Page 60 - An essay on the diseasesof the jaws, and their treatment

88 AN ESSAY ON THE hope of arresting the disease was abandoned. It is, however, not improbable, that had this case been attended to only one year earlier, the health of this unfortunate man might have been perfectly re- stored by the treatment I shall presently describe. OF OSSEOUS, FrBEO-CAETILAGINOUS, SARCOMATOUS, EUNGOUS, AND OSTEO-SAKCOMATOUS TUMOURS AND EXCRESCENCES OF THE JAWS. Sometimes from some accidental excitement, or from a peculiar irritation produced by the osseous structure upon the perios- teum, the membrane Hning the cavity of the jaw, or the exter- nal periosteum and gums, during the progress of the diseases already described, large tumours or excrescences are formed on these parts. These tumours are either of a soft fleshy cellular structure, or of a fibro-cartilaginous and osseous kind, forming various sorts of exostoses, which seem to be equally common to both jaws.* When they occupy the upper jaw, they may some- * As this treatise is not intended so much to be a descriptive account of the diseases of the jaws as a practical essay on their nature and treatment, it would be out of place here to enter upon the peculiar appearances and morbid anatomy of these tumours, which are, doubtless, familiar to the medical reader. M. Andral is of opinion that it is useless to attempt to give particular designa- tions to the infinite variety of appearances that may be assumed by the organisable morbid products, wliich are deposited in various textures of the body. The chief practical distinction usually now made, in respect to the forms of the disease under consideration, is that between the benign and malignant tumour. This is the division which Mr. Fergusson, in his clinical lectures ("Lancet," 1841-42, vol. i. p. 890) principally insists on. The malignant tumour he describes as rapid in growth and development, with a disposition to fungate, and want of defined limits after attaining a certain size—the neighbouring textures being seemingly involved in the disease, and the whole mass, at a very early period, feeling soft and pulpy, and in a more advanced stage showing all the appearances of the encephaloid tumour—and accompanied by that emaciated and unhealthy aspect of the patient, which so certainly denotes the presence of a carcinomatous affection. The re- verse of all these are the characteristics of the non-maUgnant tumour. Dr. Walshe states that of the three varieties of carcinoma, the encephaloid is pecu- culiarly " the cancer of the upper jaw." This author farther remarks that car- cinoma of the maxilla occurs generally unassociated with cancers in oth^r parts of the body.— (Walshe on Cancer, p. 560.) Notwithstanding these apparently distinct characters, in practice it is no easy matter occasionally to recognise them. This difficulty is, however, of little real consequence, as regards the cxirative plan of treatment directed to the mouth, since that is equally applicable to every variety of the disease, and, unhke the