IRREGULAR'ITY. 確立された規則または直線からの逸脱。
歯の不規則性。 「フォックス氏は言う。「永久歯が規則正しい位置を獲得するのを妨げるいくつかの状況があり、しばしばその配列に非常に大きな不規則性を生じさせる。
最も多い原因は、牙の吸収による永久歯の増加と仮歯の減少が同時に起こらないことである。永久歯が生えそろう前に、仮歯の牙が吸収され、子供の努力で仮歯を取り除くことができるようになることはまれである。
永久歯が生えそろう前に、仮歯の牙がほとんど吸収されていないケースは非常に多く、永久歯を生やすために抜歯したときに、仮歯の牙が吸収されていないこともよくある。
永久歯が不規則に生えるのは、一番近くにある仮歯の抵抗が原因であることが多い。仮歯が小さく、ぴったりと生えている場合は常にそうであるが、永久歯の切端は仮歯よりもはるかに大きいため、より多くのスペースを必要とする。しかし、仮歯の脱落によって残されたスペースは、永久歯の規則的な位置に対して小さすぎるため、仮歯は隣の歯の圧力にさらされ、その結果、しばしば向きが変わってしまう。
歯並びが不規則になるもう一つの原因は、永久歯が仮歯のスペースに対して大きすぎることである。切歯と犬歯は、チリ歯よりもはるかに大きいため、スペースが必要であり、そのスペースがないために、適切な位置から外れてしまう。中央の切歯は斜めに配置され、その端が前方に向いているか、後方に押しやられ、中央の切歯と犬歯の間や後方に位置している。犬歯は突出しているため、口唇がかなり突出しており、小臼歯は非常に不規則に配置されている。」
上記に加えて、顎の奇形も不正咬合の原因として挙げられる。上歯槽弓は時に狭すぎ、圧縮されたような外観を呈し、上唇が前歯を覆わないように突出している。また、上顎歯槽弓の幅が広すぎて、口元が扁平になり、歯が離れて見えることもある。いずれの場合も見た目の印象は悪いが、前者の方が後者よりも悪い。下顎も同じような欠点がある。
このような欠点は幼少期に見られるもので、この欠点について研究してきた人々の多くは、遺伝性のものであり、他国よりもある国の人々に特有なものであると見なしている。また、この病気にかかっている人のほとんどが、良好な口蓋とよく発達した顎を持っているという事実が示すように、この病気は無償の奇形であるとする人もいる。
したがって、この病気は、顎の形態異常の発生に何らかの影響を及ぼしていると考えることはできない。
また、上顎にはもう一つの奇形が見られることがあるが、これも同様に説明が難しい。上唇、歯槽骨縁、口蓋弓が1つまたは複数に分かれ、歯の配列が不規則になるものである。この奇形は先天性のものである。
過剰歯も不規則な歯並びの原因のひとつである。しかし、このような例は比較的まれである。

