Unable to judge 
 whether the apparent deformity be transient or 
 not, and anxious that the teeth shall, at least, not 
 be a source of disfigurement, the parents, in the 
 absence of a dentist, are naturally led to consult 
 their medical attendant. Not unfrequently they 
 
 B 
 
2 
 
 IRREGULARITIES OF THE TEETH. 
 
 bring children, with the request that some par¬ 
 ticular temporary or permanent tooth may be 
 extracted, the removal of which they consider will 
 avert or cure an irregularity. 
 
 In a great number of these cases all appear¬ 
 ance of deformity passes away as dentition be¬ 
 comes completed, but in a considerable proportion 
 malplaced teeth retain their abnormal positions, 
 and so give rise to permanent irregularities. Such 
 irregularities tend to cause or accelerate premature 
 decay of the teeth, and are also often alone suffi¬ 
 cient to impair the general symmetry of the face. 
 By judicious treatment, however, they may, as a 
 rule, be prevented or cured; but, on the other 
 hand, by unnecessary interference, both injury and 
 suffering are inflicted upon the patient. It will be 
 understood, therefore, that an acquaintance with 
 the causes and nature of irregularities forms a 
 necessary acquirement of those who undertake to 
 deal with them. 
 
 Where mechanical apparatus is required, the 
 treatment of these deformities passes beyond the 
 province of the surgeon. He, however, ought to 
 be able to judge when he may interfere with 
 advantage by extracting teeth, or when he may 
 refrain with safety, and thus avoid inflicting 
 unnecessary pain. He should also be able to 
 
IRREGULARITIES OF THE TEETH. 
 
 3 
 
 recognize the cases which require to be promptly- 
 referred to the dentist, in order that they may not, 
 by delay, be rendered difficult of cure, or irre¬ 
 mediable. 
 
 It is impossible to lay down rules which shall 
 serve the surgeon in every instance, since excep¬ 
 tions constantly present themselves. Neverthe¬ 
 less, by a brief discussion of the general characters 
 of these affections, and by a reference to some of 
 the more common examples, practical knowledge 
 may be imparted to him which, as well as guarding 
 him against error, will enable him to deal success¬ 
 fully with many cases. It cannot be expected 
 that, in addition to the numerous and extensive 
 subjects with which one in general practice has to 
 be thoroughly acquainted, he will burden himself 
 with complex points in dentistry. If, therefore, 
 the part which the practitioner should take in such 
 cases can be concisely and clearly indicated, the 
 objects of this contribution will be fully achieved. 
 
 It may be well to premise that, in speaking of 
 irregularities, reference is made to the permanent 
 teeth only. No object would be gained by the 
 treatment of irregularities of the temporary teeth, 
 since they are shed in early life ; but, indeed, they 
 are rarely, if ever, malplaced. 
 
 The number and characters of the temporary 
 
 B 2 
 
4 
 
 IRREGULARITIES OF THE TEETH. 
 
 teeth, and their relations to the permanent set at 
 the period of eruption, may be usefully remem¬ 
 bered. The temporary set consists of ten teeth in 
 each jaw—namely, four incisors, two canines, and 
 four molars. These are afterwards replaced by 
 the permanent incisors, canines, and bicuspids. 
 The developing incisors and canines may be roughly 
 stated to occupy bony crypts in the upper jaw 
 above and behind, and in the lower jaw below and 
 behind, the partly absorbed roots of the temporary 
 teeth which they respectively succeed. The bi¬ 
 cuspids replace the temporary molars, and are 
 contained in crypts within the divergent fangs of 
 those teeth. The permanent molars are situated 
 in that portion of bone altogether posterior to the 
 deciduous teeth. 
 
 The age at which second dentition commences, 
 varying from the fifth to the eighth year, is of 
 little or no importance, but the order in which the 
 
 teeth are cut is invariable, and is as follows : first 
 
 ✓ 
 
 molars, central incisors, lateral incisors, first bi¬ 
 cuspids, second bicuspids, canines, second molars, 
 and lastly, after the lapse of a few years, the third 
 molars or wisdom teeth. 
 
 With a knowledge of the order of eruption and 
 of the following characteristics which distinguish 
 the permanent from the temporary set, the surgeon 
 
IRREGULARITIES OF THE TEETH. 
 
 5 
 
 will not be likely to sacrifice a valuable tooth by 
 mistake—an accident which happens by no means 
 rarely. An error of this kind is, however, hardly 
 possible, except in the case of the incisors and 
 canines. The permanent molars will be known 
 from their position posterior to the temporary 
 teeth; whilst the bicuspids may be easily recog¬ 
 nized, since no such tooth exists in the deciduous 
 set. The permanent incisors, if present during the 
 persistence of the temporary set, will be found 
 posterior to the teeth which they replace. They 
 are larger in size, firmer and denser in structure, 
 and have along their cutting edge three small 
 tubercles, which give them a serrated appearance. 
 Their enamel, extending beneath the surface of the 
 gum, terminates in an imperceptible slope towards 
 the fang, whilst in the temporary teeth it ends in 
 an abrupt ridge, which can be defined by the finger¬ 
 nail, at the level of the gum. This distinction 
 applies equally to the whole series. The perma¬ 
 nent canines may be distinguished by their great 
 size in comparison with the corresponding tem¬ 
 porary teeth, and by their position, which is exter¬ 
 nal and prominent. In the case of these teeth 
 also, a characteristic ridge may be felt along the 
 external alveolar wall, which corresponds to the 
 fang of the tooth. 
 
6 
 
 IRREGULARITIES OF THE TEETH. 
 
 In terminating these preliminary remarks, it is 
 desirable to refer to a somewhat popular error. It 
 is commonly believed that the premature extrac¬ 
 tion of temporary teeth may act as a cause of 
 deformity of the jaw, and thus of irregularity of 
 the teeth. This belief is not substantiated by 
 physiological facts, and is, moreover, disproved by 
 practical experience. Whilst, therefore, we should 
 guard against uncalled-for interference, we should 
 at the same time not hesitate to extract those 
 temporary teeth the removal of which is necessary 
 for the cure of deformity, or for the relief of 
 disease. 
 
 I now come to speak more particularly of the 
 different varieties of irregularities. They may be 
 divided into two classes :—First, those in which 
 the jaw is well formed, but in which, owing to 
 retention of the temporary set, permanent teeth 
 are forced into unnatural positions. Secondly, 
 those due to deformity of the alveoli, or of the 
 body of the jaw itself. 
 
 In the first class, if the temporary teeth be 
 removed sufficiently early, those that are displaced 
 tend spontaneously to assume their proper positions. 
 Should, however, the deformity be allowed to con¬ 
 tinue for any great length of time, the teeth 
 become fixed, either by the consolidation of the 
 
IRREGULARITIES OF THE TEETH. 
 
 7 
 
 bone, or by the advance of the contiguous teeth, 
 or by the locking together of the upper and lower 
 sets when closed. The nature of these cases will 
 be made clear by a reference to the most common 
 example, illustrated in Fig. 1, where the permanent 
 
 Fig. 1. 
 
 incisors of the upper jaw are seen to occupy a 
 posterior position owing to the persistence of the 
 temporary teeth. The prompt extraction of the 
 latter would enable nature to effect a cure. if, 
 however, this were delayed until the permanent 
 
 r 
 
 teeth were fully protruded, they would pass, on 
 closure of the jaws, behind instead of in front of 
 the lower incisors, as shown in Fig. 2. A per- 
 
 Fig. 2. 
 
 manent obstacle to their forward movement would 
 
8 
 
 IRREGULARITIES OF THE TEETH. 
 
 thus be opposed, which could only be overcome by 
 the mechanical means of which I have afterwards 
 to speak. 
 
 A. corresponding irregularity occurring in the 
 teeth of the lower jaw is shown in Fig. 3, to which 
 
 Fig. 3. 
 
 similar remarks apply. Delay here, however, is 
 not so dangerous as in the case of the upper set. 
 The normal position of the lower teeth being 
 behind those of the upper jaw, the danger of lock¬ 
 ing does not exist, and mechanical interference is 
 rarely required. The extraction of the temporary 
 teeth should, nevertheless, not be too long delayed, 
 lest the adjoining permanent teeth, taking a for¬ 
 ward position, prevent the advance of those that 
 are displaced. 
 
 This first class comprises a great variety of 
 irregularities of the incisors. They may be crowded 
 together so as to overlap each other, as in Fig. 4, 
 
 Fig. 4. 
 
IRREGULARITIES OF THE TEETH. 
 
 9 
 
 twisted on their axis, as in Fig. 5, or, indeed, may 
 
 Fig. 5. 
 
 be displaced in almost any direction. The duty of 
 the surgeon is to promptly extract the offending 
 temporary teeth, and, should the deformity not 
 speedily decrease, at once to refer the case to the 
 dentist. 
 
