REPORT OF COMMITTEE ON PATHOLOGY AND 
SURGERY. 
BY 
W. H. ATJKIXSOX. 
[Read before the A, D. Aat Boston, 1866.] 
After a survey as complete as the circumstances of the case 
will permit, the following conclusions may be pronounced: 
I. All true authority resides in the mind capable of correctly 
interpreting nature. 
IL All correct surgery coincides with, rather than opposes 
the normal energies of the body. 
111. Hence, a conservative is the only legitimate surgery. 
IY. When the principles underlying a thorough and correct 
apprehension of a really conservative surgery shall have been 
understood, correlated and taught, ninety-nine per cent of the 
necessity for surgical manipulation will have been annihilated. 
Y. So long as an injured part, soft or bony, is capable of 
being supplied with fresh arterial blood, it may be resuscitated; 
but just so far as this supply is permanently prevented from 
entering the territory involved, necrosis is sure to supervene to 
increasing extent, if the points first devitalized be not promptly 
removed. 
YI. All advance is made through the things we suffer. 
YII. Medicine and surgery, no less than dentistry, owe 
much of their present elevation to the reckless blunders of their 
practitioners. 
YIII. Any agent capable of unfavorably modifying physio- 
logical activity is a poison in the exact ratio of its power to do 2 
this; when favorably sustaining physiological action, it is a 
food; and when it neutralizes pathological agencies, it is an 
antidote a medicine. 
IX. The time is fast approaching when we, as dental 
surgeons, will conserve pulps and parts of pulps as anxiously 
and successfully as the other organs and parts of organs of the 
human body. 
An exhaustive report upon even a single example of patho- 
logical manifestation involves the focalization of all knowledge, 
of not only pathology, but also real physiology, or normal func- 
tion; and, so far as ultimate or primate actions are concerned, 
is now quite among the impossibles to even the highest scholar- 
ship ol our most indefatigable workers to demonstrate to ordi- 
nary apprehension. 
• What, then, shall be done ? Shall we listlessly fold our 
impotent hands and do nothing, because we cannot accomplish 
the most magnificent results by a single effort at solving the 
entire protean problem of disease? 
In all ages, men have been inspired with the desire to secure 
perpetual youth —in a word, to find the means of immunity 
from pain and perpetuity of pleasure; but that grand catholi- 
con th® universal panacea has pronouncement, as yet, 
only in the magnificently bewitching ideal! It is frequently 
said to be of little use to be able to recognize a disease for 
which we know not the remedy. In the abstract, this would 
be true; but, as it is usually meant, it is far from it, 
for it signifies a remedy in the shape of a medicine speci- 
fically adapted to antidoting the mischief, and not a knowl- 
edge that the disease had a certain course to run, and then 
die by exhaustion of the power of the virus causing it, or 
the susceptibility of the system to respond to it. Poisons 
expend themselves by limitation resultant upon entering into 
combination with the tissues, or by diffusion and dispersion to 
remote distances in the fluids favoring their escape from the 3 
body by profluvia, or their infinitesimal attenuation. Some 
poisons act with such potent energy as to destroy life instantly, 
in an incomprehensible manner; while others lay the founda- 
tion of pathological states that may lay dormant throughout a 
lifetime nay, a whole series of generations, only awaiting the 
favoring conditions to break forth in all their destructive energy 
in the over-fed and under-worked, and under-fed and over- 
worked, or under-rested, progeny who have inherited the molec- 
ular disability. Thus, it is apparent that foods become poisons 
and poisons foods, according to the circumstances of the system 
into which they are introduced. This will be more and more 
clearly seen as we progress with the detail of the physiological 
principles arid movements out of which our apprehensions of 
pathological manifestations take their origin and means of ad- 
measurement and differentiation. 
At the suggestion of the Chairman of the Committee on 
Pathology and Surgery, I will endeavor to say something upon 
the past and present apprehensions of the profession respecting 
syphilis. 