歯列不正の治療法 歯列不正の症例は実に様々であり、時にはその性質が複雑であるため、歯科医の技量と創意工夫が最も試されることが多い。症例によって治療方法は異なる。同じ症例でも使用する手段を変えたり、治療の段階によって使用する器具を変えたりする必要が生じることも多い。また、治療が完了するまでに必要な時間が長くなることもあり、すべての歯科医師が行使できる以上の忍耐力と実践力が求められることもある。
フォックス氏は、「歯の脱落中に不規則な歯並びが生じた場合はすべて、障害となる仮歯を除去し、次に不規則な歯に最も適した方法で圧力を加え、歯を正しい位置に誘導することである」と述べている。
また、「下顎では、永久歯の中心切歯の成長が仮歯の吸収を超えると、そのすぐ後ろに舌に向かう方向に成長する。この2本の新しい歯は、一般に、4本の仮歯の内面をほぼ覆うほど幅が広い。したがって、これらの歯のためのスペースを確保するために、4本の仮歯を抜歯する必要があります。その後、新しい歯が徐々に前に出てくるが、その際、子供の舌の圧力が自然に助けとなり、親や看護師の指が助けとなることもある。
「仮の中心切歯が緩み、永久歯が生え揃う前に抜けてしまった場合、そのスペースが十分に広くなることはほとんどなく、新しい歯は両側が前方に向いたまま生え揃うか、一方が他方よりも先に生えてくることになる。この場合、2本の側切歯は抜歯しなければならない。
「永久歯の中央切歯が完全に生え揃うと、4本の仮切歯が入っていたスペースの3分の2を占めるようになるため、永久歯の側切歯が現れると、中央切歯と仮切歯の後ろに部分的に配置される。
このような配列は、常にではないが、遠心と犬歯の間にスペースがないために、側切歯に強いられることが多い。最後に述べた歯と歯の間のスペースは、4本の切歯にとって十分であることが多い。
4本の永久切歯は、暫間切歯と犬歯のスペースのほぼ全部を占めている」とフォックス氏は続ける。永久歯の犬歯は大きいので、十分なスペースがないと、非常に不規則になります。内側に入り込むこともあるが、ほとんどの場合、外側で歯肉を切ってしまい、仮切歯から仮大臼歯までの円形ラインから大きくはみ出してしまう。この場合、最初の仮臼歯を除去する必要があることは明らかである」。
F氏は、永久歯の萌出順序を明らかに間違えている。最初の仮臼歯と、時には2番目の仮臼歯は、カスピダティが生える前に小臼歯に生え替わるので、最後に述べた歯のためのスペースを確保するために、どれかを除去する必要が生じるとすれば、それは1番目か2番目の小臼歯か、あるいは最初の永久歯であるモラレスが虫歯になっている場合であろうが、前歯は前歯よりも小さいので、どれかを犠牲にする必要が生じることは比較的まれである。
しかし、F.氏によれば、「下顎の小臼歯が不規則であることは、あまりない。
「上顎では、永久歯の中切歯が、仮歯の後ろの歯茎を通過することがある。このような場合、仮歯の間のスペースがないために仮歯の向きが間違っているのであれば、4本の仮歯を抜歯しなければならない。
仮の中央切歯が抜けると、そのスペースは一般的に永久歯にとっては狭すぎるため、歪んだ形に押し付けられてしまう。その縁は規則正しいカーブを描かず、斜めに立ったり、時には一方が他方より先に立ったりする。このような症例では、一時的な側切痕を除去する必要がある。」
最後の段落で推奨されている方法は、顎の前歯部は仮歯を装着しても寸法が増加しないという誤った考えに基づいている。しかし、歯槽骨縁のこの部分で起こるわずかな増大と、永久歯の遠心の圧力に仮歯の側切歯が屈服することで、ほとんどの場合、仮歯は歯列弓における適切な位置を獲得する。したがって、暫間側切歯と永久側切歯の間にスペースがないために、永久側切歯が間違った方向に成長せざるを得なくなった場合にのみ、永久側切歯を抜歯する必要があります。
永久歯の中央切歯は非常に幅が広く、4本の仮歯のスペースの大部分を占め、永久歯の側切歯のためのスペースはほとんどありません。時々、歯は端を通り、前方に突出することもある。このような場合には、仮歯を除去することが絶対的に必要であり、この操作を適時に行わなければ、不揃いを改善することは困難である」。しかし、仮歯を抜くのは、永久歯を入れるスペースを確保するためか、よほど差し迫った必要性がある場合を除き、行うべきではない。上記の方法は誤った理論に基づいている。
しかし、フォックス氏は、「最大の変形は、一般に、側切歯と犬歯のためのスペースがないために生じるものであり、あまりにも長い間放置されると、通常は永久歯になる」と付け加えている。
しかし、歯列不正の予防に必要な手段については、「歯列」の第2章、「指導法」の記事を参照されたい。 フォックス氏は、前歯の不正咬合の種類を次のように列挙している。
第一に、「上顎の永久切歯が仮歯の後ろの歯肉を切開し、かなり成長するまで残っている場合、それらは常に内側に立っているため、口を閉じると下顎の切歯が先に立ってしまう。この種の不規則性には4つの状態がある。1つ目は、片方の中切歯が内側に入り込み、下顎の歯がその前に来ている状態で、もう片方の中切歯は本来の位置を保ち、下顎の歯の前に立っている状態。
「2つ目は、両方の中切歯が内側に入り、下の歯の後ろに来るが、側切歯は下の歯の前に出ている場合である。
「第三は、中央の切歯は正しく配置されているが、側切歯が非常に内側に立っている場合であり、口を閉じると、下の歯がその前に突出し、それらを後方に保つ。
「第四は、上顎の切歯がすべて内側に入り込み、下顎の切歯がその前に閉じている場合である。これは、下あごの長さが長すぎるために、上あごよりもかなり前方に突出しているために起こることがある。しかし、このような症例の大半は、完全に怠慢に起因するものであり、早期の治療によって完全に改善することができる。
また、上顎の犬歯も上顎切歯と同じように正しい位置から逸脱することがあるが、アーチの後方に突出して下顎の歯の内側に当たることは少ない。
フォックス氏によれば、歯の位置を変更する最も適切な時期は、13歳か14歳になる前である。しかし、一般論として、歯の移動が遅ければ遅いほど、将来、歯の周囲の窩洞や歯肉が病気にかかりやすくなる。
下の歯の内側に当たるほど後方に出ている上の歯を、歯列弓の前方に移動させるには、「2つの目的を達成しなければならない。
1つ目の目的は、口のアーチに合った器具を使用し、両側の丈夫な歯に装着することで、前方の固定点を作り、そこに不規則な歯にあらかじめ固定した結紮具を装着し、時々結紮具を付け替えることで、一定の圧力が保たれ、歯が前方に引き出されるようにすることです。
「2つ目の目的である下顎の抵抗をなくすためには、上顎と下顎の歯の間に介在物を入れて、歯が完全に閉じるのを防ぎ、不規則な歯が前に出てくるのを妨げるようにしなければなりません。
「この器具は、金でも銀でも構わないが、簡単に曲がらないような丈夫なものでなければならない。この金の棒は、口の形に合わせて曲げなければならず、仮歯、あるいは永久歯の「モラール」まで届く長さが必要である。結紮が必要な場所には穴を開けなければならない。穴は、固定する歯と反対側の部分と、不規則な歯がある場所と反対側の部分に開ける。次に、象牙の小片をバーに接続する、
象牙とバーを2つのリベットで固定することができる金の小片によって。この象牙片は上の歯の研磨面の下を通り、そこに固定され、歯が閉じるのを防ぎ、その結果、前方の障害物をすべて取り除く」。
「次に、不規則な歯に結紮具を巻きつけ、両端をバーの穴に通し、しっかりと結ぶ。2〜3日後にこの結紮具を外し、新しい結紮具を装着する。3〜4日おきに新しい結紮具を使用し、歯を他の歯と一直線に並べるのに十分な圧力をかけ続ける。