 The canines are very subject to displacement, 
 being frequently forced into an external prominent 
 position. This constitutes a very unsightly irregu¬ 
 larity. The common practice in such cases is to 
 extract the projecting teeth. Such a proceeding 
 cannot be too strongly denounced. The canines 
 are the strongest and most durable of the teeth ; 
 they contribute most to the symmetry of the 
 mouth, with the exception of the incisors, and they 
 can, moreover, almost invariably be brought by 
 treatment into their proper places. It may indeed 
 at once be stated that the extraction of a permanent 
 incisor or canine for the cure of irregularity is very 
 
10 
 
 IRREGULARITIES OF THE TEETH. 
 
 rarely justifiable. Obstructing temporary teeth 
 should first be removed. Should it be absolutely 
 necessary subsequently to sacrifice a permanent 
 tooth, the choice will, as a rule, fall upon the first 
 molar. This tooth, unfortunately, even in early 
 life, is either so extensively carious as to require 
 extraction, or is at least in a condition in which it 
 could not be expected to endure during many 
 years. If, however, the first permanent molar be 
 free from decay, the choice may fall upon the 
 second bicuspid, the loss of which is but little 
 damaging to the appearance. 
 
 It may, perhaps, be asked how the extraction 
 of a tooth situated so far back as the first molar 
 can relieve crowding at the front of the mouth. 
 It is found that on the extraction of such a tooth 
 the pressure is very rapidly relieved, that the 
 crowded teeth spread equally apart, and that in a 
 comparatively short time the space previously 
 occupied by a large tooth becomes obliterated. 
 
 The required room being thus gained, nature 
 will in many cases complete the cure; in some a 
 mechanical apparatus will be necessary. 
 
 After the general observations that have been 
 made the bicuspids may be dismissed with the 
 remarks, that they are sometimes displaced by the 
 retention of portions of the deciduous molars, that 
 
IRREGULARITIES OF THE TEETH. 
 
 11 
 
 this displacement is usually in an inward direction 
 (Fig. 6), and that the treatment is similar to that 
 of the incisors. 
 
 Fig. 6. 
 
 The molars are rarely malplaced except in cases 
 due to malformation of the jaw. Irregularities of 
 this class will occupy my next paper. 
 
 Irregularities due to malformation of the 
 jaw are now to be considered. In the recognition 
 of these cases the point of the greatest value 
 obviously is a knowledge of the exact form of a 
 well-shaped maxillary arch. The anterior portion 
 of this arch, containing the incisors, canines, and 
 bicuspids, forms an almost perfect semicircle, whilst 
 those portions containing the molars continue the 
 arch backwards in slightly curved and divergent 
 lines. Flattening or contraction of this arch, or 
 abnormal development of any portion of it, give 
 rise to irregularities of the teeth. 
 
12 
 
 IRREGULARITIES OF THE TEETH. 
 
 This class of irregularities is most frequently 
 congenital, and at the same time hereditary, a 
 peculiar abnormality of the jaw being, in this 
 manner, reproduced in many members of a large 
 family. They may, however, be due to injury or 
 to other accidental causes. Their nature will be 
 rendered evident by a few typical examples. 
 Fig. 7 represents an extreme instance of a common 
 
 Fig. 7. 
 
 variety. Here we see a protrusion of the central 
 incisors, apparently due to abnormal development 
 of the premaxillary bone. Fig. 8 illustrates a 
 
 Fig. 8. 
 
 somewhat similar deformity of the lower jaw, due 
 to a maldevelopment of the anterior portion of 
 
IRREGULARITIES OF THE TEETH. 
 
 13 
 
 the alveolar ridge. An individual affected with 
 this deformity is said to be underhung, the four 
 incisors, and sometimes the canines, passing with¬ 
 out the upper teeth when the mouth is closed. 
 
 The V'shaped or contracted arch, instances of 
 which daily present themselves, is shown in Fig. 9. 
 
 Fig. 9. 
 
 This gives rise to endless varieties of displacements 
 of the teeth. The incisors and bicuspids are often 
 forced inwards, the canines generally in the con¬ 
 trary direction ; so that an irregularity exceedingly 
 damaging to the expression of the countenance is 
 the result. 
 
 A somewhat rarer example, shown in Fig. 10, 
 is equally disfiguring in its effects. In this ex¬ 
 ample the molars approximate on closure of the 
 mouth, but the incisors remain apart and cannot 
 be brought into contact. This is in consequence 
 
14 
 
 IRREGULARITIES OF THE TEETH. 
 
 of a malformation of the posterior portion of the 
 lower jaw, by which the molars, being placed on 
 
 Fig. 10. 
 
 too high a level, prevent the rest of the set from 
 coming together. 
 
 The distinction between the first and second 
 classes of irregularity is rendered manifest by 
 these examples, and nothing would be gained, did 
 space allow, by multiplying them. It is evident 
 that little can be done by the surgeon in the 
 second class. In the treatment of this variety, it 
 is necessary in the first place, to consider the 
 desirability of extracting teeth for the sake of 
 obtaining space. Secondly, where teeth must be 
 sacrificed, it is necessary to decide which of them 
 can be removed with the greatest advantage. 
 Next comes the question of the extraction of such 
 malplaced teeth as are not amenable to mechanical 
 treatment. Lastly, there is the designing and 
 construction of the mechanical apparatus required 
 for the completion of the cure. With the many 
 
IRREGULARITIES OF THE TEETH. 
 
 15 
 
 details here involved, none but those who make 
 dentistry a special study, can be expected to be 
 practically acquainted, and these cases must, there¬ 
 fore, be considered almost altogether beyond the 
 province of the medical practitioner. 
 
 A few remarks on the mechanical treatment of 
 irregularities may be added in conclusion. They 
 will be of service in determining the cases which 
 are capable of being either improved or cured by 
 the application of apparatus. 
 
 Instruments for the purpose of altering the 
 position of malplaced teeth are constructed to 
 fulfil two objects : to prevent the locking together 
 of the teeth on dosure of the mouth; and to 
 exert such continued pressure or traction on those 
 teeth which are irregular, that they may be gra¬ 
 dually compelled to assume a normal position. 
 To fulfil these objects, a plate of metal or of vul¬ 
 canised india-rubber, as shown, in situ , in Fig. 11, 
 
 Fig. 11. 
 
16 
 
 IRREGULARITIES OF THE TEETH. 
 
 is accurately adapted to the teeth and palate, the 
 molars being covered with sufficient thickness to 
 prevent the front teeth from meeting. A fixed 
 point is thus formed, to which springs or levers, 
 elastic bands or wedges of wood, may be attached 
 in any desired situation. These may be arranged 
 to exert, with great nicety, any amount of force 
 required, and to effect the desired result without 
 exciting unnecessary inflammation. 
 
 In order to make this treatment more clearly 
 understood, two of my recent cases may be de¬ 
 scribed. Fig. 11 shows, in position, the instru- 
 
 Fig. 12. 
 
 ment employed in the regulation of the case 
 represented in Fig. 12. This was an irregularity 
 of the first class, one lateral incisor being dis¬ 
 placed inwards, and held in its malposition by the 
 lower teeth on closure of the mouth. The plate 
 covering the molars kept the jaws sufficiently 
 apart to prevent the front teeth from meeting. 
 The obstacle to the forward movement of the 
 tooth being thus removed, but a slight amount 
 
IRREGULARITIES OF THE TEETH. 
 
 17 
 
 of pressure was required to force it into its normal 
 position. To obtain this pressure a piece of com¬ 
 pressed hickory was fixed between the plate and 
 the back of the tooth. The moisture of the mouth 
 caused the wood to expand, and, in expanding, to 
 drive the tooth slowly in the desired direction. 
 The wood was renewed by larger pieces at inter¬ 
 vals of a day or two, as the cure progressed, until 
 at length, the teeth having assumed the regular 
 
 Fig. 13 
 
 appearance, shown in Fig. 13, the case was dis¬ 
 missed. 
 
 The next case, of which Fig. 14 is a representa- 
 
 Fig. 14. 
 
 tion, was of a somewhat different character. The 
 irregularity here consisted of a twisting of the 
 central incisors on their axes. The apparatus 
 
 c 
 
18 
 
 IRREGULARITIES OF THE TEETH. 
 
 with which it was treated is shown in situ in the 
 next drawing (Fig. 15 ). It consisted of a vulcanite 
 
 Fig. 15. 
 
 frame, closely in contact with the inverted angles 
 of the teeth, hut clear of the rest of their surfaces. 
 From each side of this frame there proceeded a 
 flat spring of hard gold wire, and these, extending 
 round in front, were arranged so that their free 
 extremities kept up constant pressure on the 
 everted sides of the irregular teeth. By this means 
 the distorted incisors were compelled gradually to 
 revolve, and in a comparatively short time the 
 
 Fig. 16. 
 
 deformity was entirely removed. Fig. 16 is from 
 a cast of the case after treatment. 
 
IRREGULARITIES OF THE TEETH. 
 
 19 
 
 By similar contrivances the alveolar border, and 
 evenj the whole jaw, may, when necessary, be modi¬ 
 fied in form. For instance, in the contracted or V~ 
 shaped palate, an apparatus would be made to 
 maintain equal pressure from within outwards 
 along the alveolar margin. In time the required 
 expansion of the arch would be accomplished. 
 
 Other cases may be advantageously dealt with 
 by instruments fixed externally. Thus the case 
 represented in Fig. 10 would be treated by a con¬ 
 stant upward traction of the chin, a cap of leather 
 adapted to that part being attached to a strap 
 across the head by strong elastic bands at each 
 side. 
 
 Fig. 17. 
 
 This apparatus and its application are shown 
 in Fig. 17. 
 
20 
 
 IRREGULARITIES OF THE TEETH. 
 