Probably the great underthought of all the past and most of 
the present, is, that this disease owes its existence to a poison, 
(“ raateries morbi ” “ virus,”) -varying in degrees of intensity 
and quantity of power! That it is, in the main, propagated 
by unclean contacts is indisputable; but that these alone are 
capable of originating it in an otherwise healthy organism, 
leaves us in the dark as to its origin in the first case. Just 
what is meant by intensity as opposed to quantity is not so 
easy of comprehension and definition. For susceptibility of 
the system upon which it is inoculated is involved in the 
inquiry no less than many other conditions of temperament of 
the body, temperature of the part, and many modifying cir- 
cumstances, without a knowledge of all of which we are unable 
to diagnose a case or calculate its character, progress and 
termination. 4 
It will probably be most in accordance with prevalent ideas 
to treat it as a germ—a seed the stages of evolution of 
which makes its character and presence known by the effects 
produced in the body. All germs require a favorable nidus in 
which to display the powers of the typal force which formed 
them and is holden in their mysterious grasp. 
The grains demand at least three conditions, viz: light, heat 
and moisture, and flourish best in good air and plenty of soil. 
Just in what the physical body of the germ of syphilis 
consists-we will not pretend to say at this time; but that it 
holds specific relations to the neural-(mucoid-)sea, in the soft 
and hard parts of the body we have the tangible testimony of 
sight and sense. 
Whether the so-called stages of primary, secondary and 
tertiary “ syphilization ” are due to the specific character and 
strength of the virus, or to the varied resistant powers of the 
diverse tissues it invades, admits of some dispute. Lest 
some objection be made, I will state here that the term 
u syphilization ” will be used to denote the saturation of the 
system by the virus, or malign presence upon which the disease 
denominated “ syphilis ” depends, and not to signify any techni- 
cal methods of inoculation or number of repetitions thereof 
necessary to exhaust the susceptibility to the infection of 
syphilis or other cachexia for which inoculations were or might 
be invoked. 
Were this germ proven to possess specificity of size, form 
and solidity, it were an easy task to calculate the highways and 
byways through which it could pass with ease or with effort, 
and the degree of vigor with which it would coincide with or 
differ from and supplant the normal nutrient movements of the 
parts into whose territory it was admitted. But until we are 
blessed with this insight into the incubation and development 
of this potent presence, we must content ourselves with annota- 
tions of such results as do come within reach of our present 5 
power of cognition, setting them down as parts of the process 
of the demonstration so certain to be fully pronounced in due 
process of procedure. 
Syphilis, at present, is recognized alone by the ravages it 
effects. The regularity and similarity of these, as they present 
to the observer, are relied upon as testimony to the identity 
of the cause producing them. Uniformity identity of mani- 
festation —is necessary to diagnosis; hence the value of the 
diagnosis is exactly commensurate witli the degree of intelli- 
gence of the observer. 
Chronothermal conditions have such modifying influence upon 
functional manifestations that a general rather than a strictly 
special identity and uniformity is alone attainable, upon which 
to base our diagnosis that “these ravages depend upon syphi- 
litic poisoning. The important effort at generalization in 
nosological arrangements, reducing all disease to a unitary 
origin and type, so ignominiously scouted by the many, is 
•nevertheless worthy of the gravest consideration. 
Let us inquire, then, “Is syphilis the unitary door and 
lype ” through which all disease enters, and toward which every 
pathological manifestation points for primal and ultimate 
solution, explanation and successful treatment. 
It all “ solids arise from and depart through liquefaction,” and 
“ all oils (liquids) are but concentrated gases; and these con- 
densed ethers; and these but spirit in like constraint,” we ought 
to be able to deduce the tremendous equation that « all things 
differ but in degree,” of differentiation of spirit-affinity! This 
would, if clearly apprehended, unravel the whole mystery 
of « chronothermalicity,” “infection,” “disinfection,” evolution, 
culmination and decadence or death (extinction) of all bodies 
and of disease: No less than that, all cure, and truly scientific 
management of bodies laboring under aberrant currents of 
force, depend upon modifications effected in the unseen «typal- 
spirit-presence,” constituting the motive energy of all bodies 6 
seen and unseen. Just so soon as this knowledge is fully 
attained, by plodding detail of observation, or by instantaneous 
inspirational obedience to that which energizes all, a word, a 
touch will be (shall I not rather say is), all that is necessary to 
exorcise the malign presence, and then the body spontaneously 
returns to a state of health. 
