Page 75 - An essay on the diseasesof the jaws, and their treatment

— DISEASES OF THE JAWS. 53 turc—osteo-sarcoma or exostosis—I would advise tliat it should not be interfered witli until it be found that nature is unable to remove " I am now about to press upon your attentiou a most important consideration; that is, that these ftree parts—the teeth, the alveolar processes, and the gums are one in natural constitution, and consequently one in disease. When tumours arise by the side of the teeth, you will do well to recollect, that unless on re- moving the tumour you also take away the tooth, gum, and alveolar process, you leave parts which are disposed to renew the disease, and you do not in effect era- dicate the tumour."—("Lancet," 1833-4, vol. iL, p. 216.) This observation, as to the close relation of the gum, tooth, and socket, is a very valuable one, but in a practical point of view, its importance depends on which of the three is to be considered the part primarily affected. What has already been said regarding the causes of the affections of the jaws, has, I should hope, made it sufficiently clear that the teeth are the structures originally at fault, and not the alveoli. It is obvious that, on account of the close connexion sub- sisting between these parts, if tliat which is the origin of the mischief be re- tained, the associated parts will remain disposed to renew the disease; but on the contrary, if the offending member be disconnected with the others, these will naturally resume their wonted state of quiescence. It is to the teeth, then, that our measures must be principally directed. The ex- traction of such of them as are embraced by these tumours, with due attention to other sources of excitement, is of itself sometimes sufficient for a cure; while every other operation invariably fails when not accompanied by the removal of the structure wliich was the original seat of the primary disease. " In order," says Mr. Liston, " to extirpate effectually any morbid growth proceeding from the in- vestments and roots of the teeth, these must first be extracted. There is no use in attempting to remove the tiunours otherwise."— (" Operative Surgery," fourth edi- tion, p. 300.) We find Mr. Thomas Bell also giving his testimony to this fkct, as the result of liis practice. " The simple excision of this kind of tumour," he ob- serves, " is rarely successful. I have generally fovmd that, however perfectly it may be taken away with the knife, if the loosened teeth be suffered to remain, a few weeks only will elapse before it makes its re-appearance." — (" Anat. Phys. and Diseases of the Teeth," p. 234.) On the other hand, I can assert with con- fidence, that no one was ever disappointed in the result of that treatment, which is based on a thorough removal of all the local exciting causes of disease. A very interesting proof of the truth of this assertion is furnished by the following case, published by Mr. Koecker, in the " Medico -Chirurgical Review," No. Ixxv., for January, 1843. " Mr. Atlee, of Ealing, about sixty years of age, originally of a very robust constitution, had for nearly thirty years been a great martyr to the gout, for which he had taken various powerful medicines with only temporary enefit; he also frequently suffered from severe pain in the ears, and his hearing had become very defective. The patient was then under the care of Mr. Dickenson, of Eal- ing, and on consultation with Mr. Lawrence, the latter gentleman advised my being consulted. " On the 30th August, 1840, when I visited the patient, he had been bedridden for six montlis, and was reduced to a state of great emaciation and debility. On examining his mouth, it presented a most forbidding appearance; all the teeth blackened or discoloured, and much furred with tartar, were imbedded in, and surrounded on all sides, by an irregular fungous and partially ulcerated mass of a deep-red, almost livid appearance, extending above half an inch on both