1897 Journal of the American Medical Association  
and so skilful was the manufacturer that he made whole rows, even entire sets of teeth. When a patient refused to have his decayed tooth extracted the nerve was killed with a heated fine knitting needle or with mineral acids or caustic alkalies. The prejudice that a tooth must not be drawn during pregnancy was dis¬ puted by the Vienna dentist Serre. In case of an ulcerated tooth the only remedy was to remove it; but not until the inflammation had subsided so as to prevent its spreading. With
more » ... spreading. With painful and difficult eruption of teeth Hunter, as Paré had done, advised the cutting of infants' gums, but it was essential that the knife or lancet pierced through to the tooth, otherwise the operation was useless; the scar did not hinder its exit. The Erlangen professor, Isenflammer, contested this idea and therefore opposed this little operation. B. Bell, who early employed the cross incision, was of Hunter's opinion; also Richter, who had very accurately described the process of teething. Both recommended as a means of cleansing the teeth to rinse the mouth with lukewarm water after each meal, which method had already been advised by the French dentist, Guillemeau, in 1706, and wiping off the teeth with a sponge. Theden thought it neces¬ sary to clean the teeth also at night, so as to remove all particles of food. In treating sound teeth Richter discarded all powders, brushes and toothpicks, which ought never to be too pointed, nor made of soft wood, nor of metal, nor be made from quills. Even'during his time Guillemeau considered it dangerous for the preservation of the teeth to drink beverages too hot or too cold; on the other hand, he thought well-baked bread, mutton and chicken conducive to good teeth; fought against the use of golden and silver needles as toothpicks and permitted only those of quills. Dirty teeth required the application of powder prepared from cream of tartar, chalk and cinchona, with a brush, used on the lower jaw in an inverted position and vice versa· on the upper jaw. Tartar was removed with instruments; for filling the teeth zinc was also used, besides lead and gold. Hirsch of Jena advocated the use of tinfoil in 1796. According to Richter, the remedies for toothache depended upon the origin of the same. When inflammatory, caused by caries, leeches and poultices were applied; if rheumatic, tincture of cantharides, cajeput oil, camphor and elec¬ tricity were prescribed, if caused by a disordered stomach, emetics and cream of tartar; in case the origin was not known, extract of poppy and the above anti-rheumatic remedies were used. The most com¬ mon instruments for pulling the teeth, which was done toward the side on which the continuation of the socket was the thinnest, were the pelican, the English key and the dental elevator. The suppuration and the operation for the opening of the antrum of Highmore were known. In 1675, Molinetti first opened the antrum directly through the cheek by means of a cross incision and by tre¬ phining, while Meibom in 1718 first laid the socket bare by extracting the teeth implicated. To this method Cowper and Drake added that of puncturing the alveolar processes. After the Bremen physician, Runge, had compiled the first work on the diseases of the antrum (1750), the French surgeons, Bordenave, Lamorier and Jourdain, gave their special attention to this operation and published their writings in the fourth volume of the Memoirs of the Académie. Bor¬ denave recommended Meibom's method and extracted preferably the third molar, because its alveolus was the thinnest, therefore, the easiest to perforate. He at once caused a large opening, which he kept from closing by inserting a silver tube. This procedure was opposed by Lamorier, because often a sound tooth had to be sacrificed, and instead trephined above the third molar and below the cheek-bone, the most prom¬ inent part of the antrum. Jourdain, however, deemed it useless as a rule to open the antrum in this way ; he sought to find the connection with the nose, in order to free the closed passage and through this make his injections. This method was much too difficult and often impossible, consequently of no use. Lastly, Gooch is mentioned, who bored through the hard palate into the antrum, taking for granted that the same had been pushed forward by the pus. Most of the surgeons chose either Meibom's or Lamorier's method. B. Bell employed a curved trocar, in order to make a puncture from the alveolus; Desault opened from the mouth the lower portion of the fossa canina where the bone was the thinnest and where the opera¬ tion and the after-treatment were most easily accom¬ plished. These punctures and trephinings of the anterior wall are to be considered as the starting-point for the resection of the upper jaw. In a similar manner was treated the suppuration of the frontal sinus, which Richter saw break through into the skull cavity. Either the anterior wall was trephined or injections were made into the nose as soon as the pus had found its way there, or if the outer wall was already decayed, tbe too small opening was enlarged, which, however, could remain fistulous for a long time. Bilguer was once very successful in taking a bullet out of the frontal sinus and Maréchal related the case of a wound in which the brain matter was mistaken for the mucus and pus. The patient was 36 years of age, the mother of several chil¬ dren. Patient came under his care September 19, 1897. Five months before he had been calleu to see her on account of pro¬ found collapse which threatened life. A history of irregular uterine hemorrhages was elicited and a diagnosis of ruptured tubai pregnancy on the left side was made. Tatient rallied somewhat, but her condition was such that it was feared she would die under the anesthetic if an operation was done. Operation was deferred, and nothing further was heard from her until the date mentioned. At this time the doctor found the abdomen distended by a tumor on the left side and in the center as high as the umbilicus. On the right was another and appar¬ ently distinct cyst filling that side of the pelvis and extending well up into the abdomen. The enlarged uterus could be felt in the center merging into a large tumor. Upon opening the abdo¬ men a large tumor occupying the center and leftside presented a surface somewhat irregular, very dark in color, and traversed in every direction by large blood vessels that stood out prom¬ inently on the surface, reminding the author of an enormous broad ligament cyst. The enlarged uterus was enclosed in this mass, and the shading off of the tissues was so nicely done that it had every appearance of a tumor springing from the uterus, The tumor of the right side was about the size of an adult head, about one-quarter of an inch thick, and seemed to be dis¬ tinct from thelargeone, the dividing line dipping down between Downloaded From: by a University of Pennsylvania User on 06/15/2015
doi:10.1001/jama.1897.02440480029002 fatcat:sy7tgjv2qzb7vcxcrdo5bjtlle