If then, most interior spirit-affinity, contact and blending be 
the only source from whence arise the roles of functional activ- 
ity denominated ease and disease, with what sedulous care ought 
we to study our physical, mental and spiritual natures; so that 
by the knowledge of these equal affinities and necessities, we 
may be able to conserve goodness of use and avoid the dete- 
riorating contacts and blendings which have thus far held the 
dominion among the mass of mankind. From which dominion 
of contacts and blendings arise, individual being, suffering, 
development and dissolution of personal bodily presence in 
prolonged horror of inharmonious detail, in all departments of 
existence, each struggling for the uncontradicted autocratic- 
instead of the common-concurrent-jurisdiction of the field of 
action. 
It is currently reported that the “.fear of disease ” is a potent 
restraint upon otherwise reckless characters. Let it once be 
firmly established in the minds of men, as it is indisputably 
written in organology, that all associations remote as well as 
near leave their unmistakable impress upon the whole being to 
the competent apprehension, the more occult the more insidious 
for the time, and dangerous in the outcrop, and we will no 
longer see searching scrutiny into the origin, cause and charac- 
ter of pathological manifestation ignored by those who profess 
to have a mission to make, or modify the destinies of individu- 
als and communities! 
That these intensely heterodox and u hated pronouncements ” 
are not the “chatterings and tergiversations of a mind dis- 
eased,” permit the proof out of the mouths of those who most 7 
strenuously oppose them, by referring to the “ real orthodoxy ” 
of the present, in which it is everywhere said that infection and 
disinfection obey the laws of thermal motion, and have their range 
of action between 32° and 212° of Fahrenheit’s scale above 
and below which they are “ nil ” in their ability to manifest 
themselves I This doctrine is the sum of the whole labor upon 
the intensely interesting question of “ Quarantine! ” and proves 
that currental inflections and Reflections make and. mar the 
condition of man in health and disease! 
A specific poison, capable of deranging currental equipoise in 
the human body, enters the periphery of the mucoid-sea beneath 
the attenuated dermal sheath, near the mucous openings: And 
dies by conversion into accelerated normal nutrition, or rapidity 
of diffusion, or changes local molecular movements producing 
stasis in the sea, and accumulation of her waters in a bleb in 
the areolar tissues, which is incipient chancre or pock (pockeQ 
in which the germ rapidly multiplies in the.form of pus globules 
and fluid pus on all sides of this cavity: Inviting influx from 
the juices of the flesh in the immediate neighborhood, extending 
stasis and induration farther and farther until the outer wall of 
the bleb or cavity bursts from tension or external violence 
scratching or other mechanical interference, thus displaying 
the unmistakable character of “ lues venerea,” or syphilitic 
chancre. “And dies by conversion” into normal nutrient 
force, “or by rapidity of diffusion ” throughout the mucoid sea, 
modifying nutrient actions so little as to only slightly change the 
character of the great fountain of the vital pabulum, upon 
which the system subsists, which change is so very insignificant 
that it attracts no attention, and hence passes insidiously into 
every possible variety of derangement of nutrient activity, 
laying the first stone in the ease upon which a multifarious 
Pathology is built—so difficult to satisfactorily trace to this 
unitary origin of evil! 
It is thus seen that there is no safety to susceptible persons 8 
in any contacts of this virus; for although there may be no 
perceptible pock, or primary local affection, the “ diffusion ”of 
the “ evil ” may be yet more destructive to the well-being of the 
organism, than in case of regular primary infection, and reg- 
ular development of the more common (according to past 
and present doctrines) effects of the virus; by originating 
ambiguous derangements, hard to be understood, and therefore 
difficult of cure. 
The unitary primal necessity to infection, is local debility of 
dermal and hypodermal cells, the change in whose walls per- 
mits the ingress and egress of substances' which the normal 
state would effectually exclude, or convert into normal force; 
and thus their interiors become increased or reduced in size, so 
as to destroy the proper tension to favor equality of the cur- 
rental movements of the modifications of force, the exactitude 
of which constitutes normal nutrient activity. 
Pus, tubercle, and cancer, are but irregular modes of oblitera- 
tions of primates (filaments and cells) in forming and nourishing 
tissues; the origin of all of which we ought, now, to be able to 
trace to incongruity of copulative conjunctions in cells, tissues, 
organs and systems, of the currental forces that produce and 
sustain all these in individual and associate existence. 
Where the contest for dominion of the nutrition of the part is 
exactly balanced in the force or power of the diverse energies 
battling for the field, they mutually neutralize each other, and 
death (necrosis) of the territory infected is the consequence. 
