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INVASION FOLLOWING MECHANICAL INJURIES. 275

mouth without showing in their vital manifestations any distinc-
tion from the common parasites of the oral cavity, as long as the
mucous membrane remains intact. If, however, the soft tissues
have been wounded, as in extraction, or if the resistance of the
mucous membrane has been impaired, these organisms may
gain a point of entrance, and thus become able to manifest their
special actions.
Many of the fatal cases of infections following dental opera-
tions, which were formerly invariably, and are even now com-
monly, attributed to infected instruments, are most probably
to be accounted for by these auto-infections.
Every extraction not performed under antiseptic precautions
may be regarded as an inoculation which, unfortunately, often
proves very successful. The severe injuries of the soft tissues
and the bone caused by difficult extractions, as well as the open
wound left by every extraction, furnish a convenient point of
entrance for bacteria. Whoever has examined an unclean
mouth, with its broken-down teeth, inflamed gums, thick,
smeary deposits with which some of the teeth are wholly cov-
ered, will not wonder that inflammation, swelling, suppuration,
necrosis, caries of the bone, or even septicaemia and pyasmia
may follow upon operations in the mouth, nor, in such cases,
without further consideration, accuse the dentist of having used
an infected instrument.
Tulpius,''^ as early as 1674, mentions among the consequences
of toothache, " disfiguration of the face and certain death." He
calls attention to the case of the Amsterdam physician, Gosvin
Hall, who died from the effects of gum-lancing, performed in a
case of impeded eruption of the wisdom-tooth. " Verj' soon
after the gums were lanced he suffered from insomnia, delirium,
and died."
Most prol)ably this was a case of septic infection by means
of mouth-bacteria, for which the incision furnished an easy
entrance.
From this case we see that even as simple an operation as
lancing gums may not always be entirely free from danger, and
that not only the knife, but also the gums themselves should be
thoroughly disinfected before the incision is made. Subsequent