「同じように生えている歯が1本でも2本でも3本でも、治療方法は同じである。歯は通常、1ヶ月から5週間ほどで前方に移動し、下の歯が内側を通過できるほど進行したらすぐに象牙片を取り除き、歯が完全に固まるまでバーを数日間保持するだけで、歯が再び後退する事故を防ぐことができる。」
「不規則な歯並びがあまりにも長く続いている場合、それを取り除こうとしても成功は期待できない。成人のこのようなケースの治療では、最も不規則な歯並びを取り除くことで満足しなければならない。
現在では、フォックス氏が推奨したブロックや象牙の代わりに、金のかぶせ物が使用されている。後者の方が、被せる歯にうまく適合すれば、患者にとって迷惑が少なく、その結果、不便なく装着できるため、好ましい。第一の永久歯は、この目的に最も適した歯である。しかし、2番目の仮歯を使用することもできますし、仮歯が脱落して小臼歯に置き換わった場合は、他の歯よりも適していませんが、小臼歯を使用することもできます。かぶせ物を使用する場合、前歯の周囲を一周する金の棒にかぶせ物を取り付ける必要はない。
また、結紮器具を交換するたびに、ゴールドバーとキャップを取り外し、歯を十分に洗浄する必要があります。これは、歯とゴールドバー、キャップ、結紮具の間に形成される腐食性物質の化学作用によって歯が傷つくのを防ぐために必要なことである。
歯並びの乱れを改善するために、他にもさまざまな方法が提案され、採用されている。M.デラバラは、歯牙に常に作用するように結紮具を使用することを推奨している。象牙や金のブロックを使って歯が合わさるのを防いだり、口を閉じるたびに下の歯の後ろに落ちるほど歯列円より後ろに出てしまった歯を調整する永久的な障害物を形成する代わりに、彼は2本または下の臼歯にワイヤーキャップまたはグレーチングを装着する方法を採用している。この治療法が最も効果的であったとしても、いくつかの理由から好ましくない。第一に、結紮具が歯の位置からずれた部分に作用すると、隣接する歯にも同じ力が働き、他の歯が本来あるべき位置に移動するのと同じように、歯がその位置から遠く離れてしまう。第二に、歯茎に接触して刺激を与えないように装着するのは難しい。第三に、このように塗布する場合、金の延べ棒に関連して使用する場合と同じような力で作用させることができない。4つ目、そして最後の反論は、ワイヤー・グレーチングに当てはまる。これらは、象牙のブロックや金のキャップのように簡単に歯に固定することができず、また、この目的のために都合よく使用できるようなものであっても、すべての場合において、前歯が一緒になるのを防ぐのに十分な厚さの障壁を介在させることはできない。
このような不規則な歯並びを改善するために、カタランは次のような方法を提案している。M.カタランは、金製でも銀製でもよいが、後者は口腔内で腐食しやすいため、前者が望ましいとする傾斜面を、顎の咬合のたびに、ずれた歯の裏側に当たるように下の歯に固定し、本来あるべき場所に向かって前方に押し出す方法を提案している。上の前歯の数本がアーチの後方に出て、下の切歯の後方に位置するようになった場合、カタランでは歯の数だけ傾斜面を使用する。下の歯の輪の後ろに1本だけ歯がある場合は、1本の傾斜面で十分です。
下の歯に装着する金製のフレームやケースは、傾斜面を装着するためのものであり、両側の小臼歯の片方または両方を囲むような精度の高いものでなければならない。切歯の刃先と犬歯の尖端は、傾斜面で覆う必要はない。装着する際は、しっかりと固定され、傾斜面を動く偏位歯が少しでも揺れたり動いたりしないようにする必要があります。このフレームに1つまたは複数の傾斜面を調整し、偏位した歯の正しいポイントに作用するようにするには、石膏製の拮抗模型が必要です。
この器具を使用する場合、もちろん奥歯の間に物質を挟む必要はない。しかし、これを使用する前に、歯が1本以上ある場合は、その歯が入るのに十分な開口部があるかどうかを確認する必要がある。また、前進させる歯は、傾斜面の作用を受ける前に、常に意図する開口部の反対側に位置させる。そのため、結紮具を装着して歯を移動させる場合は、結紮具を装着する前に、結紮具を装着する予定の空隙の真後ろに、傾斜面によって強制的に移動させる必要がある。
歯の1本または複数が、円内に位置しているにもかかわらず、円を横切るように斜めまたは横向きに立っているため、その前面と後面が横方向に存在することがよくあります。このような場合に必要なのは、歯が1本以上ある場合は、その歯をソケットの中で部分的に丸くするだけである。これを行うために、M.デラバラはねじれた歯に金のキャップをかぶせ、そのキャップを隣の歯に回し、両側の仮の臼歯または小臼歯に固定する。筆者は、キャップよりも、歯にぴったりとフィットするゴールドリングの方が、患者にとって迷惑がかからないという理由で、より効果的であることを発見した。結紮具だけで目的を達成できる場合もある。
歯の位置を変えるには、絹よりもゴム製の結紮具の方がはるかに好ましい。
下顎切歯と歯槽骨縁の過度の発達により、下顎の前歯が上顎の対応する歯にかぶさり、顎が突出したり下唇が膨らんだりすることがある。しかし、このような奇形は、今述べたような原因によって生じるとは限らない。過度の発育や、顎の部分的な転位によって生じることもある。前者の場合、変形は歯列弓を小さくすることでしか改善できないが、これは常に面倒で困難な手術であり、患者側には膨大な忍耐と忍耐力が、歯科医側には多くの機械的工夫と技術が必要となる。使用する器具は、多かれ少なかれ複雑なものでなければならず、最も完璧な適合精度と整然とした作業が要求される。また、長時間装着しなければならず、当然の帰結として、非常に煩わしいものである。
この種の症例の治療では、まず第一に、顎の両側の第一小臼歯を抜歯する。こうすることで、目的を達成するために必要な歯列弓の収縮に十分なスペースを確保することができる。歯と歯槽骨稜の正確な印象は、別の記事で説明した方法で、あらかじめミズゴケ水で軟らかくしたワックスを使って採取する。この印象から次に石膏模型を作成し、その後に金属模型と反対模型を作成する。
これができたら、第一大臼歯と第二大臼歯が出現している場合はその上に、そうでない場合は第二小臼歯と左右の第一大臼歯の上に、これらの歯を完全に包み込むように、通常の厚さの金板をかぶせる。これらのかぶせ物を口の中の歯に被せてみて、前歯が合わさるのを防ぐのに十分な厚みがないと判断された場合は、それぞれのかぶせ物の器官の研磨面を覆う部分に、金の板片をはんだ付けし、ここまで進めたら、それぞれのかぶせ物の両側に小さな金のつまみをはんだ付けし、それぞれに絹またはゴム製の結紮具を取り付ける。これらの結紮具を前方に出し、犬歯の周囲にしっかりと結びつける。この方法で、15〜20日後には犬歯を第二小臼歯まで戻すことができるが、もし犬歯が歯槽骨稜の内側まで進まないようであれば、数日後に外側の結紮具を外し、内側の結紮具のみで残りの作業を完了させることができる。
こうして犬歯の位置が変わったら、金冠を外し、切歯の1/4インチ後方を通るような円形の金棒を、両端をそれぞれの金冠の内側にはんだ付けし、切歯の後方に穴を開け、そこに絹の結紮具を通し、口の中に入れた後、前方に持ち出して各歯の前できつく結ぶ。これらの結紮具は、上顎の対応する歯の内側に当たるまで、毎日付け替える。
筆者は、このような器具を自分以外の誰も使用したことがないが、実際に使用してみると、これまで使用したどの器具よりも効果的であることがわかった。しかし、成功を確実にし、このような器具の使用から必然的に生じる不都合を可能な限り防ぐためには、器具のあらゆる部分が最も完璧な精度で構築されていることが必要である。