Instance the sloughings of territory invaded by swellings in 
bubo, so common, and so tedious of restoration to health. 
When vital energy of a part is in its highest state of func- 
tional activity, the virus has no affinity for the already harmo- 
nious currental movements; and in such cases infection does not 
“take,” as the phrase is. But where inharmony has already 
partial residence in the locality, affinities for diverse (poison- 
ous) currents do exist, and will display themselves whenever 9 
circumstances bring a virus within the proper distance, or 
sphere of influence. 
Under such circumstances of debility in nutrient force, the 
virus is readily admitted, and rapidly diffused throughout the 
sea of pabulum, in which a modified digestion thereof takes 
place under this new dominion, and a syphilitic cachexia is set 
up throughout the extent of its ethereal territory, thus impress- 
ing the constitution with the 'primary effects of the poison, with- 
out the intervention of the digestion of the altered pabulum in 
the circumscribed sea, of a bleb, blister, or incipient chancre, as 
is the more common observation in practice. 
Thus the whole sea of the juices of the flesh (mucoid sea 
neural sea) is made to glow with the rife fermentation of the 
chancrous poison, instead of the insignificant interior of the 
little pock(-et) at the point of contact of the inoculation of the 
infectious presence. And we thus have the so-called “ secon- 
dary ” manifestations of syphilitic poisoning, involving the soft 
parts and skin in general, and the glands in particular. 
The next stage is nothing more than the expression of this 
one just described, confined to the mucoid sea in the porous 
and cancellous portions of the bones of the body, and is the 
so called “ tertiary ” form, and is long in running through its 
course, and varies much according to circumstances of constitu- 
tion, age, sex, treatment, etc., etc. 
Of that form of venereal disease variously denominated 
“ syphiloid,” “ chancroid,” “ soft chancre,” etc., etc., the oral 
surgeon lias but little concern, and so it is thought best to keep 
out of the muddle of that controversy; although close atten- 
tion to what has already been said will indicate, a correct clas- 
sification and understanding of this form, also. 
In reply to the question, why certain poisons and cachexias 
prefer particular tissues and localities in the bodies they infest, 
it must be acknowledged that the' range of recorded observa- 
tions is as yet too meagre to enable us to demonstrate satisfac- 10 
torily the analysis and synthesis upon which the proof of the 
philosophy depends. However, the facts are abundant and 
will soon find explanation, if each will but record and expose 
to others the views that spontaneously arise respecting both the 
facts and the philosophy, instead of continuing to perpetrate 
blunders of the head and hand and conceal them lest others 
also see the weakness, not to say wickedness, that stands in the 
way of advancement to higher morality and better ability! 
If new and improved apprehensions of pathology and 
appropriate surgery based thereon, are not generally accepted 
by those supposed to be competent judges of such matters, we 
need not despair, for all present orthodoxy was once in the 
same dilemma, and it has been able to work its way to recogni- 
tion. 
It may be pertinently asked, by those who advocate the old 
ideas of primary, secondary and tertiary “ forms ” of syphilis, 
how it comes that identity of treatment of these conditions does 
not result in equal promptness and certainty of cure, if indeed 
these manifestations are but the “primary” effects of the poison 
in the various tissues, as indicated in this paper ? 
An intelligible, complete reply to this query would constitute 
the very essence, germ or basis of all knowledge upon the 
momentous questions of healthy and diseased actions and their 
proper management, and would reveal the peculiarities and 
possible differences in the occult movements in every form of 
cell, tissue, organ and system. 
The attempt to perpetrate this equation in our own strength 
and acquisition of learnings in the recorded observations of our 
predecessors would smack of egotism or foolhardiness. There- 
fore let the attempt be made in deep humility and implicit reli- 
ance upon (the intensity and clarity of mind resultant upon) 
the inspirations that are born of our painful necessities, 
the source and fountain of all perceptions, past, present and 
future, of the learned and unlearned inquirers, for help to reduce facts to the philosophy by which alone they can be satis- 
factorily explained. Will you permit me to make this basal 
statement, viz: The germs from which healthy bodies are capa- 
ble of being evolved are produced by the satisfactory equation 
of plus and minus quantities of force within an amorphous 
solution of sun-md-earth presence, called chaos, which is true 
planetary substance, and the first step or stage in individual 
bodily presence or existence. When the equation of force is 
not quite satisfactory, an imperfect or unhealthy germ is the 
product, and the body capable of being evolved from it will 
possess an hereditary tendency to pathological manifestation, 
requiring the best possible regime to overcome or keep in 
latent state. 