 The almost marvellous manner in which the 
 jaws may be modified in shape by the continued 
 application of force in one direction, is not uncom¬ 
 monly illustrated in surgical cases. The sequel of 
 extensive burns of the front of the neck furnishes, 
 occasionally, an instance in point. The cicatrix 
 resulting from such an injury has a constant ten¬ 
 dency to contract. It draws the chin unceasingly 
 towards the chest, and in time causes the body of 
 the jaw to curve downwards. In cases not un¬ 
 commonly met with, the curvature is so great that 
 the alveoli are completely everted, and the incisors 
 turned altogether outwards or even downwards. 
 One of these cases is well shown in the annexed 
 engraving (Fig. 18). 
 
 Fig. 18 . 
 
 From a consideration of the principles upon 
 which the mechanical treatment of irregularities 
 is based, it will probably suggest itself that this 
 
IRREGULARITIES OF THE TEETH. 
 
 21 
 
 treatment can be much more rapidly and effectu¬ 
 ally carried out in the child than in the adult. 
 At the age at which the alveoli are in process of 
 growth, and when they do not closely embrace the 
 teeth, a malplaced tooth can be drawn into position 
 in a short time, and with the exercise of but slight 
 force; whereas in the adult, the bone being con¬ 
 solidated, the process is long and tedious. For 
 the same reasons, the cases in which the shape of 
 the jaw has to be modified are much more amenable 
 to treatment at an early age than at a later period, 
 when the osseous system is fully developed. If, 
 therefore, the opinion be formed that the treat¬ 
 ment of a case of irregularity cannot be undertaken 
 without mechanical aid, no time should be lost in 
 the construction and application of the necessary 
 apparatus. 
 
22 
 
 ON DISEASES OF THE TEETH. 
 
 In the review of Mr. Christopher Heaths work 
 in the last number of the Journal, ifc is justly 
 pointed out that, “ in proportion as dental surgery 
 has been advanced to its legitimate position it has 
 assisted the general surgeon to a better knowledge 
 of many diseased conditions of the jaws which had 
 hitherto escaped his notice until they presented for¬ 
 midable or malignant characters, such as rendered 
 surgical interference, if not fatal, at least difficult 
 and dangerous.” It is gratifying to find that facts 
 of this kind are becoming appreciated by the medi¬ 
 cal profession, and that, accordingly—the constitu¬ 
 tional as well as the local effects of dental disease 
 being recognized—many cases which require the 
 co-operation of the dentist are now frankly referred 
 to him both by physicians and surgeons. 
 
 Facial Neuralgia .—Cases of facial neuralgia— 
 among affections which come under the care of the 
 physician—are almost invariably referred to the 
 dentist, in order that diseases of the teeth, constitu- 
 
FACIAL NEURALGIA. 
 
 23 
 
 ting, probably, the exciting cause of the pain, may 
 be removed before medical treatment is commenced. 
 No affection falls in the hrst instance more legiti¬ 
 mately within the province of the dentist. When we 
 remember the physiological fact that irritation of a 
 nerve commonly manifests itself by pain at some 
 point distant from the seat of injury, and when 
 we consider that the fifth nerve, which supplies 
 branches to the teeth is distributed also to 
 nearly the whole of the head and face, and that 
 comparatively few persons are entirely free from 
 dental disease involving irritation of fibres of this 
 nerve, it is not difficult to understand that affec¬ 
 tions of the teeth are the most frequent exciting 
 causes of neuralgia of the face, and that this is 
 among the most prevalent of diseases. For these 
 reasons it is evident that until every trace of den¬ 
 tal disease has been removed it is impossible to 
 assert with confidence that a case of facial neuralgia 
 is due to constitutional causes alone. As to the 
 proportion of cases, however, distinctly traceable 
 to each cause, considerable difference of opinion 
 prevails. Thus, Gross declares the vast majority 
 are due to diseased teeth, while Dr. Aitken ap¬ 
 pears to hold the opposite opinion. Dr. ITandfield 
 Jones describes three well-marked varieties of 
 facial neuralgia : 1st, the reflected or sympathetic, 
 
24 
 
 FACIAL NEURALGIA. 
 
 such as is excited by carious teeth; 2nd, that pro¬ 
 duced by organic central disease ; 3rd, the variety 
 due to nerve debility caused by the special miasm 
 which gives rise to ague, or by other influences. 
 This uncertainty existing, it becomes more than 
 ever the duty of the physician to allow no probable 
 exciting cause to escape him. The teeth are un¬ 
 doubtedly among these causes, and since it is at 
 all times a desirable object to bring them into a 
 healthy state, the physician should have no hesita¬ 
 tion in seeking the co-operation of the dentist in 
 every case of facial neuralgia. Moreover it is not 
 sufficient to take the patient’s assurance that his 
 teeth are not decayed, or that he does not suffer 
 from toothache. Patients are often unconscious of 
 the presence of disease, and teeth which do not 
 ache are frequently the excitants of neuralgic pain. 
 No practitioner would proceed to treat a case of 
 neuralgia of the knee in a child until he had ex¬ 
 amined the hip-joint, the most probable seat of 
 disease, nor would he treat neuralgia of the right 
 shoulder before inquiring into the state of the 
 liver, nor pain in the left upper arm before ex¬ 
 amining the heart. Can he then, consistently, 
 ignore the teeth when dealing with neuralgic pain 
 of the face ? 
 
 I, however, by no means deny the existence 
 
FACIAL NEURALGIA. 
 
 25 
 
 of idiopathic neuralgia. I admit that it may 
 be common in malarious districts, but I believe 
 that it is comparatively rare in London. There is 
 one point which should be borne in mind, and which 
 is well expressed, by Dr. Brinton. He remarks, 
 “ There are plenty of facts which suggest that lesions 
 of nerves not necessarily painful may become so 
 from causes originally by no means local. Thus, 
 I believe there are hundreds of peopie walking 
 about London this minute, the diseased nerves of 
 whose carious teeth would be speedily roused into 
 severe neuralgia by two or three nights of sleepless 
 watching and anxiety, or by two or three days of 
 insufficient nourishment, or of violent and exhaust¬ 
 ing exertion of mind or body. And, conversely, 
 I am sure that a generous diet will often relieve 
 the agony arising from sheer involvement of 
 nerves in a cancerous deposit/’ Here we have 
 the explanation of the fact that many cases of 
 facial neuralgia due to the teeth are cured by 
 quinine or other tonics. The cure is, however, 
 not permanent, or at least the patient is liable to 
 relapses until the fons et origo mail be removed. 
 
 At the West London Hospital many cases of 
 neuralgia come under my notice, and I think it is 
 the general custom of the staff to send their 
 patients for an examination of the teeth. This 
 
26 
 
 FACIAL NEURALGIA. 
 
 examination is most carefully made, so that no 
 carious cavity or other mark of disease shall escape. 
 Those teeth which are hopelessly diseased, that is, 
 which evidently cannot be brought again into a 
 healthy state, are at once removed. Among these 
 I enumerate teeth which are too extensively 
 carious or broken down for filling, or which are 
 affected with necrosis or exostosis or chronic 
 alveolar abscess. These necessary operations, 
 formerly so much dreaded by the patient, are now 
 performed without hesitation, since they may be 
 rendered painless by nitrous oxide gas, or by some 
 other of the harmless anaesthetics which we now 
 possess. Carious cavities are next filled, and in 
 this great care is taken to prevent increase of the 
 susceptibility of the teeth to changes of tempe¬ 
 rature. For this purpose the so-called osteo¬ 
 plastic answers admirably, and in those cases where 
 the pulp is exposed or only protected by a thin 
 layer of dentine, a coating of this filling is always 
 placed at the bottom of the cavity. Where in¬ 
 flammation of the gums and periostitis prevail, 
 local means are taken to subdue them, while at 
 the same time attention is given to the general 
 health. In some cases iodide of potassium is 
 administered; in others, where the patient is 
 debilitated, quinine and iron are prescribed. 
 
FACIAL NEURALGIA. 
 
 27 
 
 The following cases will illustrate this treat¬ 
 ment. The first is typical of a very large class. 
 
 M. B- set. 25, applied at the hospital on 
 February 11th, 1868. She had been, as she ex¬ 
 pressed it, “ a martyr to face-ache” for many 
 months. The attacks usually came on in the 
 evening, and affected the right ear and the right 
 side of the face. The pain sometimes extended 
 down the neck and arm of the same side. She had 
 decayed teeth which occasionally ached. On ex¬ 
 amination the right lower wisdom tooth and second 
 molar were found extensively carious and very 
 tender. These were extracted, and five weeks 
 afterwards the neuralgic pain had not recurred. 
 It is interesting to remark how commonly, as 
 in this case, “ ear-ache” is associated with disease 
 of the teeth of the lower jaw. 
 
 S. J—, set. 50, applied May 8th, 1868. He 
 described pains of a neuralgic character about the 
 head and face, from which he suffered. He said 
 he had no decayed teeth, but some of them ached 
 after contact with hot or cold fluids. Examina¬ 
 tion showed that there were no carious teeth, but 
 that the palatine fangs of both the right and left 
 upper first molars were exposed by the absorp¬ 
 tion of their alveoli, and were necrosed and coated 
 with tartar. These were the sensitive teeth. They 
 
28 
 
 FACIAL NEURALGIA. 
 
 were extracted, and the result has been the cessa¬ 
 tion of the neuralgic attacks. 
 
