TREATMENT OF EFL-MS.—Whether the g.rowth present be a simple or malignant one, the sooner it is removed the better. The tumor, and the tooth or teeth and the portion of the alveolar process in volved, should be cut out, this constitut ing the only safe mode of treatment. Mere scrapina; is followed by a return of the tumor in almost every case, whether simple or malignant. The portions of bone to be removed being mapped out, two vertical incisions are made with a Hey saw, and the diseased mass is re moved with forceps, after havin7 been dis3Peted from its surroundings.
Four eases of epulis personally operated upon, in all of which an attempt had been made to remove the growth without sacrificing the teeth, and in all there was prompt recurrence. Thus far the prompt removal. after drawing the teeth from whose base the tumor had sprung, has been effectual, and was likely to continue so. All eases of tumor of this kind re moved at the hospital from 187S to 18S8 have been followed, and neither recur lenec nor death has occurred. Where the growth appears on both sides of the alveolar process, at least one of the teeth, and often both, must be drawn to give free access to the periosteum. In this dis ease the dangers of palliative delay are not great, on account of the fact that it has, in the beginning, at least, only local malignancy. Al. Il. Richardson (Boston Med. and Surg. Jour., Oct. 2, '90).
Conclusions from observations of epu lis; 1. In none of personal cases of epulis have evidences of general or secondary invasion been observed, and it has been sufficient to remove the tumor and to ex tract the roots or teeth with which they were connected to cause the arrest of the disease. 2. In all cases treated there has been a great neglect of the hygiene of the mouth. This has been the case especially with persons working in copper, or eut lers, whose teeth accumulate a character istic tartar which appears to predispose them especially to these neoplastic forma tions. F. D. Rodriguez (Cronica Medieo quir. de la Habana, Oct., '90).
Necrosis.
Necrosis of the jaw may be due to any condition liable to give rise to inflamma tion of its periosteum by injury due to extraction of teeth, by various suppura tive diseases, the acute exanthemata, pyzemia, actinomycosis, etc., or by the
action of various diathetic processes, such as syphilis, tubercle, or leprosy. It is most frequently caused by the fumes of phosphorus (see beyond), and by mer cury taken internally. Deficient nutri tion, scorbutus, or other conditions in which the organism is deprived of its vital pabulum frequently manifests ne crosis of the jaws as a symptom. It may thus occur at any age, and does seem to show a predilection for either the upper or lower maxillary.
Necrosis is always preceded by deeply seated and intense pain; the parts are red, inflamed, and tumefied. After a time the pain is somewhat reduced and sinuses are formed, from Nvhich a fcetid pus exudes. The teeth are loosened and fall out, and the cavity left is bathed in pus. A probe passed in any of the si nuses reveals the presence of dead bone by conveying to touch the characteristic sensation of roughness. Portions of the bone become detached and are easily removed.
Case of a boy, aged 6 years, taken sick with influenza in December, 18S9. Dur ing convalescence fcetor and swelling of the mucous membrane of the right cheek noticed. Fever set in on the fourth day, and a gangrenous area was noticed which spread rapidly to the right half of the upper lip and invaded with special vio lence the osseous portion of the upper jaw. The whole of this bone was com pletely carious. The face on the right side presented an enormous cedema, which hid the eye completely. There was an abundant and fcetid salivation and an odor of cadaveric putrefaction.
Complete excision of the diseased upper jaW was performed by which the whole of the osseous lesion was removed. The gangrenous soft parts were partially re moved and burned with the Paquelin cautery, and the cavity packed thor oughly with iodoform gauze. In two months there was complete recovery without marked deformity. Christovitch (Bull. Gen. de Th6r., Nov. 15, '90).