The nourishment, as well as the reproductions, of tissues, organs 
and beings, is effected from this same fountain of pabulum (or 
chaos), under the guidance of typal power, which had its origin 
as stated above, the conditions of which made it healthy or 
debilitated, and limited it in possibilities of duration, size, 
generic, specific and other characters. It is evident, then, that 
concurrent jurisdiction or dominion of sun-and-earth energies 
constitute the measure of health, and that any discordance in 
this working together in the body, soul and spirit, will institute 
poisonous or pathological states of the being in whom they occur. 
As there is a difference between the healthy and unhealthy 
constitution ,of germs, so, too, there is a difference between 
sickening and death of the bodies capable of functional action. 
Debility renders infection (demoniac dominion) possible, and 
disinfection (exorcism) is most promptly effected by antidoting 
the poison and supplying nutriment to the weakened organism. 
It may now be asked why mercury has thus far been the remedy 
in syphilis ,* the answer to which should simply be, because it 
has been known to have the power to break down, deoxidize 
the debilitated, poisoned cell-structures into an amorphous, 
chaotic state, thus rendering purgation of the juices of the flesh 12 
an easy effort to the system, ridding it of the malign presence 
beneath the skin in the mucoid sea by the profluvia, diaphoresis, 
ptyalism, catharsis, etc., etc., following its administration. 
When this purgation is complete, it only remains for the vital 
energies to heal the local lesions of dermal parts, and the effects 
of the poison have no further active agency. But, when the 
poison has found lodgement in the deep glandular and osseous 
structures, effecting death of cellular interiors, the mercury is 
not alone able to cause the solution and removal, by profluvia, 
of the dead and debilitated primates, and hence the so-called 
secondary and tertiary indications which result from obstruc- 
tions, causing abscesses in glands, which must be discharged or 
• encysted, and also causing necrosis in bones, which must be dis- 
solved and washed away, or continue to be a source of irrita- 
tion until removed by mechanical means. Thus it is clear, that 
the irritations and tedious consequences of the failure on the 
part of the systemic powers, or the surgical attendant to remove 
necrosed parts in glands and in bones, depends upon this 
inability or neglect, and not the specific virus of syphilization. 
The remedies relied upon to remove these obstructions in 
glands and bones as the results of syphilis, viz: the iodides of 
mercury and potash are as potent solvents and deobstruents in 
cases of the so-called non-syphilitic as syphilitic necrosis of 
glandular and osseous tissues. 
And now, from all that has been said, is it not easy to deduce 
the correct treatment of syphilis, viz: 
For incipient chancre, the abortive extirpative treatment by 
caustic, scissors or knife. (As a caustic the saturated solution 
of pure iodine in creosote is preferred.) And good and suffi- 
cient feeding to secure pure and abundant arterial blood to ren- 
ovate and sustain the system. 
For fully developed chancre, add to the abortive treatment 
constitutional raercurialization (the protiodide of mercury is 
preferable) and a nourishing regimen. 13 
For glandular obstructions and eczematic eruptions, push 
vigorously the mercurialism and decided increase of the good 
feeding coupled with scrupulous cleanliness. 
For periosteal and bony obstructions, heroic doses of iodide 
of potassa, and prompt and decidedly deep incisions to evacuate 
local obstructions beneath the periosteum, and in the coriutn of 
the shafts of the long and other dense bones, following up the 
supporting regime. 
There are two distinctly marked advances upon « orthodox,” 
general and oral surgery, viz : First, the conservation and rapid 
reproduction of bones when involved in injuries that formerly 
predetermined their ultimate loss; and, second, the conservation 
of bruised and inflamed soft parts, by local relief, induced by 
free incisions to remove extravasations; and support, to favor 
fresh influx of pure blood, by which rapid repair is effected. 