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DENTAL SURGERY. Chirurgia dentium. That branch of medicine which has reference to the treatment of the diseases of the teeth and their connections, and which at the same time embraces the prosthesis, or replacement of the loss, of these organs with artificial substitutes.

So remote is the origin of dental surgery, and imperfect the records of ancient medicine, that it cannot, at the present time, be traced with any degree of accuracy. We learn, however, from HERODOTUS, the Grecian historian, that when he went to Egypt, from his then comparatively barbarous home, to learn the sacred mysteries and the sciences in the world's earliest nursery of learning and civilization on the banks of the Nile, he found surgery and medicine divided into distinct profession. There were surgico-physicians for the eye, others for the ear, others for the teeth, and so on for the different classes of disease the appropriate professor was found. This division, by an unalterable law of the human mind, would have given great skill and efficiency to the various practitioners, had not each been confined, under a penalty of death, to fixed prescriptions; but to what extent the remedies and modes of practice at this early period of the world's history, were successful in the cure of disease, the chasms made in the annals of ancient art and science, by the destruction of the great Alexandrian library, must forever leave the world in ignorance.

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During the time of HIPPOCRATES, who flourished about three hundred and sixty years before the Christian era, it is evident that little was known concerning the anatomy and physiology of the teeth, as is shown by the fact, that this celebrated physician, in treating of these organs, calls them, "A glutinous increment from the bones of the head and jaws, of which the fatty part is dried by heat and burnt." In the fetus he says, "they are nourished by the food of the mother, and after birth by the milk which the infant sucks from the breast." He also describes a method that existed for a long time previously to this period, of fastening teeth with gold wire, and he recommends several dentifrices for cleaning the teeth, which evidently comprises most that was known of the diseases and treatment of these organs at this epoch.

Although the writings of Aristotle show that the teeth were not altogether overlooked by him, they, at the same time afford abundant evidence that his knowledge of their anatomy and physiology was very meagre. Man, he asserts, has more teeth than woman, and that this difference is found to exist between the sexes of various animals, as in sheep, goats and pigs. In man, he states, that only the front teeth change, and that the age of animals may be ascertained by their teeth. Another of the errors propagated by this writer is, that the teeth continue to grow in length during life.

ARETEUS, in treating of tooth-ache, seems utterly at a loss to account for its cause, and contents himself, by stating, that it was known only to God. But CELSUS, who flourished during the first century of the Christian era, describes at some length, the method of procedure for the extraction of teeth, and it is in his writings that the first mention is made of filling the cavities of carious teeth. He does not, however, recommend this operation for the purpose of arresting the progress of disease, but merely to strengthen the walls of a carious tooth, preparatory to extraction; an operation, he advises only as a dernier or last resort, and for the purpose of preventing the necessity of it, he recommends a variety of remedies for the cure of tooth-ache, as for example, the actual cautery, hot oil, caustic medicines, &c., with a view of destroying the vitality of the organ. But when extraction becomes indispensably necessary, he says, if the tooth cannot be taken out with the hand, forceps must be used, and for the removal of a root, after the crown has broken off, under the forceps, he recommends the employment of an instrument, termed by the Greeks, rizagra. It would also seem that the alveolar processes were frequently fractured in the operation, and when an accident of this sort happened, he directed that the broken bone should be removed with a vulsella. He also notices some of the diseases of the gums, the loosening of the teeth, the eruption of the permanent teeth behind the temporary, and some of the methods of treatment laid down by him, are practiced even at the present day.

But the best writings of ancient times on the teeth, now extant, are those of GALEN, who wrote in the second century after Christ, after having enjoyed the medical advantages offered by that eldest and most splendid of libraries which was so soon afterwards doomed to the flames by the hand of barbarian power, This writer describes the teeth as being formed during intra-uterine life, though they remain concealed in the alveoli until after birth. He also gives a very minute description of the forms, functions and evolutions of these organs.

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The art of dentistry was cultivated by Greece and Rome, during their most palmy days of splendor and prosperity, chiefly in aid of the charms of beauty, and hence, so far as the paucity of medical works which have been handed down from these nations, enables us to determine, was principally confined to the replacement of the loss of the natural organs with artificial substitutes. Dentistry, in fact, does not seem to have made much progress for many centuries; for, when vandalism shut down upon the world, and learning itself was hidden in the gloom of the dark ages, then every torchlight of science feebly glimmering over the waste of ignorance and superstition, and every star that shown in the moral and scientific horizon, were quenched in that chill night of ages which threw its deadly penumbra over the world.

During this pause in the vitality of learning. Dentistry fared no worse than any other science. Demonology and the curative art were antagonistic, and the cabalistic mummery of gloomy and monastic ascetics was called in, to eradicate pain and disease, by the aid of charms and incantations.

From the time of Galen, until the sixteenth century, few traces of the art of dentistry, are to be found among the records of medicine. In connection with the anatomy of the teeth, AETIUS mentions the fact that they have an opening in their roots for the admission of small nerves, which he regards as the reason, that these organs are the only bones which are liable to become painful, and RHAZES has described, though very imperfectly, the process of dentition, but with regard to the replacement of the loss of the natural teeth, ALBUCASIS is said to have been the first to teach that it might be done, either with other human teeth, or with substitutes made from bone.

VESALIUS, who has been styled the restorer of human anatomy, and author of "De Corporis Humani Fabrica," published at Basil, in 1543, describes the temporary teeth as constituting the germs of the permanent teeth—an error into which some other of the older writers have fallen. EUSTACHIUS, however, may be regarded as the first to have given any thing like a correct description of the number, growth and different forms and varieties of the teeth. He describes their condition and arrangement in the jaws previous to their eruption, and refutes the erroneous opinion that the roots of the temporary serve as germs for the permanent teeth. URBAIN HEMARD, also a writer of the sixteenth century, gave a very good description of the teeth of both dentitions, both before and after their eruption. He also points out the differences between them and other bones, and describes their diseases. About the time Hemard's Researches upon the teeth made their appearance in France, a memoir upon the teeth was published in Germany, another in Spain, and another in Switzerland. The first was written by G. H. RYFF, and published in 1587; but this is not a work of much merit; the second was written by F. M. CASTRILLO, and published at Madrid in 1557, and the other by E. ERASTRUS, was published at Bale, in 1595.

But it was not until near three hundred years ago, about the time of the revival of letters, that AMBROSE PARE, in his celebrated work on Surgery, gave evidence of the vitality of dentistry amidst

the awakening chaos of ancient science and erudition, that the treatment of the diseases of the teeth began to attract much attention. His remarks upon this subject were only a promise of what the present age is fulfilling in this department of physical alleviation, for they are intermixed with numerous absurdities

and improbabilities, which half awakened science had not yet shaken off, as she was slowly arousing herself for her final, her noblest triumphs.

