Page 36 - An essay on the diseasesof the jaws, and their treatment

14 AN ESSAY ON THE Mr. Fox, in his " Natural History of the Teeth," as well as others which I shall refer to in the sequel of this Essay, and also from general experience; nor do they seem to be less dangerous in the one than in the other; nor to differ materially in their progress of ravage and destruction;* for, while it may be justly supposed that this progress in the upper jaw is facilitated by its greater vascularity and more spongy structure, it must also be considered that this difference of structure, as well as the situation of the upper jaw, affords a greater chance of natural palHation, by the more convenient absorption or discharge of the matter formed by the disease ; and while the more dense osseous construction of the under maxilla, and the greater activity of the absorbents in one way retards the progress of the malady; from the lesser curative activity possessed by these parts, and their inconvenient situation for the discharge of the matter, it is less counteracted by the former, and more aggravated by the latter, in the under than in the upper jaw. In the same way we may account for the fact, that when the upper jaw is affected, the soft parts connected with the disease are more frequently subject to cancerous ulcerations without much tumefaction; while in the under jaw, sarcomatous and osteo-sarco- matous tumours are more liable to occur, and ultimately prove fatal by the supervention of carcinoma. • It is surprising that this point ia not universally conceded. The fashion set by early writers, of treating the diseases of the upper and lower jaw as distinct in their nature and origin, is still generally followed, and even the most recent and exact writers acknowledge the fact of their identity with great hesitation. " Tumours of the upper jaw," says Mr. Fergusson, in his " Practical Surgery," " may, like those last referred to, [of the lower] be connected with the gums, the alveoli, the harder portions of the bone, or possibly with the interior of the antnim ; indeed, making allowance for the differences in the position, shape, and other physical characters, between this and the lower maxilla, there is consi- derable resemblance between the diseases of each." It will be seen by analysing the catalogue of cases in the Appendix, that of the 331 whose seat is specified, 56*19 per cent, occurred in the upper, 42-29 per cent, in the under, and 1-51 per cent, in both jaws; and that of the 304 cases whose nature and seat are noted, there occurred — : Inflammation and suppuration of the upper jaw 12-82, under jaw 3-98 per cent. Necrosis ditto 3-98, ditto 5-59 ditto. Fibrous and such like tumours ditto 20-06, ditto 15-13 ditto. Fungous and similar tumours ditto 14-47, ditto 14-11 ditto. Carcinomatous and malignant tumours ditto 4-93, ditto 4-93 ditto.