In the practical expression of the first, it is only requisite to 
remove so much of the already necrosed bone as is fully 
deprived of the circulation of fresh blood, by enucleating it 
from the soft parts. After freeing so much as desirable by the 
spud and saw and file or forcep, proceed to rasp, file, or scrape 
away all the dead and dying parts until the fresh, living bone is 
invaded, which is known by the oozing of the bright, arterial 
blood from the cancelli and haversian canals. Then proceed to 
wash out the debris and blood, after which a solution of 
chloride of zinc, 20 grains to the ounce of water, should be 
injected to arrest the bleeding and induce an exudate of blood 
plasm with which to unite the severed parts by the colloid mass 
out of which the new tissues take their origin. 
One word more about dressing: Be careful to do no more 
than remove effete matters that may appear in the locality. 
For, if not careful to only do this, the plasm and soft granu- 
lations will be liable to be washed away by the force of the 
jet from the syringe, and thus retard the cure by an over- 
treatment, which is, if anything, worse than under-dressing, 
both of which should be sedulously avoided. 14 
The second example of advance in doctrine and practice 
consists in that which has been denominated “ abortive treat- 
ment of inflammations ” by mechanical and medicinal means. 
Dr. W, W. Allport, of Chicago, has reduced this to a definite 
and comprehensible manipulative proceeding, so far as exposed 
pulps and cornua of pulps are involved, in his admirable method 
of extirpating the exposed part with the rapid, delicate cut of 
a peculiar instrument, freeing the lips of the wound from 
attachment to the surrounding dentine, .by which procedure 
the lips are allowed to fall into contact by the resilience of 
the tissues, thus securing union by the first intention. This 
process is eminently conservative of the life of the pulps 
submitted to it, as is now verified by a number of cases, which 
have proved successful in preserving them for the performance 
of their proper function, whatever that may be. At least one 
case of loss of half the bulbous portion of the pulp of a superior 
incisor has resulted in not only conservation of the remain- 
ing portion of the pulp, but the force resident therein has 
thrown out and organized a complete protection of secondary 
dentine. This is testified to by Dr. Allport himself, Dr. M. S. 
Dean and Dr. L. P. Haskell. I myself, saw the same case at 
the point, when the plasm out of which the calcigerous protec- 
tion has been evolved, was occupying the chasm across its 
deepest portion, in contact with the living, pulsating pulp, which 
could be distinctly seen through the beautifully transparent 
shining colorless mass which has so condescended to be wrought 
into the much coveted and now attained calcareous protection 
to the delicate tissues beneath. 
There are but two methods of resisting the advancement 
claimed, viz: First, to deny the facts, and, second, to say “ they 
are nothing new.” 
It is well known how discourteously the writer of this has 
been treated by those who counted themselves the embodiment 
of knowledge, for no other reason than that he advocated the 
possibility of that which is now so triumphantly proven. REPRODUCTION OP THE ALVEOLAR PROCESSES. 
BY 
W. H. ATKINSON. 
[Bead before the A. D. A., at Boston, 1866.] 
These bodies, like all the tissues and organs composing the 
living human organism are constantly being destroyed and 
reproduced in their integral parts. 
And he who best understands this process called destruc- 
tive and constructive assimilation will be best able to com- 
prehend the possibilities and probabilities of the same process 
when it is expressed in larger territories than is common under 
the ordinary circumstances of the growth and nutrition of these 
in normal waste and supply. 
The primal necessity of vital activity in any part, is supply 
of the arteriose and neural bloods, in whose joint communion 
alone the primates of organs can be formed and sustained. 
Wherever, then, the supply is cut off, death, proportionate to 
the privation, will ensue. When the territory of a single cell 
alone is thus circumstanced, it is readily removed and replaced 
by enlargement of the adjacent cells, or the reproduction of a 
new one to take its place or converted into a mere filament of 
scar or connective-tissue by the collapse of its wall and the 
escape of contents into the neural sea (juices of the flesh), in 
which it is either converted into pabulum by the digestion 
peculiar to that place, or it is carried into the general circula- 
tion and disposed of as effete matter. And thus the system is 
happily rid of this dead body whose presence was intolerable 
to its living neighbors. 
Let an indefinite number of contiguous cells be in the cir- 16 
cumstance just delineated, and we have incipient abscess. 