 A young lady, about 20 years of age, was sent 
 to me on October 8th, 1867, by Dr. Norton, of 
 Bayswater. She had been residing in the West 
 Indies, and had suffered whilst there and since 
 her return from frequent attacks of excruciating 
 neuralgic pain. She had been in the habit of 
 taking large doses of quinine and other remedies 
 without apparent effect. She had decayed teeth 
 but no toothache. On examination it was found 
 that the lower bicuspids on each side were decayed 
 and broken down to a level with the gum, but 
 they were not tender, and did not appear to be 
 the seat of active disease. There were a few 
 cavities in other teeth with sensitive dentine, but 
 no exposure of the pulp. 
 
 The roots were extracted. They were found 
 to be enormously exostosed, their apices being en¬ 
 larged to a size almost equal to that of an ordinary 
 crown of a bicuspid. The carious cavities in other 
 teeth were filled. This treatment was followed by 
 a permanent cure of the neuralgia. 
 
 Rev. P. C—, aet. 43, of rheumatic diathesis, 
 applied to me, December 27th, 1865. He had 
 been suffering for a considerable period from facial 
 
FACIAL NEURALGIA. 
 
 29 
 
 neuralgia. During the last few weeks the whole 
 of his teeth had become tender and loose. The 
 teeth were found free from caries, but were the 
 seat of general periostitis. There was slight 
 absorption of all the alveoli. The second molar 
 and wisdom tooth of the right upper jaw were 
 hopelessly loose. They were extracted. Three 
 grains of iodide of potassium in an ounce of 
 decoction of bark were ordered to be taken three 
 times a day. The bowels were also attended to. 
 Blood was abstracted locally by dividing, with a 
 sharp scalpel, the swollen gum in the interstices 
 of the teeth, and washing the mouth with warm 
 water, and this operation was repeated on several 
 occasions. Under this treatment all the symptoms 
 disappeared in the course of a month, and the 
 neuralgia had not returned when I saw him on 
 July 8th, 1S67. 
 
 G. S—, set 20, a student of medicine, applied 
 to me at the commencement of the last long vaca¬ 
 tion. He said he suffered from “ maddening” 
 attacks of neuralgia, which came on generally 
 when he was working hard and confined to the 
 house. These attacks subsided under the adminis¬ 
 tration of purgatives followed by large doses of 
 quinine. He had toothache also, but his teeth 
 
30 
 
 FACIAL NEURALGIA. 
 
 were so bad that he had been afraid to have them 
 looked at. It was found that he had hardly a 
 sound tooth in his head, and that about eight of 
 them were broken down beyond repair. The 
 latter were extracted and were found in various 
 conditions of old-standing disease, some exostosed, 
 others necrosed, and nearly all coated with organ¬ 
 ized lymph. The cavities in other teeth were 
 filled. The treatment was followed by a permanent 
 cure of the neuralgia. 
 
 This case falls under the class to which apply 
 the remarks of Dr. Brinton. Numerous nerve- 
 fibrils are subjected to chronic irritation. When 
 the patient is in robust health, pain is manifested 
 only in the immediate neighbourhood of the disease, 
 namely, the decayed teeth. When, however, he 
 becomes depressed and when his general health is 
 disordered, the irritation which had previously 
 given rise to toothache only, now brings on wide- 
 spreading neuralgia. Relieve his loaded bowels 
 and stimulate him by large doses of quinine and 
 the pain vanishes, only, however, to return again 
 and again under similar circumstances, as long as 
 the exciting cause remains. 
 
 The following case will serve to exemplify that 
 
INDIGESTION. 
 
 31 
 
 variety of facial neuralgia which, defying all local 
 and even constitutional treatment, must be ascribed 
 to some deep-seated cause. 
 
 A. M—, mt. 64, applied at the hospital on July 
 24th last, for the purpose of having the last of her 
 teeth, a lower canine which was very loose, ex¬ 
 tracted. She volunteered the statement that for 
 several years she had been a sufferer from neu¬ 
 ralgia. Her teeth had all decayed, but their ex¬ 
 traction afforded no permanent relief. She pointed 
 to the course of the nerves over the right side of 
 the face as the seat of pain, and this she said was 
 of the most agonising character. The right eye 
 too was affected during the attacks, and tears 
 flowed in abundance. Her general health, with this 
 exception, remained pretty good. She had been 
 treated at various hospitals and dispensaries with¬ 
 out permanent relief. She believed, however, that 
 the pain was mitigated and sometimes stopped by 
 the aconitine ointment, which she rubbed in vigor¬ 
 ously with the point of her finger at the painful 
 parts. 
 
 Indigestion .—In indigestion, much can be 
 done by the dental surgeon to assist the phy¬ 
 sician in his treatment. The presence of a few 
 
32 
 
 INDIGESTION. 
 
 carious and tender teeth is often sufficient to 
 prevent the effectual mastication of the food, 
 much of which is consequently swallowed in 
 masses, which, resisting the action of the gastric 
 and intestinal secretions, pass through the di¬ 
 gestive canal entirely unaltered. Among the 
 minor and common effects of impaired mastication 
 is the occurrence of dyspepsia and colic, more 
 or less severe in character, caused by the presence 
 of such indigestible masses in the alimentary tract, 
 which from their unaltered condition assume the 
 nature of foreign bodies, and thus become a source 
 of irritation. These circumstances in persons of 
 vigorous constitution may be productive of no 
 further evil, but in those of delicate health, and 
 with powers of digestion naturally feeble, they 
 may most materially aggravate the particular 
 symptoms under which the patient labours. This 
 is more especially the case in those afflicted with 
 diseases which are associated with mal-assimilation, 
 such as scrofula and consumption. In these indivi¬ 
 duals it is almost invariably found that the teeth 
 are of the most defective character, so that those 
 in whom it is most necessary that the food should 
 be perfectly triturated in order to facilitate the 
 work of the digestive apparatus are, as a rule, 
 least able to prepare their food for these already 
 
INDIGESTION. 
 
 33 
 
 overburdened organs. Similar observations apply 
 to persons of advanced age. The teeth have 
 usually been lost by the time when, from decay of 
 the constitution, the digestive powers are becoming 
 feeble, and thus food is swallowed in a condition 
 in which it can be but imperfectly acted upon or 
 assimilated. 
 
 It will be seen that much good may be achieved 
 by restoring the power of mastication either by 
 bringing remaining teeth into a healthy state, or 
 by the insertion of artificial substitutes for those 
 that are absent. In hospital practice we are re¬ 
 stricted to the first of these means, because, for 
 obvious reasons, we cannot supply the patients 
 with artificial teeth, and thus unfortunately the 
 good which might be done is curtailed. Speaking 
 to me on this subject a few weeks ago, my colleague, 
 Dr. Maudsley, remarked how hopeless was the 
 treatment of some cases of dyspepsia, in which, 
 owing to the loss of teeth, mastication could not 
 be performed. He suggested that the institution 
 of a charity for supplying the poor with artificial 
 teeth would confer a real benefit upon many. 
 This practicable suggestion, it appears to me, is 
 well worthy of consideration, and therefore I here 
 publicly record it. 
 
 D 
 
34 
 
 INDIGESTION. 
 
 I have notes of many cases in which imme¬ 
 diate benefit has arisen from restoring the power 
 of mastication by the insertion of artificial teeth. 
 The following is a striking example. It forms 
 the sequel of a case which I described before the 
 Odontological Society early last year, and which 
 was published in the Journal. 
 
 A. S—, set. 23, was sent to me on November 
 22nd, 1867. She presented a good example 
 of that class whose delicate frame, brilliant com¬ 
 plexion, and large eyes, we are wont to consider 
 to some extent characteristic of phthisis. Of 
 this disease, however, no active symptoms were 
 to be observed. She came to consult me about a 
 fistulous opening on the face near the angle of the 
 jaw on the left side, which, with short intervals 
 of closure, had existed for two years. She had 
 applied to an advertising “ Dental Firm,” who, dis¬ 
 regarding the principal causes of her sufferings, 
 had contented themselves with inserting an upper 
 set of teeth attached by pivots to remaining 
 roots. 
 
 She informed me, that in addition to the an¬ 
 noyance of the chronic fistulous discharge, she had 
 toothache and frequent neuralgia. She could not 
 attempt mastication, and hence confined herself 
 
INDIGESTION. 
 
 35 
 
 almost entirely to liquid food. Dyspepsia with her 
 was constant. Her appetite was bad, and she 
 suffered from headache and from colic and dis¬ 
 orders of the bowels. She was thin, and thought 
 she was losing flesh. 
 
 Every tooth in her head, with the exception 
 of the lower incisors and canines, was found 
 decayed and broken down to a level with the gum, 
 the external discharge obviously proceeding from 
 the chronic suppuration about those in the left 
 lower jaw. 
 
 She was placed under the influence of chloro¬ 
 form on two occasions (nitrous oxide was not yet 
 in use as an anaesthetic), and the whole of the 
 decayed roots were extracted. This was followed 
 by the rapid healing of the fistula, and by an 
 immediate amelioration of the general health. 
 The greatest benefit was, however, manifested, 
 when, after the lapse of a proper time, a set of 
 teeth was provided with which she was enabled 
 thoroughly to masticate her food. Her dyspepsia 
 vanished, and no longer restricted to fluids, she 
 availed herself of a suitable nourishing diet. The 
 result has been—increase of flesh, improvement of 
 appetite, of colour, and of spirits, until she is now 
 in every respect in perfect health. 
 
