Page 42 - An essay on the diseasesof the jaws, and their treatment

20 AN ESSAY ON THE itself fraught with more immediate danger than the other modes of treatment; and, although it may now and then succeed, it is scarcely practicable in very late stages of the disease. Indeed I am inclined to assert, that there is no chance of its success at any later period than when a simple removal of the exciting causes, with the consequent tumour, and a due attention to the con- stitution, would fail to ensure a complete, and certainly a more desirable cure.* OF THE CAUSES OF THE DISEASES OF THE JAWS. The proximate causes of these diseases are, as far as my experi- ence has enabled me to judge, inflammation, suppuration, and mortification, commencing in the alveoli and the periosteum, and thence extending to the osseous structure, and the lining membrane of the cavity of the jaw.f * Although there are many cases in which excision, more or less extensive, of the jaw-hones, has been resorted to, when the curative means at the command of dental surgery ought instead to have been put in practice, still there are continu- ally occurring cases, which having, from neglect or mismanagement, been allowed to run their course through all the early stages in which they might have been cured, are no longer within the reach of dental treatment ; the greater part, or the whole of the bony structure of the jaws being disorganised, and the parts con- verted into a mass of disease, bearing hardly a trace of tooth, gum, or socket. Cases such as these, having been permitted to proceed beyond the province of the dentist, and the organs that he would have to operate upon being no longer in ex- istence, must be considered as utterly incurable, and consequently as requiring the operation of amputation—the only remaining resource of art. And an admi- rable application of the art of surgery it is, which frees the wretched sufferer from a load of disease equally disgusting to himself and those around him, when all other means have ceased to promise hope. But, unfortunately, the most dis- tressing cases of disease of the jaws are beyond the power of even operative sur- gery; the malignant character assumed by such, and the consequent certainty of their being reproduced, deter the surgeon from attempting an interference, which would inevitably prove but a prolonging of suffering, if not immediately fatal. The result of numerous cases of excision of the jaws proves that tumours of the most enormous size, if not of a malignant nature, may be successfully removed by amputation. At the same time, the history of a vast number of even the most malignant cases shows, that in their early stages they might have been effectually controlled by dental treatment, and at no period of their coarse ia there any other plan that offers a chance of cure. t Some increased action or irritation either in the investing or lining membrane of the maxillae, undoubtedly constitutes the first link in the chain of morbid causes. The vascular membrane lining the a'.vcolar depressions, is by much the most fre- f