Page 73 - An essay on the diseasesof the jaws, and their treatment

DISEASES OF THE JAWS. 51 suddenly, but by a gradual process; and it is obvious tbat any enlargement, especially of the bony structures, can be removed only by a gradual increase of the natural energy of the parts, and by considerable efforts of the constitution proportioned to the pre- vious gradual increase of the malady. OP THE TREATMENT OF MALIGNANT OR CANCE- EOUS AFFECTIONS OF THE JAWS. Even in this aggravated state ofthe malady, if it has not extended its ravages to the important organs connected with the upper jaw, and if the constitutional strength of the patient has not been much reduced, a perfect cure may not unfrequently be obtained by a ju- dicious adoption of the remedies abeady enumerated.* In those cases, however, in which the malady has proceeded to so great an extent, as to render thfc above mode of treatment, and the energetic application of these general and local means insuffi- * When these measures are properly carried out, the patient has had every chance given him, but not otlierwise. Unfortunately, however, this is seldom or never the case, for when the disease is considered of a character at all malig- nant, and, consequently, imfit for the operation of excision, the patient is gene- rally allowed to die with his mouth still retaining the exciting causes of his dreadful malady. The following case, extracted from one of the surgical journals of the Glasgow Eoyal Infirmary, affords a melancholy example of this neglect of remedial mea- sures : — " Thomas Alcorn, aged sixty. Springing from alveolar process of right side of upper jaw, is a soft spongy tumour. It extends from the first bicuspid tooth to the last molar, and is nearly twice the size of a common walnut. It lies principally on the external surface of the alveolar process, but a small portion of it passes to the internal surface. It is partly of a pale red and partly of a dull red colour, and is dotted with numerous whitish spots, some of which are slightly elevated above the surrounding surface. The first molar tooth has been re- moved, and the probe passes to the bottom of its socket without feeling rough bone. Second molar also partly removed, but root still remains. The two bicuspid teeth are loose in their sockets ; but the last molar tooth remains firm. Has occasional darting pain in tumour. Is subject to tooth-ache, and several of his teeth are carious. First observed tumour three months ago, then about the size of a pea, and seated over the socket of the first molar tooth. First and second molars were loose be/ore the appearance of the tumour, and had been frequently the seat of tootli-ache. In this case, there was no operation, as the patient was phthisical, and apparently in a dying state — (" Journal^of Wards, Nos. vii. " and xii.," 28th May, 1829.) E 2