108 
POPULAE SCIEI^rOE NEWS. 
[July, 1891. 
I need not tell you how fearfully prevalent 
decay of the teeth or dental caries is. I have no 
doubt that most of you have experienced its un- 
pleasant effects in some form or other, and tlie 
question naturally arises, "Wliat is it?" We 
have seen what an extremely hard and seemingly 
indestructible substance enamel is, but at tlie 
present day there is no tissue of the body wliich 
so soon f.ills a prey to disease. Why is tliis? I 
will give you the answer in the words of the emi- 
nent dentist, Sir John Tomes: "Caries is an 
effect of external causes in which 'vital' forces 
play no part. That it is due to the solvent action 
of acids which have been generated by fermenta- 
tion going on in the mouth, organisms having no 
small share in the matter ; and when once the dis- 
integrating process is established at some con- 
genitally defective point, the accumulation of 
food and secretions in the cavity will intensify 
the mischief by furnishing fresh supplies of acid." 
Acid, therefore, is the great enemy of the teeth, 
and when the enamel is dissolved away sufficiently, 
bacilli and micrococci, which are always present 
in the mouth, appear upon the scene, and feed 
upon the gelatinous matrix of the dentine. Mean- 
while, in the cavity so formed, food is constantly 
collecting and remaining. You know better than 
I do the fermentative processes, first the alcoholic 
and then the acid, which take place in starchj' and 
other food stuffs remaining at blood heat and 
under other favorable conditions. I dare say you 
could all give me the equations right off, but I 
think I have shown you pretty clearly how the 
mischief takes place. Besides, in many fevers 
the saliva instead of being alkaline becomes quite 
acid. 
Now the next question that presents itself is, 
"How is it that dental caries is so prevalent?" 
In the crypt of Ilythe Church there is an interest- 
ing collection of the skulls of our early forefath- 
ers, and on examining them, the dentist is struck 
by three peculiarities common to them all, name- 
ly : (1) the almost total absence of caries ; (2) 
the great wearing away of the teeth which has 
taken place ; and (3) the largeness and Arm devel- 
opment of the jaws. Bret Harte in one of his 
poems asks, "Is civilization a failure?" and I 
think we must admit that as regards teeth it is; 
the jaws now-a-days being smaller than those of 
our ancestors, and the teeth not worn away with 
use, but by disease, and more or less overcrowded 
and irregular. The cause* of this change for the 
worse are, briefly, as follows, viz. : Tlie food we 
eat. Our food now-a-days, ))y the time it comes 
to the table, is so well cooked that it is half eaten 
for us, and it is a well-known law of nature that 
when any member is not required to exert itself, 
it dwindles in proportion to its inactivity ; that is 
one reason why our jaws are smaller. Another 
reason is natural selection. In choosing our 
wives, most of us would, I think, prefer a lady of 
a refined cast of features rather than one who was 
heavy-jawed and thus coarse looking; her pecu- 
liarities in this respect would be more or less 
transinitted to her offspring, and this again is no 
doubt another factor in producing smaller jaws. 
But the jaws being composed of softer tissue than 
that of the teeth which they contain, changes take 
place more quickly in them than in the teeth ; 
therefore we have jaws getting smaller and teeth 
remaining more the same size, the consequence 
being overcrowding, which is a very active agent 
ill producing caries. Add to these our artificial 
mode of life, improper food containing far too 
little bone and teeth-forming elements, excite- 
nuMit and worry of our modern life, and last, but 
not least, dyspepsia, and you have, I think, suf- 
ficient explanation of the cause of tooth deteriora- 
tion. 
The results of caries are, toothache in its many 
forms, whether from irritation of the dentine, 
irritation or inflammation of the tooth pulp and 
of the membrane surrounding the tooth in its 
socket (which if unchecked lead to abscess at the 
root of the tooth, with temporary or permanent 
disfigurement), neuralgia (often at parts of the 
face and head remote from the offending tooth), 
loss of teeth (either from decay or extraction), 
fetid breath, etc. 
I think I am right in saying that two of the 
most common diseases of the present day are neu- 
ralgia and indigestion, and although specialists 
are inclined to think that every malady is closely 
connected with the disease of which they make a 
specialty, yet I think you will agree with me that 
a very large proportion of the two diseases named 
arise from tooth trouble. To put it roughly 1 
might say, neuralgia when the teeth are in, indi- 
gestion when they are out. It is pointed out in a 
very interesting and able paper, by Dr. MacNaugh- 
ton Jones, upon " Dental Reflexes," how neuralgia 
and lesions of the eye, ear, and other parts of the 
head and face are directly attributable to carious 
teeth, and how in many cases relief and cure have 
followed extraction, although, of course, some- 
times the mischief is too firmly rooted to be per- 
manently dislodged. 