 This case suggests some remarks upon the 
 
 d 2 
 
36 
 
 NECROSIS OF THE JAW. 
 
 subject of the extraction of decayed roots pre¬ 
 paratory to the insertion of artificial teeth. It 
 is commonly believed that the removal of roots 
 is in every case necessary. On the contrary, 
 whilst the presence of any number of roots rarely 
 prevents the adaptation of serviceable artificial 
 teeth, they may, when they remain firm and free 
 from pain, be often retained with advantage. It 
 is only in cases such as that last related, where 
 they are a source of constant suffering to the 
 patient, that their removal becomes desirable, and 
 then not so much to facilitate the insertion of 
 artificial teeth, as to relieve the patient, and to 
 prevent the evil effects upon the health, which are 
 so often induced by extensive dental disease. 
 
 Necrosis of the Jaw .—Two cases of necrosis 
 of the jaw in infants have recently been referred 
 to me by the surgeons of the hospital. They 
 illustrate a point which has more than once 
 given rise to discussion, namely, whether after 
 the removal of portions of dead jaw-bone, together 
 with the crypts containing rudimentary perma¬ 
 nent teeth, these teeth are redeveloped in the new 
 bone which may be formed ? 
 
 I need not relate my cases in detail. In both 
 
NECROSIS OF THE JAW. 
 
 37 
 
 there was a history of inflammation commencing 
 in the gnm about the temporary teeth, spreading 
 thence from the alveoli to the periosteum of the 
 jaw, and terminating in death of a portion of 
 bone. As usual in these cases, the children were 
 cachectic, and the treatment was therefore directed 
 more particularly to the general health. Locally 
 detergent lotions were used to overcome the 
 horrible fetor. The dead bone was not interfered 
 with until perfectly detached, when it was drawn 
 out through the openings in the gum. 
 
 In the first case a portion of bone was removed 
 en masse , containing the lower temporary incisors. 
 The necrosis had stopped short in the direction of 
 the permanent saccules, and these did not come 
 away. In this instance, therefore, I confidently 
 anticipate that the permanent teeth will in due 
 course appear. 
 
 In the second case, which was in the upper 
 jaw, the temporary teeth fell out, and the alveoli 
 exfoliated, and small pieces were from time to time 
 brought to me by the mother. At length larger 
 masses became detached. These were removed, 
 and in them were contained the developing per¬ 
 manent central incisors. In this case I have 
 equal confidence in predicting that permanent in¬ 
 cisors will not be produced. In cases like these, 
 
38 
 
 NEURALGIA. 
 
 in which the teeth have been supposed to reappear, 
 the explanation is, that the saccules with the 
 rudimentary teeth have not been removed but have 
 remained attached to healthy tissue, and have in 
 time become surrounded by new bone. It is con¬ 
 trary to all physiological principles that a structure 
 so complex as a tooth crypt and its contents could 
 be redeveloped after destruction by disease. 
 
 Cases such as I have here related, and which 
 cannot be uncommon in the practice of most 
 dental surgeons, suffice to show that dentistry is 
 no unworthy ally of medicine. But, indeed, if the 
 prevention and cure of disease and the relief of 
 suffering constitute the practice of medicine, does 
 not dentistry occupy par excellence the position 
 we claim for it as a branch of the practice of 
 medicine in the broad sense of the word ? 
 
 In my last contribution, several subjects of 
 considerable interest and importance were briefly 
 touched upon, and to these, as they are’worthy of 
 more lengthy discussion, I will now return. 
 
 Neuralgia .—First, with regard to neuralgia. 
 I mentioned the physiological fact that irritation 
 
NEURALGIA. 
 
 39 
 
 of a nerve commonly manifests itself by pain at 
 some point distant from the seat of injury, whilst 
 not unfrequently the injured part itself remains 
 free. Being ignorant of the manner in which in¬ 
 fluences are communicated from one part to other 
 parts of the nervous system, we cannot account for 
 these phenomena, which, nevertheless, present 
 themselves daily in the observation of disease,—as 
 already exemplified by an inflamed liver giving 
 rise to pain about the right shoulder; a diseased 
 hip-joint producing pain at the knee ; and an 
 irritated tooth-pulp exciting pain at remote parts 
 of the head and face. 
 
 The following cases, bearing upon this subject, 
 which are quoted by Dr. Handheld Jones, may be 
 here cited as a supplement to those related in my 
 last paper. “ Freidberg records four cases of 
 severe pain in the face, involving in three all the 
 divisions of the fifth nerve, and refractory to all 
 internal treatment, which at length yielded to the 
 extraction of one carious tooth. The remarkable 
 circumstance was, that other carious teeth had 
 been previously extracted without relief, although 
 they were painful and aching, while the tooth 
 which appeared to be the cause of the neuralgia 
 was painless/’ 
 
 Beyond merely exciting distant pain, irritation 
 
40 
 
 NEURALGIA. 
 
 of a peripheral nerve may give rise to functional 
 disturbance of the brain, or other great nerve- 
 centres, resulting in various phases of morbid 
 action. “ Dr. Brown-Sequard maintains,” says 
 Dr. Handheld Jones, “ that various forms of 
 vertigo, of epilepsy, and also of hysteria, chorea, 
 tetanus, &c., may be due to irritation starting from 
 a centripetal nerve, and frequently slightly felt, 
 or unfelt, at the seat of injury; and that sup¬ 
 pression of the irritation may promptly cure the 
 patient. Graves reports a case where an extremely 
 severe cough, which had resisted all treatment 
 directed to relieve bronchitis, ceased at once on 
 the exptilsion of a mass of tapeworm by a dose of 
 turpentine. It does not appear that any symp¬ 
 toms had existed in this case to announce the 
 presence of the intestinal parasite. Perhaps the 
 following instance is still more proving, inasmuch 
 as the seat of irritation was in a much more sen¬ 
 sitive part. A married lady had suffered for a 
 considerable period from a spasmodic pain in the 
 womb, which ceased completely on the extraction 
 of a tooth that had not caused any material 
 annoyance.” 
 
 I must not be understood to imply from this 
 that dental disease, except in rare cases, is the 
 exciting cause of nervous affections of a nature 
 
NEURALGIA. 
 
 41 
 
 more alarming than neuralgia. My object is to 
 show that the phenomena of this disease are 
 among the most ordinary and least wonderful of 
 the inexplicable manifestations of reflex nervous 
 irritation. There is, however, abundant evidence 
 that grave derangement of the nerve-centres does 
 occasionally result even from the mere irritation 
 of the dental nerves. For instance, Mr. Tomes 
 relates two cases of epilepsy which, resisting all 
 previous treatment, were cured by the extraction 
 of exostosed teeth. A further illustration is fur¬ 
 nished by the diseases of the teething period in 
 infants. At this period, the nervous system is 
 very susceptible of morbid influences, and it com¬ 
 monly happens that disorders of an aggravated 
 character are produced by the irritation of the 
 dental nerves occurring during difficult dentition. 
 That this irritation is often the sole cause of the 
 symptoms is proved by the fact that in many 
 cases an attack of convulsions is instantly cured 
 by an incision into the indurated gum covering a 
 developing tooth. 
 
 Reverting to facial neuralgia, if to all these 
 facts we add that there are no symptoms which 
 serve to distinguish the variety of the disease due 
 to constitutional causes from that set up by local 
 irritation, it will be seen that the importance of 
 
42 
 
 NEURALGIA. 
 
 searching for these local causes cannot be over¬ 
 estimated. 
 
 The examination of the teeth should be made 
 by a skilled person. It is not sufficient to glance 
 into the mouth for carious cavities, each tooth 
 must be separately explored with the aid of instru¬ 
 ments and a mouth mirror. A careful search must 
 be made in the interstices of the teeth, where 
 carious cavities are often concealed. It is next to 
 be remembered, that neuralgia may be excited by 
 necrosis, by exostosis, and also by inflammation 
 and thickening of the dental periosteum. The 
 signs of these diseases must therefore be looked 
 for. In the absence of other symptoms, the of¬ 
 fending tooth, when the mischief is situated about 
 the root, will be sometimes discovered by a current 
 of cold water, or by a smart tap with an instru¬ 
 ment. Should it be loose or discoloured, or should 
 its alveolus be absorbed, it will of course readily 
 attract attention. It must be borne in mind, how¬ 
 ever, that in these cases every decayed tooth is by 
 no means condemned to extraction. Neuralgia 
 may frequently be effectually guarded against by 
 filling cavities of decay, and so protecting the 
 sensitive structures of the teeth from irritation 
 and from sudden changes of temperature. I al¬ 
 luded to the value of the so-called osteoplastic 
 
NEURALGIA. 
 
 43 
 
 filling in this treatment. The following case will 
 illustrate its use :— 
 
 Three years ago a member of our profession 
 had a lower molar filled with gold. The tooth 
 was extensively carious, and the pulp was nearly 
 exposed. After the operation, it remained sensi¬ 
 tive to changes of temperature, and when it was 
 touched by anything extremely cold there resulted 
 pain of a neuralgic character, shooting along the 
 right cheek and eyelid. Having waited several 
 months in the hope that the sensibility would 
 subside, I removed the gold, filled the bottom of 
 the cavity with osteoplastic, and, when this be¬ 
 came hard again completed the stopping with 
 gold. 
 
 The osteoplastic being a very bad conductor 
 of heat, prevents the communication of sudden 
 changes of temperature to the pulp, and since the 
 tooth was refilled, it has remained under all circum¬ 
 stances free from pain, and the neuralgia has not 
 recurred. 
 