Paré maintains that the teeth, "like other bones, suppurated, and were subject to inflammation; the breeding of worms," &c. In treating of the extraction of teeth, he says: "For the better plucking out of the tooth, the patient should be placed in a low seat, bending back his head between the tooth-drawer's legs; then the tooth-drawer should deeply scarify about the tooth, separating the gums therefrom, and then, if spoiled, as it were, of the wall of the gums, it grow loose, it must be shaken and thrust out by forcing it with a three-pointed lever, but if it stick in too fast, and will not stir at all, then the tooth must be taken hold of with some of the toothed forceps, now one, then another, as the greatness, figure, and sight shall seem to require," &c. Unless the operator is skilful, he says, he may remove three, and, sometimes, leave untouched the one which caused the pain.

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On the replacement of the loss of these organs, he observes, "Teeth artificially made of bone or ivory may be put in the place of those that are wanting; and they must be joined one fast unto another, and, also, fastened unto the natural teeth adjoining that are whole; and this must chiefly be done with a thread of gold or silver, or, for want of either, with a common thread of silk or flax, as it is declared at large by Hippocrates."

SCALIGER denies that the teeth have any sensation, and believes them to be, in this respect, analogous to the nails; while KERKRING says they are similar to other bones. Concerning the structure of the teeth, MALPIGHI asserts that they consist of two parts; the interior, which is a bony lamella, consisting of a fibrous network; but among the writers of the seventeenth century, LEEUWENHOEK, upon this subject, is, by far, the most explicit and satisfactory, and many of his microscopical observations have been shown by the researches of later writers to be very nearly correct. He distinctly promulgates the doctrine of the tubular structure of the bony part of these organs.

But it is to PIERRE FAUCHARD, that we are indebted for the first systematic Treatise on Dental Surgery, which was published in France in 1728. This work, making two 12mo volumes, and, altogether, about nine hundred closely printed pages, gives a minute description of all that was known, at that period, of the anatomy, physiology and pathology of the teeth and their connections, as well as the various practical details connected with the treatment of the diseases of the mouth and the application of artificial teeth, palatine obturators, &c. But dental operations, even at this time, were performed in a very rude and bungling manner.

But, although a number of works were contributed to the literature of dental surgery, and among which we should not omit to mention those of BUNON, LECLUSE, JOURDAIN, BOURDET, HERISSANT and BERDMORE, but with the exception of the original suggestions of these authors, few improvements were made in practice until towards the close of the eighteenth century. Paré wrote in 1579, and in 1771, JOHN HUNTER, wrote the first, and in 1778, the second part of his Treatise on the Teeth, on which the broad and firm foundation of the English school of dentistry was laid. This has, subsequently, been improved and beautified by BLAKE, Fox, KOECKER, BELL, NASMYTH and other distinguished men of the dental profession.

What that eminent anatomist and surgeon, John Hunter, was to the English school of dental surgery, BICHAT was to the French modern school, as he, with others equally philosophic, taught that no theory should be received, however plausible, which could not be proven by demonstration. Neither Hunter nor Bichat were practical dentists, but the mighty energy of their minds embraced the dental with the other branches of surgery; and the principles of physiology and pathology at large included this important branch, and revealed the connection and sympathies of the teeth with the entire frame work of man. BLANDIN, Bichat's editor, although not a practical dentist, was much better acquainted with the science of the teeth than Bichat himself; and Cuvier's extensive researches into osteology, as well as the arcana of nature at large, all, all came in to aid the French dental surgeons: SERRES, DELABARRE, F. CUVIER, ROUSSEAU, MAURY, LEFOULON, and DESIRABODE, have illustrated the modern improvements of the art and science, building, as they have, on the foundation laid years before, by FAUCHARD, BUNON, BOURDET, LECLUSE, JOURDAIN, HERRISANT, BAUME, LAFORGUE, and others.

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It would, doubtless, be interesting to the dental student, if we were to trace more in detail, the progress of this branch of surgery through the eighteenth century, but the limits to which we have restricted this article will not permit us to do so. Although it advanced steadily during almost the whole of this period, its progress has been, by far, more rapid since the commencement of the present century. Profiting by the experience of the past, as well as by the spirit of enterprise and improvement now rapidly diffusing itself abroad over the whole civilized world, nerving the energies of mind for new and greater achievements in every department of science and art, and animated by a spirit of noble emulation, many practitioners of dental surgery have devoted themselves to its cultivation with an enthusiasm and zeal which have enabled them to overcome every difficulty and to arrive, almost, at the highest summit of professional excellence.

The publication in France, in 1802, of a work by Laforgue, on the Theory and Practice of the Art of the Dentist, was followed, in 1805, by a work, written by GARIOT, on the Diseases of the Mouth, published, 1806, and by an elaborate Treatise, written by Prof. Baume, on First Dentition, and the Diseases that accompany it. In the same year a work, written by LEROY, (de la Faudiguere,) on the Diseases of the Gums, was published, and a Treatise, entitled, Manual of the Art of the Dentist, written by JOURDAIN and MAGGIOLO, was issued from the press in 1807. But besides the above named work by Laforgue, the author of it has written a number of articles on the Diseases of the Teeth, which were published in 1808, and a Dissertation on First Dentition, published in 1809. About the same time, a well written work, from the pen of Duval was published, who is, also, the author of several other works, one on Second Dentition, published in 1820, and another on Mechanical Dentistry, published in 1828, besides several small Essays.

The next work which we propose to notice is from the pen of C. F. Delabarre, and is entitled Odontology, which was published in 1815.-In 1819, a work from the same author, was issued from the press, and in 1820, a Treatise on Mechanical Dentistry. - From the pen of this able writer, we are also indebted for a Treatise on Second Dentition, intended as a supplement to his former work upon the same subject.

A Manual on the Anatomy and Physiology of the Teeth, and a Treatise on Dental Physiology, Pathology, and Therapeutics, both written by LEMAIR, were published, the first, 1816, and the last in 1822. In 1819, a Treatise on the Anatomy and Physiology of the Teeth, and Dentition, written by Serres, was also issued from the press.