Just so soon as death and disruption of this cell-territory, or 
rather cells of this territory, take place, a digestion is attempted 
of this material, which, when it succeeds, becomes the nidus in 
which new cells proliferate to restore the part, and repair is 
effected by the first intention, and so our incipient never 
becomes mature abscess. But, in case of inability of this diges- 
tive effort to perform its intent, a lower form of vital activity, 
called chemical, steps in and digests the matters into sanies, 
pus, etc., and then true abscess has declared its dominion in 
that territory, and is present in proper form and pronounce- 
ment. When this abscess is evacuated by natural or artificial 
means, the same process of repair goes on to complete the cure, 
and is now called reproduction by the second intention of the 
kindly guardian whose mission it is to care for the parts involved. 
Thus it will be readily seen that the two forms of reproduc- 
tion called first and second intention, arc but differing degrees 
of the identical forces at work in caring for the body as a 
whole by attending so assiduously to the primates of which it 
is composed and upon whose integrity and well-being its own 
health and vigor so absolutely depend I 
•The only barrier in the way of absolutely successful treat- 
ment of these cases by the surgeon, is want of sharpness of 
vision, corporal and mental to detect them in these stages of 
pronouncement. The necrosed cells, dead bodies, in the second 
example of privation of supply are the cause of the necessity 
for local or surgical interference. 
The sanies and the pus corpuscles are incapable of being 
wrought into healthy pabulum; hence the imperative necessity 
for their removal. I would never wait for the slow process of 
nature to open an alveolar abscess, but would boldly plunge 
into its most interior just so soon as it was cognizable, thus 
saving loss of substance and loss of time in the cure, no less 
than entering an efficient caveat against unlimited extension 
into the processes and surrounding parts in poorly constituted 17 
frames. If the territory over which stasis has been pronounced 
be vigorously incised, even into the bony processes, the necessity 
of “ reproduction of alveolar processes ” will have been annihi- 
lated. 
But where from neglect, or any cause, the supply has been so 
long prohibited from entering the territories of soft parts or 
bones, that death (necrosis) has actually already ensued, we 
need not despair of success most marvellous and complete, if we 
are only humble and earnest enough to observe the law and 
effect the work indicated by kind nature’s lead. That is, 
remove the dead and dying territories, and encourage, by 
judicious support, the disconsolate, mangled neighborhood from 
which they were forced, until a fresh colony of cells can be 
induced to occupy the ground so perfectlj7, as to defy minutest 
survey to detect that they- were not the very original cells 
and lineal descendants which primarily occupied that territory. 
There are two distinct forms of death of the alveolar pro- 
cesses, both of which are amenable to cure by simple incision, 
if done at the proper time and stage of development. I refer 
to solution of the lime and animal basis in which it is lodged; 
and necrosis, properly so called; both of these conditions result 
from interruption of the circulation which supplies these thin 
processes and trabeculae. 
Traumatic lesion may produce necrosis, but never immediate 
solution of these bones. 
Constitutional vice, resultant upon the introduction of a 
poison (virus) into the system, can alone so derange the nutrient 
activity as to induce rapid solution of the alveolar plates in 
situ. Mercury carries the palm in this respect, especially in the 
free margins of the alveolar process, dr edges of the sockets in 
which the teeth are held; and the thin, hard palatal process of 
the superior maxilla forming the fornix or roof of the mouth, 
anterior to the palatal bones proper. 
These last yield very often to syphilitic poisoning, and inju- 
dicious or heroic mercurialization. In fact it is common, under 18 
such circumstances, to see all the bones of the head and face 
defaced and dissolved through their whole extent: worm-eaten, 
gnawed, frail and fetid. 
Recovery in such cases can only take place under the best 
care and treatment, the principal of which consists in abundance 
of highly nutritious food to support the system, while adminis- 
tering heroic quantities of the iodide of potassium. This rem- 
edy has the effect of washing out the virus (and debris of 
broken down osseous and soft structures), whether syphilitic 
or mercurial. 
Mercury should not be continued after the second stage of 
syphilization has been partially controlled by it, unless the 
iodide of potassium also be given at the same time; as, when mer- 
cury is relied upon alone, and continued after the secondary symp- 
toms have subsided, it is so very apt to coincide with the disease 
in preference to antidoting it, as it did in the former condition. 