 Digestion .—A few more remarks now upon 
 the teeth in relation to digestion. 
 
 The principal office of these organs is to tritu¬ 
 rate the food, and to mingle it with the salivary 
 secretions. This act, which constitutes the first 
 
44 
 
 DIGESTION. 
 
 step in the process of digestion, is recognized by 
 all physiologists and physicians as an operation of 
 great importance. Were other evidence wanting, 
 it would, indeed, still be obvious that nature 
 would not have provided so perfect an apparatus 
 for the trituration of the food, and so complex an 
 arrangement for the secretion of saliva during the 
 act, if mastication could be dispensed with. The 
 utility of this process can be, however, more 
 directly demonstrated. Mastication effects changes 
 in the food which very materially influence the 
 subsequent stages of digestion. These changes 
 are of two kinds—mechanical and chemical. Of 
 the first. Dr. Carpenter says, “ Mastication is 
 evidently an operation of great importance in 
 preparing the substances afterwards to be operated 
 on for the action of their solvents ; and it exactly 
 corresponds with the trituration to which the 
 chemist would submit any solid matter, that he 
 might present it in the most advantageous form 
 to a digestive menstruum. The complete dis¬ 
 integration of the alimentary matter is, there¬ 
 fore, of great consequence; and, if imperfectly 
 effected, the subsequent processes are liable to 
 derangement. Such derangement we continually 
 meet with, for there is not, perhaps, a more fre¬ 
 quent source of dyspepsia than imperfect mastica- 
 
DIGESTION. 
 
 45 
 
 tion 9 whether resulting from the haste in which the 
 food is swallowed , or from the want of the instru¬ 
 ments proper for the reducing operation ” 
 
 The chemical changes accomplished during 
 mastication are due to the saliva, which, acting 
 upon the insoluble starchy constituents of the food, 
 converts them into sugar, a perfectly soluble com¬ 
 pound, capable of being at once taken up by the 
 absorbents of the stomach. If, however, these 
 constituents of the food be unacted upon in the 
 mouth, they remain unchanged until passing from 
 the stomach they enter the intestine, and become 
 influenced by the pancreatic and other secretions. 
 Under such circumstances, it is clear they may 
 become a source of irritation in the stomach, and 
 their digestion must impose an extra burden upon 
 the intestinal portion of the alimentary tract. On 
 this point Dr. Habershon writes, “ Imperfect mas¬ 
 tication greatly increases the work of the digestive 
 
 organs.The action of the saliva 
 
 upon the starchy elements of farinaceous food is 
 also facilitated when sufficient time is allowed for 
 the food to be thoroughly mixed/’ Upon the 
 same subject, Dr. Leared says, “It is most im¬ 
 portant that solid food should be duly prepared, by 
 chewing, for the action of the stomach; and it is 
 also important that the starchy elements of the 
 
46 
 
 DIGESTION. 
 
 food be sufficiently submitted to the action of pure 
 saliva.” 
 
 The evil effects which arise from inability to 
 masticate vary in degree of severity with the age 
 and constitution of the patient. They seldom 
 pass in the robust adult beyond an occasional 
 attack of dyspepsia. It is, however, evident that 
 inability to masticate may produce more serious 
 results in those whose digestive power is naturally 
 weak, and who, under favourable circumstances, 
 would find a difficulty in digesting even the most 
 carefully selected diet. Masses of food, acting as 
 mechanical irritants, may keep up chronic dys¬ 
 pepsia ; and, at the same time, the difficulty of 
 assimilation being increased, it is reasonable to 
 infer that general debility, already existing, may 
 be aggravated. Such results might be anticipated 
 in scrofula and consumption, diseases to a great 
 extent connected with mal-assimilation, that is, in 
 which, owing to some constitutional defect, the 
 processes of nutrition are imperfectly performed. 
 Indigestion of the most marked character is in¬ 
 variably present in these affections. “ Ever since 
 tuberculosis has become more studied as a con¬ 
 stitutional affection,” says Dr. Aitken, “ it has been 
 rendered more apparent that the disorder of the 
 digestive organs is the primary disorder of func- 
 
DIGESTION. 
 
 47 
 
 tion which ushers in the cachexia ; and that a 
 certain form of dyspepsia is not only present in 
 the hereditary strumous constitution, but is capable 
 of generating the bad habit of body, and of lead¬ 
 ing ultimately to the deposition of tubercle.” It 
 is a remarkable fact, that in these diseases the 
 teeth are in most cases of so defective a character, 
 that mastication can be but imperfectly performed. 
 Now, without by any means assigning to the teeth 
 a share in the causation of a strumous dyspepsia,” 
 which undoubtedly depends primarily upon some 
 innate defect, I am convinced, from the observa¬ 
 tion of a considerable number of cases, that it is 
 most materially aggravated by inability to masti¬ 
 cate, and that the restoration of the function of 
 the teeth is of great value as an aid in its 
 relief, and also in the amelioration of the general 
 symptoms. 
 
 It must be sufficiently obvious, from a con¬ 
 sideration of the physiology of digestion, that 
 dyspeptic symptoms of any degree of severity may 
 have their entire origin in the condition of the 
 teeth, and that there is no case of indigestion 
 which will not be aggravated by inability to masti¬ 
 cate. It is often difficult to fix upon the actual 
 cause of disorder in a process so complex as di¬ 
 gestion, in which the functions of many distinct 
 
48 
 
 DIGESTION. 
 
 organs are engaged. If, however, dyspeptic symp- 
 * toms become mitigated or cured on the restoration 
 of a function previously suppressed by disease, 
 there can he no reasonable doubt that the suppres¬ 
 sion of that function had at least a share in 
 . originating them. 
 
 In the following cases the exciting cause of 
 the disorder was, clearly, inability to masticate, in 
 other words, omission of the first act in the process 
 of digestion, which it is the function of the teeth 
 to perform. Instances of a similar kind are 
 common. 
 
 N. S—, aged 56, a vigorous country gentle¬ 
 man, was brought to me in January, 1867, by 
 Dr. Skimming, of Molesey. He stated that his 
 appetite was good, but that being toothless he was 
 obliged to “ bolt ” his food. His dyspeptic symp¬ 
 toms were flatulence and eructations, and occasional 
 attacks of severe griping pain, coming on an hour 
 or two after meals. 
 
 A set of teeth was made for him. He re¬ 
 mained continually under observation after these 
 were inserted, and there was no return of the 
 dyspepsia. 
 
 The next case was of a more serious character. 
 
 Mrs. A. M—, aged about forty-five was sent to 
 
DIGESTION. 
 
 49 
 
 me in June, 1866, by Dr. Bate, of Maida Hill. 
 She suffered from frequent headache and from that 
 characteristic mental depression which, being so 
 universally associated with indigestion, has caused 
 dyspeptic and hypochondriac to become almost 
 synonymous terms. She complained of pain in 
 the stomach after meals, of occasional vomiting, 
 and also of eructations of fetid gas. Her tongue 
 was foul, her appetite bad, and her bowels irre¬ 
 gular. These symptoms had persisted in spite of 
 Dr. Bates judicious medical and hygienic treat¬ 
 ment. 
 
 On inquiry I found that during the last ten 
 years she had been wearing a set of artificial teeth, 
 with which she had never been able effectually to 
 chew. They had been altered several times, as 
 remaining natural teeth decayed, and this had ren¬ 
 dered the fit so imperfect that for a long time they 
 had been quite useless in mastication. 
 
 I made a set of teeth for her, and the medical 
 treatment was again resumed. This time it was 
 successful, and the indigestion yielded to measures 
 which hitherto had proved entirely ineffectual. 
 
 I have already remarked that inability to 
 masticate may undoubtedly constitute the sole 
 cause of indigestion, and that it must in every 
 
 E 
 
50 
 
 DIGESTION. 
 
 case aggravate dyspeptic symptoms originating 
 elsewhere. When, however, it is asked if it be 
 the invariable custom of practitioners in cases of 
 dyspepsia to inquire whether the function of the 
 teeth is properly performed, I am afraid we must 
 answer that this matter is too often overlooked by 
 the physician as well as by the patient. Every 
 organ concerned is carefully examined, the teeth 
 are forgotten. It is difficult to account for this. 
 The importance of mastication is, as we have seen, 
 fully recognised by physiologists and physicians. 
 That the power of mastication lost in consequence 
 of the absence or disease of the teeth, can be, in 
 the vast majority of cases, effectually restored by 
 the dentist is also invariably pointed out by 
 writers on indigestion. I will not however dwell 
 longer on this topic, but will content myself in 
 conclusion, with adding the following extract from 
 the well known work of Sir Thomas Watson. 
 The testimony of such an authority alone is suffi¬ 
 cient to show that I have neither exaggerated the 
 importance of the relation which the teeth bear to 
 the disorders of digestion, nor over-estimated the 
 value of the aid which dentistry furnishes in the 
 treatment of the varied conditions of disease which 
 are classed under the common term dyspepsia. 
 
 Sir Thomas remarks, “I am not at all sure that 
 
DISEASES OE THE TEETH. 
 
 51 
 
 the increased longevity of modern generations is 
 not, in some degree, attributable to the capability 
 of chewing their food which the skill of the dentist 
 prolongs to persons far advanced in life.” 
 
