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twenty-four months is required by it to destroy the vitality
of the lining membrane and bony structure of the tooth, al-
though this progress is much more rapid
in the temporary,
than in the permanent teeth, and may sometimes be greatly
accelerated by accidental or artificial causes ; such
as, falls,
blows, acids, caustics, the actual cautery, and surgical opera-
tions
; all of which might be considered as likely to be no
less violent in their future morbid effects, than they are rapid
in destroying the vitality of the tooth.

Of the Symptoms of Complicated Caries*

The symptoms of complicated caries, like those of simple
caries, differ according to the state of the malady, and the
violence of the local and general causes by which the nerve
of the tooth is irritated.
In its first stage the disease seldom produces so much in-
flammation in the lining membrane as to render it very pain-
ful, and its effect is generally no more than a slight irritation
or hard pressure, on exposure to heat or cold, as real tooth-
ache is very rarely found to result from the disease in this
stage.
The symptoms of the second stage differ from those of the
first only in the degree of their violence and frequency.
The pressure of a blunt probe will produce more or less pain,
and the slightest external or general irritation, arising, for in-
stance, from heat or cold, or acids, or indigestion, or a little
more wine than usual, may bring on a violent fit of the tooth-
ache ; but when the inflammation in the lining membrane

* Koecker, pages 240 to 245.