Page 38 - An essay on the diseasesof the jaws, and their treatment

16 AN ESSAY ON THE If judiciously treated, the latter cases admit of more successful treatment than the former ; but, on the contrary, if neglected or ill managed, they afford the most dangerous varieties of the disease. If art lends its aid to remove the local causes of the disease, nature will soon effect a perfect cure without further assistance.* • A case lately presented itself to me, the early history of which exemplifies so fully the above remark, that I cannot refrain from detailing it. The patient was a young German lady, who, being on a visit to this country, had put herself under the care of one of our fashionable dentists, on account of the deplorable state of her mouth, which contained many stumps that were productive of much local and constitutional irritation. She had had, however, the good sense to refuse to submit to this gentleman's plan of supplying the deficiencies of her mouth, without extracting the offensive and irritating roots and dead teeth. The plan of treatment proposed by Mr. Koecker and myself, namely, in the first place to render the mouth completely healthy, by the removal of all local causes of irrita- tion, and then to insert an artificial piece suited to her case, she at once agreed to. Nine stumps and dead teeth were accordingly extracted under the influence of ether, the idiopathic diseases of the teeth were attended to with the most salutary effect, and, by the insertion of a proper mechanical preparation, we have had the satisfaction of restoring our patient to a state of comfort and renewed health, to which she had long been a stranger. The following history of this case I beg to give in the lady's own words ;— " The subject of the present notice is a Livonian by birth, and seems to have inherited from her parents, in common with her brother and sister, a disposition to bad teeth and morbid gums ; from her childhood she has sufibred much from tooth-ache. At the age of seventeen, she left her home and went to reside in Moscow, where she still continued frequently to suffer from tooth-ache, (^n one occasion, in the depth of winter, the thermometer being fifteen degrees Keaumur below the freezing point, ex- cited by the pain, and anxious to consult her sister, who resided at some distance, as to the advisabilty of having the teeth extracted, she left her dwelling on foot, in thin shoes, not at all suited to walking over the snow and ice at such a season. Thereupon the pain increasing, the lady, in whose family the patient was residing deemed it necessary to consult a medical man on the subject, and accordingly sent for the family surgeon, who, on examining the cheek, at first declared it to be of no importance, and prescribed some drops to be put into the tooth on cotton. A few days after this, the cheek began to swell very rapidly, and a bluish spot showed itself under the lower jaw of the left cheek. The surgeon now returning, and con- sidering it as a simple gathering, deemed it necessary to open it, and without warn- ing the patient of his intention, made a deep incision in the cheek, whence, however, flowed no humours, but blood alone. The red ulcerous appearance of the jaw and cheek extending, the advice of several medical gentlemen of considerable ex- perience and reputation was had recourse to, more than one of whom declared the case to be that of a cancer; and finally it was proposed to cut it out. The young lady, however, dreading so terrible an operation, ere she consented, re- solved to have recourse to one gentleman more—Dr. P., chief physician and operating surgeon of one of the largest hospitals of Moscow. Dr. P., on ex- amhiing the face, and after minute inquiry, declared it as his opinion, that there was no case of cancer at that moment, that it was decidedly a case of fistula, but that, if the teeth were not directly extracted, or if the cheek were neglected,