 We thus see that when in a state of disease, 
 besides being a source of intense local suffering, 
 the teeth are frequently the exciting cause of pain 
 extending over the head and neck, and even to 
 more remote parts of the body, in consequence of 
 the irritation produced by them being commu¬ 
 nicated to the nerves supplying those parts. We 
 find further that the teeth are intimately associated 
 with the disorders of the digestive functions. In 
 addition to this, diseased teeth are among the 
 commonest exciting causes of various surgical 
 affections of the jaws and neighbouring parts, 
 such as necrosis, ulcerations, abscesses, and tumours 
 of several kinds. 
 
 Some of these affections will form the topics 
 of my next paper. 
 
 I concluded my last paper with the remark, 
 that diseased teeth were among the commonest 
 exciting causes of various surgical affections of the 
 
 e 2 
 
52 
 
 DISEASES OF THE TEETH. 
 
 jaws and neighbouring parts, such as necrosis, 
 ulcerations, abscesses, and tumours of several 
 kinds. 
 
 These facts are duly recognized by surgical 
 authorities. Thus Gross remarks, “ The influence 
 of the teeth in inducing and maintaining ill- 
 health in the jaws, gums, eyes, ears, head, and 
 lymphatic ganglions, as well as in other parts of 
 the body, is displayed in a great variety of ways, 
 and deserves the most careful consideration of the 
 general practitioner. Without an intimate know¬ 
 ledge of their relations, he must remain ignorant 
 of the pathology of some of the most common 
 
 affections about the head and face, and be conse- 
 
 ✓ 
 
 quently unable to treat them upon correct scientific 
 principles.” Mr. Liston, in his “ Elements of 
 Surgery,” says, “ From the presence of carious 
 teeth or decayed portions of teeth many evils, 
 both local and general, ensue. They are fre¬ 
 quently the cause and the sole cause of glandular 
 swellings in the neck, terminating in or combined 
 with abscesses ; of enlargement and inflamma¬ 
 tion of the tonsils, either chronic or acute; of 
 ulcerations of the tongue and lips, which often 
 assume a malignant action from continued irrita¬ 
 tion ; and of continued constitutional irritation, 
 which may give rise to serious disease.” 
 
NECROSIS OF THE JAW. 
 
 53 
 
 Necrosis of the Jaw .—Necrosis of the jaw, 
 arising from diseased teeth, was illustrated by 
 the two cases in infants related in my first paper. 
 Instances similar to these in their origin and 
 history commonly occur in adults. Inflammation 
 of the sockets of diseased teeth, extending to the 
 periosteum of the jaw, proceeds to suppuration, 
 and terminates in death of a portion of the body 
 of the bone. In this stage the disease passes from 
 the province of the dentist to that of the surgeon. 
 It may, however, be useful to relate the following 
 case, which is still under treatment, and which I 
 have had repeated opportunities of examining in 
 consultation with Mr. A, Trehern Norton. He 
 agrees with me that the mischief, undoubtedly, 
 had its origin in the dental disease. 
 
 J. T—, aged thirty-six, applied to Mr. Norton 
 in January last, with the left side of the face 
 extensively enlarged. The swelling wms soft and 
 fluctuating in two places, one beneath the malar 
 bone, the other in the submaxillary region. Both 
 of these were opened and a large quantity of 
 offensive pus was evacuated. On examination 
 with a probe, necrosis of the body of the jaw was 
 detected through the lower orifice, but bone was 
 not felt through the upper one. On looking into 
 the mouth it was found that the molars on the 
 
54 
 
 ULCEES OF THE TONGUE. 
 
 diseased side were much decayed. The gum was 
 swollen and spongy, and offensive matter flowed 
 into the mouth. The first molar was now ex¬ 
 tracted, and attached to it came away a por¬ 
 tion of the outer lamina of the bone with the 
 alveolus, forming together a mass of greater size 
 than the tooth. The mischief, however, did not 
 cease here, and a profuse discharge continued to 
 flow from both the external openings, as well as 
 into the mouth. I now extracted the second 
 molar and the wisdom tooth, and found on further 
 exploration that the necrosis involved the coronoid 
 process. The patient, a highly intelligent man, 
 gave a clear history of dental caries leading on to 
 periostitis, and resulting in the extensive necrosis 
 above described. 
 
 This case, as I have observed, is still under 
 treatment, but on some future occasion I shall 
 probably report its result. 
 
 Ulcers of the Tongue .—Ulcers of the tongue 
 are not rarely caused by the constant friction of 
 that organ against the ragged edges of decayed 
 teeth. 
 
 The following is an exemplification of the 
 serious aspect which this at first trifling affection 
 may assume, and it illustrates the fact that, in 
 
ULCERS OF THE TONGUE. 
 
 55 
 
 these cases, the injury is so gradually inflicted 
 that the patient often remains unconscious of the 
 true seat of the irritation. 
 
 T. F—, aged sixty, was sent to me on No¬ 
 vember 29th, 1867, by Mr. Reid, the house-surgeon 
 at the West London Hospital. Three months 
 before this he had sustained a fracture of the 
 lower jaw on the left side. The case appeared to 
 go on well, but he suffered a good deal of pain. 
 When, however, the fracture became firmly united, 
 the pain was so much aggravated by mastication 
 that he had altogether abandoned the attempt to 
 take solid food. His tongue was swollen and 
 painful, and the glands below the jaw were en¬ 
 larged, indurated and tender. 
 
 Being old and feeble he was reduced to a truly 
 critical condition by his constant sufferings, com¬ 
 bined with the inability to take solid food. 
 
 The recent fracture would have led one to the 
 belief that mischief was impending in the bone. 
 On a careful examination, however, the true 
 nature of the case was revealed. A decayed 
 molar had been driven inwards by the blow that 
 had caused the fracture, and the tongue in con¬ 
 stant movement against the ragged edges of this 
 tooth had become abraded and ulcerated along a 
 
56 ABSCESSES IN CONNECTION WITH THE TEETH- 
 
 considerable extent of its left border and under 
 surface. On the extraction of the offending tooth 
 the ulcer healed, and all the local symptoms sub¬ 
 sided in the course of a week. 
 
 Abscesses in connection with the Teeth. —Ab- 
 cesses in connection with the teeth are seen in 
 their simplest and commonest form in the ordi¬ 
 nary “ gumboil.” This consists of a collection of 
 matter confined between the gum and the bone, 
 resulting from inflammation of the lining mem¬ 
 brane of the socket of a tooth. In a severer form 
 of the same affection the cheek becomes involved 
 in the inflammation, great swelling takes place, 
 and lymph is thrown out which proceeds to sup¬ 
 puration. At this stage the matter, if it do not 
 find a free exit into the mouth, will frequently, 
 and more especially when aided by poultices, 
 point and burst externally. Thus there results a 
 fistulous tract between the diseased tooth and the 
 external surface of the cheek, which remains open 
 and discharging as long as the inflammation con¬ 
 tinues. 
 
 A case of this kind was mentioned in my first 
 paper. Similar instances constantly present them¬ 
 selves ; sometimes in private practice, but more 
 often among hospital patients, who are more prone 
 
ABSCESSES IN CONNECTION WITH THE TEETH, 57 
 
 to neglect their diseases until they assume an 
 aggravated form. 
 
 There is a popular error on this subject which 
 prevails to some extent, even among the more 
 intelligent classes. The belief is that it is both 
 difficult and dangerous to remove a tooth when 
 great swelling and inflammation of the soft parts 
 are present. There are no grounds whatever for 
 such a belief. The tooth is usually loose, and 
 there are no special difficulties attending its ex¬ 
 traction. No harm can possibly arise from the 
 operation, while on the contrary, much good must 
 follow it. It provides at once a free vent into the 
 mouth for the matter and so does away with the 
 danger of the bursting of the abscess through 
 the cheek. The tooth has usually to a great 
 extent lost its vitality and constitutes the sole 
 cause of the mischief. We accordingly find that 
 after its removal further treatment is seldom 
 required. 
 
 When ignorant of the true nature of their 
 malady or loth to believe that mischief so ex¬ 
 tensive could arise from the teeth ; patients often 
 endure prolonged and severe suffering, to the 
 serious detriment of their general health. They are 
 fortunate when, as in the following case, necrosis of 
 the jaw does not also ensue. 
 
58 ABSCESSES IN CONNECTION WITH THE TEETH 
 
 Mrs. W—, was brought to me by Mr. Musgrave 
 of St. John's Wood, on April 20th, 1869. About 
 a year previously an ineffectual attempt had been 
 made to extract a lower molar, the crown of the 
 tooth alone having been broken away. She sub¬ 
 sequently suffered great pain, and the side of the 
 face became considerably swollen. Poultices were 
 applied and an abscess formed and burst externally. 
 The discharge continued for many months until the 
 patient was reduced to a condition of great de¬ 
 bility. At length she came under the care of 
 Mr. Musgrave, who, as soon as she was able to 
 leave the house, brought her to me. 
 
 I found the parts about the left side of the 
 jaw much enlarged and indurated. There was an 
 opening near the left angle of the jaw discharging 
 freely. The case altogether closely simulated ne¬ 
 crosis of rhe jaw. There was indeed good reason 
 to suspect—although it did not appear on exami¬ 
 nation—that injury to the bone had been inflicted 
 by the long-existing inflammation. There could 
 however, be no hesitation in removing the broken 
 tooth—the primary cause of the mischief. Ni¬ 
 trous oxide gas was therefore administered and 
 the roots were removed. The patient was then 
 sent home. In the course of a few days it became 
 evident from the rapid subsidence of the local 
 
ABSCESSES IN CONNECTION WITH THE TEETH. 59 
 
 symptoms that there was no dead bone to come 
 away, and that the case would soon be so far well. 
 As soon as she had regained a little strength the 
 patient was removed to the sea-side. 
 