It may also be well to mention in this place, that during the first fifteen or twenty years of the present century, a number of pamphlets and essays on the manufacture of mineral artificial teeth, were published in France, and in 1821, quite an elaborate treatise upon the same subject, written by AUDIBRAN, made its appearance. The credit of the invention of these teeth is ascribed by some to DUCHATEAU, an apothecary of St. Germain, but the claim of a dentist by the name of N. DE CHEMANT to it, was so fully established that royal letters patent were granted him both in France and England. Although these teeth were manufactured in France as early as the year 1788, they were not brought to a sufficient degree of perfection, to completely supersede the use of animal substances for artificial teeth, until about the year 1833, when the improvements made in the United States obviated most of the objections that had previously existed to their employment. At present, they are decidedly preferred by dentists to every other description of artificial teeth. The introduction of the use of mineral artificial teeth was the commencement of a new era in dental prosthesis, for, although it was a long time before they were brought to sufficient perfection to render them desirable substitutes for the natural organs, yet it gave an impetus to improvement in this department which has been attended with the most happy and salutary results.

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Although interesting only in a physiological point of view, the work of F. Cuvier, which treats on the Teeth of Mammiferous Animals, and their Zoological Characters, should not be passed without notice. It was published in 1825, and contains one hundred plates. It is one of the richest contributions to the science of odontology, which had, at the period of its publication, appeared.

MIEL, in 1826, gave to the dental profession a well written and valuable work on the Art of Directing Second Dentition. In 1828, a splendid work, illustrated by thirty beautiful plates, on the Comparative Anatomy of the Teeth of Man and other Animals, by Rousseau, was issued from the press, and eight years previous to this time, small treatise, by the same author, on First and Second Dentition, was published. But the best work on practical dentistry, which had appeared in France, at the period of its publication in 1833, is from the pen of F. MAURY. In 1836, a valuable treatise, by professor BLANDIN, on Dental Anatomy, was published. This work deserves to be ranked among the first upon the subject on which it treats.

In 1841, a work, by LEFOULON, on the Theory and Practice of Dental Surgery, made its appearance. A Treatise on Irregularity of the Teeth by SCHANGE, was published in 1842. But the best elementary work on the Science and Art of Dental Surgery, which has appeared in France, is from the pens of DESIRABODE & SONS. It occupies upwards of eight hundred pages, and has passed through two editions. The last was published in Paris in 1845. It treats on almost every subject coming within the province of the dental surgeon.

   To the foregoing works, many more might be added, but those which we have already noticed will suffice to show the progress which the science and art of dental surgery has made in France since the commencement of the present century. The French have written much upon the subject, and have contributed largely to its advancement. They were its earliest, and, for a long time, its most zealous cultivators. For the assiduity with which they have studied its principles, the ingenuity and talent they have brought to its aid, and the energy and zeal with which they have applied themselves to the development of its resources, they are entitled to the highest praise.

Leaving the French school, we shall proceed to examine very briefly the progress which dental surgery has made in Great Britain, during the same period. The publication of Dr. Robert Blake's Inaugural Dissertation on the Structure of the Teeth in Man and various Animals at Edinburg, in 1798, was followed in 1803 by the first part of Fox's celebrated Treatise on the Natural History and Diseases of the Human Teeth, and in 1806, by the second part. Both of the above works hold a deservedly high place in the literature of this department of medicine; they have been quoted by almost every subsequent writer, but the latter, as having more of a practical character, has been more extensively read than the former, and that portion of it which treats on the anatomy and physiology of the teeth, ranks, even now, among the best works extant upon the subject. But the doctrine that all of the diseases of the teeth are analogous to those of other bones, as more distinctly promulgated to the dental profession than had been done by any previous author, although even now maintained by several very able European writers, has subsequently been very conclusively shown to be erroneous. The publication of this work, however, at once gave to the subject, as a branch of the healing art, an importance, which it had never before had, and awakened a spirit of inquiry which soon led to the adoption of a more correct system of practice than had hitherto been pursued.

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Four years after the publication of the second part of Mr. Fox's work, a small Treatise on the Structure, Formation, and Management of the Teeth, by FULLER, was issued from the press. The year following, a work written by MURPHY, on the Natural History of the Human Teeth, with a treatise on their diseases, from infancy to old age, was published. But as both of the last mentioned works were chiefly designed for the popular reader, they did not, either in a scientific or practical point of view, contribute much to the advancement of dental surgery. Two other works of a somewhat similar character were published, one in 1819, and the other in 1823. The first was written by MR. BEW, and the last by GERBAUX.

But the best treatise on dental pathology and therapeutics which had come from the English press at the period of its publication in 1826, is from the pen of LEONARD KOECKER, M. D., and is entitled, Principles of Dental Surgery, and the dental profession are indebted to the same author for two other works, one on the diseases of the jaws, published in 1828, and the other on Artificial Teeth, published in 1835.

In 1827, MR. FAY published a description of a mode of using forceps, invented by himself, for the extraction and excision of teeth. It is hardly necessary to say that the advantages proposed to be gained by the last named operation have not been realized. In 1831, a small treatise written by J. P. CLARK, was published. But one of the most popular works that has yet appeared in England, is from the pen of MR. THOMAS BELL, an able and highly accomplished writer. This work was published in 1830, and in 1831, it was followed by a work on Operative Dental Surgery, written by MR. SNELL, but previously to this period, a small work, entitled the Surgeon Dentist's Manual, by G. WAITE, had made its appearance, as well as several other small treatises. Mr. Waite is also the author of a well written treatise on the structure and diseases of the gums. In 1835, Mr. Jobson gave to the profession a treatise on the Anatomy and Physiology of the Teeth, and four years after the publication of this work, a treatise, written by Mr. Robertson, made its appearance, in which the Chemical Theory of Dental Caries, is ably advocated.

In 1839, an Historical Introduction, to Researches on the Development, Structure, and Diseases of the Teeth, by A. NASMYTH, was issued from the press, embodying the views, as well as the result of the researches of almost every writer of note, upon the subject. Mr. Nasmyth is also the author of three Memoirs on the Development and Structure of the Teeth and Epithelium, which were published in 1841. These contain the result of a series of highly interesting microscopical observations made by the author upon these subjects, and constitute a rich contribution to the science of odontology. It is proper to mention in this connection, that a highly interesting and ably written paper on the Development of the Pulps and Sacs of the Human Teeth, written by MR. GOODSIR, was published in the January No. for 1839, of the Edinburg Medical and Surgical Journal.

