234 ON DISEASES OF THE DENTAL APPARATUS 
granulated, dry, and resistant to the touch ; of a greyish tint, ana- 
logous to that of a sphacelated bone. This is the summit of the 
root of the tooth deprived of the osseous partition that in the 
healthy state closes and separates it from the interior of the sinus. 
The operator then arms himself with an iron punch rounded at 
the point, which he applies to the extremity of the root in the 
sinus, and having dilated the mouth by a few turns of the specu- 
lum oris, in such a manner as to place the superior and inferior 
arcades at a distance from each other, he commands an assistant 
to strike the head of the punch in short hard blows, after every one 
of which he assures himself whether the tooth loosens, in order to 
proportion the force of the succeeding blows to the resistance. 
The adhesion of the tooth soon gives way under this treatment, 
and is punched into the mouth, generally in two fragments, ac- 
cording to the direction of the caries. 
Sometimes, from the great length of the tooth, and the arcade 
of the under jaw being exactly opposite that to be operated upon, 
the diseased organ cannot be punched completely into the mouth, 
because the distance between the two dental tables is not sufficient 
to allow of the entire length of the loosened tooth to be pushed 
through into the mouth : it is then necessary to twist or wrench it 
out with a pair of long pincers, the handles of which must be se- 
parated from each other to increase the power of the operator. 
The operation terminated, the vegetations of the mucous mem- 
brane, as far as they can be reached, must be excised ; then, in order 
to arrest the abundant hemorrhage which results from this excision, 
and at the same time to modify the state of the membrane — 
pledgets of tow moistened with a diluted solution of nitric acid or 
some other caustic, should be applied. 
It is really extraordinary with what rapidity structural destruc- 
tions so considerable as those resulting from this operation are 
repaired by the wonderful workings of the organic economy. The 
first time that we were called upon to perform it, we considered 
the animal which had been submitted to it as almost entirely 
incurable; in fact, that it was nearly impossible. The sinuses 
laid open by a large breach of nearly two and a half inches in di- 
ameter communicated with the mouth by an enormous opening 
corresponding to the alveole in which was lodged the tooth, whose 
root had acquired nearly treble its normal volume. Again, the 
lining membrane of the maxillary sinuses, as also of the frontal, 
had suffered the transformation that we have above described to 
its greatest degree. And, finally, we should remark, that it re- 
quired efforts almost beyond belief to loosen the tooth and force 
it from its alveole. Still, however, to our great surprise, the ani- 
mal made a good recovery. 
