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THE DECAY OF THE TEETH, ETC. 167
This disease has not hitherto been accounted for it' it had
;
been always on the inside of the cavity it might have been
are apt to be followed by rapid and general caries of the permanent
teeth. Cholera, and all diseases accompanied with extreme prostration
of the vital powers, and cases attended with great loss of blood are
liable to be followed by a rapid decay of the teeth.
Certain climates or localities would appear to predispose the inhabi-
tants to diseases of the teeth. Thus, what has been termed expulsive
gingivitis, prevails in the district of Lower Austria, extending from the
south of the plains of Vienna as far as the province of Styria. (1) These
effects of climate are exerted on the membranes rather than upon the
teeth themselves.
The exciting causes include an acid condition of the fluids of the
mouth, certain derangements of the digestive organs, which are accom-
panied by acid eructations, the use of acids such as vinegar and lemon
juice as articles of food, and the employment of the stronger acids
when administered as medicines.
Various theories have been advanced from time to time in explanation
of dental caries, but they may all be referred to one of the three follow-
ing :—the inflammatory, the chemical, or the chemico-vital.
Fox says, " The proximate cause of caries appears to be an inflamma-
tion in the bone of the crown of the tooth, which, on account of its
peculiar structure, terminates in mortification." This writer, however,
would appear to have confounded caries, or partial death of the tooth,
with necrosis, or total death of the tooth, for he remarks, " If a sound
tooth, that has been recently extracted, be broken, the membrane will
be found to be firmly attached to the bone of the tooth, forming the
inner cavity. But when this membrane becomes inflamed, it separates
from the bone, and the death is the consequence."
That this is the proximate cause of caries, appears to be highly pro-
bable, by remarking that caries of other bones is caused by a separation
of those' membranes which cover them, and which are attached to
them." (2)
Mr. Bell, who proposes to substitute the term Gangrene of the
tooth for caries, and defines it as " mortification of any part of the
tooth, producing gradual decomposition," also asserts that inflamma-
tion is its proximate cause : " Still, however, the true proxi-

(1) See Lectures on Diseases of the Dental Periosteum, by R. T. Hulme,
p. 54. London, 1862.
(2) The Natural History and Diseases of the Human Teeth, by Joseph Fox,
Pt. 2, p. 12. Second Edition. London, 1814.