There is far too much apathy shown by the 
British public about the loss of their teeth, in 
fact, about the care of their teeth altogether. We 
must not look upon a tooth as an isolated mem- 
ber; .it must be looked upon as a part of a beauti- 
ful and symmetrical organization, from which one 
member cannot be taken without affecting the 
others; so that when we sit down and have a 
tooth out and pat ourselves on the back for being 
very plucky, not one out of a thousand reflects 
that in having that troublesome grinder out he 
has deprived himself also of the use of its antago- 
nists; and very often, as time goes on, the con- 
tiguous teeth to the one extracted tilt over, and 
instead of having a good grinding surface, we 
have a bad one or none at all ; and again, when a 
tooth has lost its antagonist, the tendency is for 
it slowly to elongate, loosen, and come out. Then 
when tlxe back teeth are lost, food is improperly 
masticated by nibbling it, like a rabbit, with the 
front teeth, which were never made to bear the 
strain, and which consequently are pushed out- 
wards, or the food is bolted, and indigestion is the 
natural result. The sufferer often endeavors to 
cure the disease without remedying the cause, 
and, of course, fails. All the pepsin and bismuth 
in the world will not make up the loss of masti- 
cating teeth. 
The remedies for the state of things which I 
have briefly touched upon are : (1) strict per- 
sonal attention to the teeth, night being the most 
important time; (2) conservative treatment of the 
teeth, that is to say, having tlicm preserved by 
the process of stopping, or filling, which consists 
in removing all the decayed portions of a tooth 
and filling the cavity so made with some suitable 
filling. This process of filling teeth is, when effi- 
ciently performed, the most successful operation 
in any branch of surgery, the disease being 
checked, the injured tissue being replaced, and 
the tooth made in every respect as useful as be- 
fore it was attacked by disease. Of course the 
earlier the stage of decay, tlie more probaljle that 
this state of affairs will ensue; like other diseases, 
it must be nipped in tlie bud if jKissible ; (3) .State 
control. 
The loss of teeth among the children of the 
poorer classes and also among the men in«the 
army, navy, and civil service is very great. 
When I was dental assistant at the Evelina Hos- 
pital for chililren, in Southwark, I had a pretty 
thorough insight into the condition of the mouths 
of the children of the poor ; that condition I can 
only describe as shocking. ITieir troubles, of 
course, commence with teething ; their temporary 
teeth soon decay and are extracted, and the per- 
manent ones very soon follow suit ; no attention 
is paid to them by parents, and, of course, the 
teeth quickly take revenge. For iirivate individu- 
als and institutions to cope with this sort of thing 
we should want dozens of dental charities where 
we at present have one. In London there are two 
purely dental hospitals, and each of tlie general 
hospitals and dispensaries have their dental de- 
partments, which are more or less complete, but 
they can do but a very small proportion of the 
stopping which is actually required; it would 
take too long. So the condition of things is, 
firstly, that the patients, as a rule, are those who 
visit the hospitals not being able to stand their 
toothache any longer, and have their teeth ex- 
tracted ; and, secondly, that teeth which could be 
saved with care, time, and attention are often sac- 
rificed from sheer want of time on the part of the 
dentist to the institution, or on that of the pa- 
tient. Ill the army and navy, again, and the post- 
oflice, though tlie possession of sound teeth is one 
of the requirements for admission into these ser- 
vices, the State takes no pains to see that the 
youths who seek to enter upon these careers have 
had their teeth previously attended to, and con- 
sequently many otherwise likely lads are debarred. 
Again, after they hiwe been admitted into these 
services there are no dentists attached to the ser- 
vices, and the doctors are otherwise engaged, or 
if their services .are requisitioned it is but lor 
the old purpose, extraction. I maintain that tlie 
State should provide highly trained dentists to 
look after the children of our board schools, 
and also dentists attached to our naval and mil- 
itary forces. We admit that the soundness of tlie 
teeth is necessary for admission, and after spend- 
ing large sums on our soldiers and sailors to make 
them good fighting machines we grudge them the 
attention to a disease which at present day causes 
more direct and indirect suft'ering than any other 
in om- country, and a man who cannot feed well 
cannot march well or fight well. 
Gentlemen, I thank you for listening so attent- 
ively to a paper which, owing to many circum- 
stances, is crude and somewhat disjointed, but I , 
have briefly endeavored to show you the relation 
between the individual and his teeth, how bad 
health and neglect produce bad teeth, and how 
biid teeth i)roduce or aggravate bad health. 1 
have also tried to point out the remedy, and trust 
you will do all in your power to educate and influ- 
ence others in the care of those important organs 
which seem to be dis.appearing so rapidly. 
[Specially Compiled for Popular Science News.] 
MONTHLY SUMMARY OF MEDICAL 
PROGRESS. 
BY MAURICE V. CLARKE, M. U. 
Epidemic Influenza and Insanity.— Taking 
the cases of the Danvers Hospital .and those re 
ported from other hosjiitals. Dr. Harrington firidi 
forty-eight cases in which an attack of the influ- 
enza was followed immediatelj' or in a short time 
by the development of a psychosis. In thirty-one 
cases the influenza acted as an exciting cause to 
insanity, predisposing and other exciting causes 
being clearly made out. In seventeen cases the 