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In 1841, a small Treatise on the Structure, Economy and Pathology, of the Teeth, written by Mr. Lintot, made its appearance, and soon after, a small work on the Extraction of Teeth, by Mr. Clendon. In 1845, the publication, which had been commenced in 1840, of an elaborate and very ably written Treatise on the Comparative Anatomy of the Teeth of vertebrate animals, by professor Owen, was completed. In this work, which is entitled Odontography, the physiological relations, mode of development, and microscopical structure of the teeth, are minutely described. It is also illustrated by up-wards of one hundred and sixty splendid lithographic plates, which, with the text, forms two large imperial octavo volumes.

Several valuable contributions to the literature of this branch of medicine have been made by Dr. E. Saunders, and among them are a series of Lectures on the Anatomy, Physiology and Diseases of the Teeth, delivered at St. Thomas' Hospital, and published in the London Forceps; and a pamphlet of about eighty pages, entitled, the Teeth, a Test of Age. In 1846 and '7, a course of Lectures upon Dental Anatomy, Physiology, Pathology and Therapeutics, delivered by Mr. Tomes at the Middlesex Hospital, were published in the London Medical Gazette. But one of the best practical manuals upon dental surgery which has come from the English press is from the pen of Dr. James Robinson. It was published in 1846.

Many other works might be added to the list of publications on the teeth, which have been published in Great Britain since the commencement of the present century, but as most of them were intended for the general, rather than the professional, reader, we have not thought it necessary to extend the length of this article by mentioning them. With the increase of the literature of the Science and Art of Dental Surgery in Great Britain the improvements in practice have fully kept pace. The ranks of the profession for twenty-five or thirty years, have been rapidly filling with men no less distinguished for scientific attainments than for practical skill.

In Germany, dental surgery, though its progress has been less rapid there than in France and Great Britain, has attracted considerable attention. Few works, however, of much merit have emanated from that country since the commencement of the present century. There are two, however, published at Berlin, particularly worthy of notice - one in 1803, and the other in 1842. The first of these works, written by SERRE, treats of dental operations and instruments, and forms on octavo volume of nearly six hundred pages, illustrated with upwards of thirty plates. The last is by C. J. and J. LINDERER, and treats of Dental Anatomy, Physiology, Materia Medica and Surgery, forming an octavo volume of about five hundred pages, illustrated with several plates. Both of the last mentioned treatises, are very creditable productions. But, not-withstanding the merit possessed by a few of the German works upon the teeth, practical dentistry has not attained as high a degree of perfection generally in the German states and provinces, as it has in some other countries.

The researches of PROFESSOR RETZUIS, of Sweden, have excited much attention in Europe, and though they do not go to confirm previous opinions with regard to the minute structure of the teeth, they have nevertheless thrown much valuable light upon the subject. These researches are both curious and interesting, and consist of microscopic examinations of the teeth of man and other animals, conducted upon an extensive scale, and would seem to prove the structure of these organs to be tubular. The account given of these researches by the author, has been translated into English, and are embodied in Nasmyth's Historical Introduction, which has already been noticed.

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Having now glanced very briefly at the progress of the science and art of dental surgery, in most of the principal countries of Europe, we shall proceed to notice their introduction and growth in the United States.

It has been generally supposed, that it was during our revolutionary struggle for independence, that the first knowledge of dental surgery was introduced into this country, and that the first dentist in the United States, was a man by the name of LE MAIR, who accompanied the French army which came over to our aid during that period. But this is not the fact. Mr. R. Wooffendale came over from England to New York, in 1766, and remained in this country some months, practicing in New York and Philadelphia, but not meeting with much encouragement, he returned to England in 1768. But, soon after the arrival of Le Mair, a dentist by the name of WHITLOCK came over from England. It was, therefore, from Wooffendale, Le Mair and Whitlock, that dental surgery may be said to have had its origin in the United States. But as yet, so far as the author has been able to ascertain, no regular treatise upon the subject had found its way to this country. With regard to the professional abilities of Le Mair and Whitlock, little is known, but it is probable they were limited, and that their practice consisted chiefly in constructing artificial teeth from blocks of ivory.

It is believed, however, that MR. JAS. GARDETTE, a surgeon from the French navy, was the first medically educated dentist in the United States. He came to New York in 1783, and the following year went to Philadelphia, where he soon secured a high reputation by his professional skill and gentlemanly deportment, which he retained during an eminently successful career of upwards of forty years.

MR. JOHN GREENWOOD, however, it is believed, was the first regular native American dentist. He commenced practice in New York, about the year 1778, and is said to have been the only dentist in that city in the year 1790. Possessed of great energy of character and ingenuity of mind, he rapidly acquired reputation in the profession. But Mr. Greenwood did not remain long alone in the profession in New York. About the year 1796, Mr. Wooffendale, of London, came to the United States and commenced practice in this city. About the year 1805, Dr. Hudson, of Dublin, commenced the practice of dental surgery in Philadelphia, where he soon acquired skill and reputation which he enjoyed for upwards of twenty years, when death put a stop to his professional career. But about five years previously to the last mentioned period, Dr. H. H. Hayden commenced practice in Baltimore, and being possessed of an inquiring mind, he soon availed himself of the advantages of most of the best European works upon the physiology and pathology of the teeth, which had been written. In 1807, Dr. Koecker commenced practice in the same city, but in a short time, moved to Philadelphia, where he remained until 1822, when he went to London, where he has since continued to exercise the duties of his profession. But before he left the United States, he had acquired a justly deserved high reputation for skill in the treatment of the diseases of the mouth. In the mean time, many others had entered the profession, but instead of contributing to the advancement of correct practice, they rather had a tendency to retard its progress, and bring odium upon the calling, as they were for the most part ignorant of those branches of knowledge, which it is so important for a dental surgeon to possess. But the number of dental practitioners in the United States, at the last mentioned period, was by no means great, and even as late as 1820, the number in this country, did not greatly exceed one hundred. From this time, however, they began to increase more rapidly, and although few of those who assumed the calling, did so with the necessary preparatory education, the zeal and ability with which this branch of medicine was cultivated by a few, hastened it on to- wards perfection with astonishing and unexampled rapidity. Practical dentistry, in all its branches began to assume a perfection to which it had never before, in any country, attained.