Dentists usually do not see cases until the death of the bones 
has so far progressed as to call attention to alveolar abscesses 
resultant upon the necrosed processes. Hence, the oral surgeon 
will not need to administer mercurials to the majority of cases 
requiring the assistance he is supposed to be able to give; but 
he must be able to prescribe the proper supporting and depu- 
rative treatment constitutionally, or fail to get the highest 
benefits of his local manipulations and dressings, be they never 
so skilfully and scientifically applied. 
A rich diet to support the drain upon the blood column, by 
suppurative discharge and by normal exudation into the pocket 
out of which the new structures are to be built, is as absolutely 
a part of the cure as is the antidoting of the blood poison that 
wrought the destructive mischief. 
Cleanliness of mind and body, sunlight and plenty of fresh 
air are also prime necessities of a sound cure in complete repro- 
duction of the lost alveolar processes. A few directions about 
the removal of dead and dying processes and proper dressings, 
and we close this imperfect paper. 19 
Where separation of dead portions of process has already 
taken place, a very simple procedure is necessary, viz: Enlarge 
the fistulous openings already present in such a way as to pre- 
serve the best form of pocket in which to hold the amorphous 
plasm from which we are to derive our new bones and other 
structures. After which, one simple dressing of a solution of the 
chloride of zinc, twenty grains to the ounce of water, then wine 
of opium in full strength, say twice a day for the first few days. 
The great thing is to treat just enough and not too much. 
Many failures to get good processes reproduced where they are 
gone, arc, I am quite sure, attributable to over-doing the cases 
by the anxious, young oral surgeon. 
The sole object of treatment is to change the pus-producing 
surfaces to plasm-producing agencies, so that we may have good 
material in the proper place, to be wrought into the new struc- 
tures we are so anxious to see spring up. Where the line of 
demarkation between living and dead tissues is not well defined 
in narrow limits, the question arises, shall we wait for exfolia- 
tion and separation of the necrosed parts, or shall we anticipate 
extensive destruction by at once removing all that part already 
dead? By peeling off the soft parts with a well-adapted, blunt 
instrument, like a flat-pointed burnisher, called a spud, and nar- 
row files passed through the processes in two or more places, 
freeing these dead parts from all attachment; afterwards filing 
or rasping with suitable instrument, rasp, burr, file, or scraper, 
until the living territories are invaded, which will be known by 
the peculiar living feel, and the flow of arterial blood oozing 
from the fine haversian canals and cancellous structure. We 
should most unhesitatingly give adherence to the latter pro- 
cedure; even dry lint or cotton dressings, after having thorough- 
ly cleansed out the debris of file or other instrument with warm 
water, in which a few drops of tincture of arnica are thrown, will, 
in the majority of cases, secure a nice pocket which will fill in a 
few days. 20 
•But in cases where much pus and sanies still ooze from 
the chasm from which we have removed, or thought we had 
removed, all the dead parts, it will be well to look more closely 
lest some necrosed parts yet remain. If we do not discover, by 
our best research, that such is the case, then we should dress 
the whole tortuous, winding chasm or chasms with a saturated solu- 
tion of iodine in pure creosote, on cotton pledgets that will nicely 
fit the cavities and represent the size and shape of the pocket 
we desire to hold the material out of which to reproduce 
new parts. These dressings should remain in place twenty-four 
hours and then be nicely and completely removed, and their places 
occupied with others wet in a weak solution of chloride of zinc; 
these also to remain in place one whole day. Afterwards, 
wine of opium on cotton, or dry cotton or lint, should be inserted, 
and removed twice in twenty-four hours. 
Each successive dressing will be less than its predecessor, 
until the whole cavity is filled up, in all cases that are properly 
dealt with locally and constitutionally. 
Having advised the syringe to be used in cleansing the chasm, 
after removal of the dead parts, it may be necessary to caution 
the inexperienced oral surgeon against too much violence in 
using the syringe. I have seen many cases much prolonged in 
treatment from this cause alone, by breaking down plasm and 
granulations and washing them away by the force of the stream. 
And of course the cure must be retarded by such loss of the 
very things we need to close up the space with new structure. 
Being aware of the ambiguity of verbal instructions alone, 
permit me to advise each one who wishes to be up to the best 
skill, and to make advances rapidly thereon, to call upon those 
who are already competent to treat these cases, and get the 
eye and hand educated as well as the ear and brain. The 
more earnest minds focalize upon any one subject the more 
rapidly will it advance to its limits of capability for good to the 
race and the profession.