 The offending teeth in these cases are easily 
 detected, being as a rule loose and extensively 
 carious, and having the gum about them inflamed 
 and swollen, with matter oozing from it on 
 pressure. 
 
 The following case illustrates several interesting 
 points. First, it shows that occasionally there may 
 occur some difficulty in fixing upon the exact seat 
 of disease ; secondly, that periosteal suppuration 
 may take place in the alveoli of comparatively 
 healthy teeth; and lastly, that in such a case the 
 teeth should not be too hastily extracted, for the 
 disease may subside under other treatment, with¬ 
 out any consequent permanent injury to them or 
 to the neighbouring parts. 
 
 X—, aged twenty-seven, assistant surgeon at 
 a metropolitan hospital, travelling by railway, in 
 September, 1867, had symptoms of inflammation 
 on the left side of the lower jaw, induced by the 
 draught during the journey. Two days after this 
 a small quantity of matter could be pressed from 
 the gum, which overlapped the partly cut wisdom 
 tooth of the affected side. The inflammation soon 
 
60 ABSCESSES IN CONNECTION WITH THE TEETH. 
 
 extended to the cheek, where a dense hard mass 
 became evident, from the deposit of lymph in the 
 tissues* The pain was considerable behind the 
 wisdom tooth, as high as the coronoid process. 
 Matter still continuing to flow from the gum, a 
 free incision was made down to the periosteum. 
 Iodide of potassium in decoction of bark had been 
 taken from the first. This treatment did not, 
 however, prevent the swelling in the cheek from 
 suppurating, for that also softened and burst into 
 the mouth. The parts now rapidly healed, and 
 nothing remained but slight tenderness along the 
 ascending ramus of the jaw. 
 
 Towards the end of October, X— again caught 
 cold while partridge shooting in wet weather, 
 and all the previous symptoms returned. The 
 gum became inflamed and spongy, so that it was 
 impossible to close the teeth or to masticate; and 
 the hardness and swelling of the cheek again 
 supervened, this time with oedema extending to 
 the eyelid. 
 
 By degrees the more acute symptoms subsided, 
 but there remained a peculiarly circumscribed hard 
 swelling, about one inch in diameter, situated on 
 the cheek opposite the anterior lower molar. 
 This persisted for many days, when it was opened 
 externally, and a small quantity of pus escaped. 
 
ABSCESSES IN CONNECTION WITH THE TEETH. 61 
 
 Poultices were applied, and matter continued to 
 escape during a period of more than three weeks. 
 X— now left town for a few days, and the wound 
 suddenly healed. 
 
 It must be here remarked that, on examining 
 the mouth after the subsidence of the first attack, 
 it was found that the first and second molars con¬ 
 tained small fillings, and that the wisdom tooth 
 was partly concealed in the ramus of the jaw. 
 There was slight and equal tenderness of each of 
 these teeth. It was thus impossible confidently 
 to fix upon either of them as the exciting cause 
 of the mischief, and it was therefore resolved to 
 adopt the ordinary treatment for periostitis, and 
 to await the result. This decision proved a wise 
 one, for, in time, all the symptoms disap¬ 
 peared, leaving behind no trace whatever ex¬ 
 cept a small and scarcely noticeable scar on the 
 cheek. 
 
 Abscesses connected with diseased teeth, are 
 usually readily traceable to their origin. The 
 matter may, however, burrow through the soft 
 tissues, and appear in situations so unusual that 
 their relation to the teeth would not at first sight 
 be suspected. The following are illustrative ex¬ 
 amples, and they show that, in cases of abscesses 
 
62 ABSCESSES IN CONNECTION WITH THE TEETH. 
 
 about the face, whose origin is not otherwise evi¬ 
 dent, it is very important that a careful examina¬ 
 tion of the teeth should be made. 
 
 The first I saw with Mr. A. T. Norton. It 
 was that of a little boy, ten years old, who had, 
 near the inner corner of his right eye, a fistulous 
 opening, simulating exactly in situation and ap¬ 
 pearance lachrymal fistula. The opening had 
 existed during several months, and had continu¬ 
 ously discharged thin purulent matter. A probe, 
 passed into the opening, was found not to take 
 the course of the lachrymal duct, but to traverse 
 the front of the bone to near the alveoli, and 
 pushed onwards, it appeared in the mouth over 
 the canine tooth. This tooth was necrosed. It 
 was extracted, and pus followed immediately, and 
 continued to flow from the alveolus for a few days. 
 There was, however, no further discharge from the 
 opening on the face, and the parts healed rapidly 
 after the removal of the tooth. 
 
 The next case was sent to me by Dr. H. F. 
 Parsons, of Beckington, to whom I am also in¬ 
 debted for the latter portion of the details. The 
 subject was a gentleman about twenty-five years 
 of age. He came to me in May, 1868, suffering 
 
DISEASES OF THE TEETH. 
 
 63 
 
 from periostitis of the second right upper molar. 
 This got well under treatment, and the tooth 
 remained serviceable in mastication until the 
 middle of August, when the periostitis returned 
 and gave much pain for a week, in spite of iodide 
 of potassium, and a couple of leeches prescribed 
 by Dr. Parsons. An offensive purulent discharge 
 was now observed to trickle from the nostril of 
 the right side, when the head was inclined for¬ 
 ward. In a few days more this discharge became 
 thin and acrid, bringing tears into the patient s eyes. 
 The tooth which had ached was then extracted, 
 and the discharge at once ceased. Dr. Parsons 
 informed me that there had been no symptoms of 
 inflammation of the antrum. What happened 
 was evidently this. An alveolar abscess connected 
 with the aching tooth had burst into the antrum, 
 and the matter had found its way through the 
 natural opening into the nose. Dr. Parsons re¬ 
 marked how closely in this instance ozcena was 
 simulated, and indeed had not the history of 
 dental disease been clear, it is easy to perceive 
 that the case might have been mistaken for that 
 affection. 
 
 An examination of the varied phases of dental 
 disease leads one to appreciate fully the im- 
 
64 
 
 DISEASES OF THE TEETH. 
 
 portance of the part which the teeth take in influ¬ 
 encing health. We see that these organs cannot 
 be neglected with impunity, and that their pre¬ 
 servation or restoration may often be the means 
 of alleviating much suffering, of assisting in the 
 eradication of grave disease, and thus of pro¬ 
 longing life. It becomes also evident that dental 
 diseases must not be regarded as entirely local 
 and isolated, for their effects spread to neigh¬ 
 bouring parts, and they act upon and are them¬ 
 selves influenced by many constitutional condi¬ 
 tions. Further, it is rendered clear that these 
 affections involve and give rise to a great variety 
 of morbid processes, as for example, those which 
 constitute inflammation and its sequelae. Now, 
 these morbid processes are essentially the same in 
 their nature, in whatever organ or situation they 
 may appear; and their treatment is invariably 
 based upon the same fundamental principles of 
 medical science. Hence it is that although he 
 confine his attention exclusively to some distinct 
 organ or part, the practitioner must, nevertheless, 
 be duly acquainted with these general principles 
 of science, if he would deal rationally and success¬ 
 fully with disease. To this there may be added 
 that, when science is ignored, and when the treat¬ 
 ment of disease is carried out as a mechanical 
 
DISEASES OF THE TEETH. 
 
 65 
 
 routine, the result is not only frequent failure, 
 but often also the infliction of great injury and 
 intense suffering upon the patient. Ignorance 
 here we may thus understand is very closely allied 
 to cruelty, and therefore under no circumstances 
 can it be tolerated. 
 
 From the consideration of these facts, we dis¬ 
 cover that ample justification exists for the efforts 
 which have been made during late years to rescue 
 dentistry from the hands of the ignorant charlatan, 
 and to place it in those of the educated prac¬ 
 titioner. It might, however, be alleged that den¬ 
 tistry, strictly confined to the treatment of the 
 diseases of the teeth, constitutes a mere mechanical 
 art. A similar belief was current not many years 
 ago, with regard to surgery, when this branch of 
 practice was pursued to a great extent as a handi¬ 
 craft. It can be shown that dentistry is no more 
 a mechanical art than surgery. The practice of 
 each it is true consists to a great extent of the 
 application of mechanical apparatus, and of the 
 use of cutting, sawing, and gouging instruments. 
 But besides manual dexterity in the use of his tools, 
 the surgeon is required to possess an adequate 
 knowledge of anatomy, physiology, and pathology, 
 —the sciences upon which his art is based, for it 
 is found that without such knowledge his treat- 
 
 t 
 
66 
 
 DISEASES OF THE TEETH. 
 
 merit must prove commonly unsuccessful, and in 
 many cases disastrous. From the dental surgeon 
 there are demanded similar acquirements, for 
 without them, even in what at first sight appear 
 to he simple mechanical details of practice, he also 
 must he liable to many errors, and his treatment 
 must constantly fall short of success, if indeed it 
 do not aggravate the very mischief for which a 
 remedy is sought. 
 
 HARRtSON AND SONS, PRINTERS IN ORDINARY TO HER MAJESTY, ST. MARTIN’S LANE.