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In 1830, the number of dentists in the United States, according to the best information upon the subject, was about three hundred, but of these, it is true, perhaps, that not more than forty or fifty had attained much practical excellence. The portals to the profession then, as now, were open to the ignorant, as well as to the educated, and in consequence of this, its numbers multiplied rapidly. In the course of five years from the time last mentioned the number of dentists in the United States had more than doubled.

But an event was now approaching in the history of dental surgery in the United States, which gave to its progress a new and unexpected impetus. The publication of the American Journal and Library of Dental Science was commenced in 1839. This was the rising of the morning star of improvement which was soon followed with more palpable evidences of the approach of day-light to the scattered members of the profession, who had hitherto toiled in comparative obscurity, almost unknown to each other and to the world. This publication aroused the energies of many, who had learned the science in years of toil, but who had not before found any appropriate medium through which to communicate their knowledge to the profession.

The formation of the American Society of Dental Surgeons, soon followed the establishment of this periodical, and at its second annual meeting, an arrangement was made with its publishers, by which it became both the property and the organ of the association. Since then, the agency of the Journal in recording the transactions of the society, in presenting the papers and the addresses read before it at its annual meetings, the discoveries and improvements in the art, as well as in the diffusion of the knowledge of foreign acquirements in this branch of surgery — has marked it as the chief ally of the society in the elevation of the profession, and in giving vigor to its associated efforts for the advancement of the science. The fact that it has become a medium of intercommunication between its members, and the repository of valuable information, should commend it to the members of the dental profession generally.

But a few months previous to the institution of the American Society of Dental Surgeons, the legislature of Maryland chartered a college with four professorships, for the purpose of affording more ample facilities of instruction in the branches of knowledge necessary to the education of an accomplished dentist, than could be furnished by any  private teacher, and thus securing to the public a sure guaranty against the  impositions of empiricism. The object of this institution is, to give those who receive its instructions, a thorough medico-dental education, so that when they enter upon the active duties of the profession, they may be enabled to practice it, not alone as a mere mechanical art, but upon sound scientific principles, as a regular branch of medicine. While the head is being educated in such branches of general medicine and surgery, as is deemed necessary to a successful practitioner in this department, and in the principles proper of dentistry, the fingers of the student, are, at the same time, regularly drilled every day in the various mechanical manipulations belonging to it, so that those who graduate in the Baltimore College of Dental Surgery, go out with advantages that can seldom be obtained from private instruction. This fact, it is believed, will ever connect the destinies of the institution with the welfare of the profession in this country. A similar institution has recently been established at Cincinnati, Ohio.

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Since the Baltimore College of Dental Surgery, and the American Society of Dental Surgeons, went into operation, four local associations of dentists have been formed, one in the Mississippi valley, one in Virginia, the third in Pennsylvania, and the fourth in New York.

In 1842, there were about fourteen hundred dentists in the United States, and now (1848) there are upwards of two thousand. But it is a source of regret that many are without any of the qualifications necessary for the exercise of the duties of so nice and difficult an art. But, notwithstanding all the discouraging circumstances which have and do still attend the progress of dental surgery in the United States, its growth has been astonishingly rapid. Fifteen years ago, an accomplished dentist might have been pardoned the thought that his art had arrived at perfection; but great improvements have been made in this department of surgery within that time, and who shall say that the succeeding fifteen years shall not be as pregnant with improvements as the past.

Although the United States may not have contributed as much to the literature of this branch of medicine as Europe, dental surgery has, nevertheless, progressed with as much rapidity here as there, and the works of American authors upon this subject, would suffer little, if at all, by comparison with similar publications of other countries. But few elementary treatises on the subject have ever been published any where, and of those purporting to be such, which have appeared during the last fifteen or twenty years, American dentists have contributed their full share.

Among the works on the teeth which have emanated from the press of this country, it may be well to mention the following: in 1819, a work entitled, a Practical Guide to the Management of the Teeth, by L. S. Parmly, was published in New York, and another work from the pen of the same author, on the Natural History and Management of the Teeth, made its appearance in 1821.

In 1822, a small work on the Disorders and Treatment of the Teeth, written by Dr. Eleazar Parmly, was published in New York and London. A small Treatise on the Structure, Formation, Diseases and Treatment of the Human Teeth, by Dr. J. F. Flagg, was published in Boston in 1822. In 1828, an Essay on the Structure or Organization and Nourishment of the Human Teeth, from the pen of Dr. J. Trenor, was published, and in 1829, a Treatise of upwards of five hundred pages, entitled, a System of Dental Surgery, in three parts, written by Dr. S. S. Fitch, was issued from the press. The first part, treats of Dental Surgery as a Science; the second, on Operative Dental Surgery, and the third, on Pharmacy, connected with Dental Surgery. This is the largest and most comprehensive work which had, at the time of its publication, appeared. In 1835, a second, and improved, edition was issued from the press.

In 1833, a poem by Dr. S. Brown, with notes by Dr. E. Parmly, entitled, Dentologia, was published. Dr. Brown is also the author of a poem, entitled, Dental Hygiea, published in 1838, and of a series of articles on Mechanical Dentistry, published in the American Journal of Dental Science. A year after the publication of the second edition of Dr. Fitch's System of Dental Surgery, a popular Treatise, entitled, Guide to Sound Teeth, by Dr. S. Spooner, made its appearance. In 1839, a practical Treatise on Dental Surgery, of nearly four hundred octavo pages, by the author, was issued from the press, which has subsequently, been enlarged to seven hundred and fifty-two pages, and passed through two other editions, under the title of Principles and Practice of Dental Surgery. The last edition was published in January, 1848. In 1843, a treatise on the Anatomy, Physiology, and Diseases of the Teeth and Gums, &c. by Dr. Paul Beck Goddard, was issued from the press, and two years after, a popular treatise on the Teeth, by Dr. Robert Arthur.

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The author would not omit to mention in this connection, that since the commencement of the publication of the American Journal and Library of Dental Science, four other periodicals devoted to the interests of dental surgery have been established, namely: The Dental Intelligencer; the New York Dental Recorder; the Dental News Letter and the Dental Register of the West. In all of which some excellent articles upon the teeth have appeared.

In thus briefly glancing at the rise and progress of dental surgery, the author has necessarily been compelled to avoid entering into details of particular modes of practice, and of improvements and inventions, which have, from time to time, been made, as well as of an analysis of the works which have been mentioned, for, if he had done so, it would have swelled the present article to a size wholly incompatible with the design of a work like the present.