An Address 
ON 
ORAL SURGERY 
Delivered before the American Medical Association. 
BY 
D. H. Goodwills, M.D., 
New York City, 
Late Clinical Assistant to the Metropolitan Throat Hospital; Permanent 
Member of the American Medical Association ; Fellow of the 
N. Y. Academy of Medicine ; Honorary Member of the 
Canada Medical Association; Member of 
N. Y. Neurological Society; of the 
Medical Society of the County 
of.IiL Y., etc 
Reprinted from the 
Transactions of the American Medical Association, 1882 
PHILADELPHIA : 
TIMES PRINTING HOUSE, 725 AND 727 CHESTNUT STREET. 
1882. ADDRESS ON ORAL SURGERY. 
By D. H. GOODWILLIE, M. B, 
NEW YORK CITY. 
Mr. President and Fellows of the American Medical Association:— 
Having been honored by you as the first presiding officer 
over the new section created by your action last year at Rich- 
mond, Va., I am before you, to answer to the duty put upon 
me. 
It is another indication of progress in the healing art that 
this representative body of the profession in this country should 
include in its deliberations everything that goes to secure health 
and happiness to mankind. 
There are two natural divisions in the subject of this Section, 
namely:— 
First.—Dental Art, which is nearly all of a mechanical nature; 
and, 
Second.—Special Surgery, which includes the treatment of all 
diseases connected with the mouth. 
To the proper practice of the latter it is necessary that there 
be added the experience of the former, with a practical knowl- 
edge of medicine and surgery. 
There are few who may possess the ability to acquire the 
requisite theoretical knowledge, and to put it into full practice 
in both divisions above referred to, as they both have become 
so intricate. 
Every properly qualified general practitioner should have at 
least a theoretical knowledge of all diseases of the mouth, so 
as to be able to make a proper diagnosis, or, by his timely 
advice, prevent disease. For this purpose I would have estab- 
lished, in Svery medical college, a chair of oral surgery, that 
would at least give a theoretical knowledge, and require it of 
every graduate—the practical instruction to be obtained in a 
hospital and dispensary devoted to this specialty. 2 
ADDRESS ON ORAL SURGERY. 
All medical officers appointed in the army and navy should 
have practical experience in all diseases of the mouth. 
In the period of more than a score of years of professional 
life, the first part of which was spent in the treatment of dis- 
eases of the teeth, and latterly has been exclusively given to 
diseases of the mouth and associate parts, pardon me for tres- 
passing on your time in giving you an outline of such experi- 
ence as, I hope, may be most interesting to you. I desire briefly 
to call your attention to some of the diseases of this part by 
illustrative cases, and to exhibit some by means of wax models, 
diagrams, etc. 
A simple interference with mastication, for instance, in the 
child, interferes with the proper nourishment of the body, so 
necessary for not only supplying the waste of the tissues, but 
for the growth and development of every organ and tissue. At 
this stage alimentation is of vital importance, and mastication 
is the very first act in the process. 
The process of development of the deciduous teeth, com- 
mencing in utero and completed early in the life of the child, 
escapes, to a great extent, from the effects of many diseases 
incident to childhood, but they often produce sad results on 
second dentition. Many disturbances of the vital processes inter- 
fere with development, and produce characteristic marks upon 
the permanent teeth, so that in adult life you may be able to 
tell what was the kind of disease, and the period at which it 
occurred in the process of development. 
Dentition is a physiological process, and seldom takes on 
pathological changes, except as influenced by some disturbance 
of the general system. During the first two years of life first 
dentition takes place; and in this period also the child is subject 
to numerous diseases, often of a dangerous kind. 
The teeth and the liver are often made the scapegoats for a 
good deal of ignorance, both professional and lay. For if no 
ready cause can be found for ailments, these poor organs get 
more than the lion’s share of the blame. 
How many thousands of children have fallen victims to the 
fallacy of the laity that teething is a disease,—a necessary con- 
secpience,—and that little or nothing can be done. So it comes 
that the ever-watchful vender of marvelous drugs and baby- 
foods finds in this a fruitful field for cultivation, to turn an 
honest penny in, and so comes to the rescue with his able assis- ADDRESS ON ORAL SURGERY. 
3 
tants in the person of parents, auntie, or some sympathizing 
friend; and between them the poor little sufferer (if he is not 
drug proof) is soon sent to kingdom come. 
Not long since, in company with the coroner, we made inves- 
tigation as to the cause of the death of a child, and found full 
evidence that its life here had received a fatal soothing, by means 
of Mother Winslow’s marvelous syrup administered from the 
hand of the mother for teething. 
At the present time I have in hands a child upon whom I 
made an operation for cleft palate and hare-lip, whose mother, 
against my strict orders, but rather taking the advice of an old 
wise auntie, persisted in secretly stuffing her child with other 
so-called baby-foods, to the exclusion of nature’s true food—milk. 
I only came off* victorious when the child’s body became cov- 
ered by a cutaneous eruption. 
In these days of enlightenment in medical science, it is deplor- 
ably true that certificates of death from teething are still given, 
as the following letter from Dr. John T. Nagle, registrar of the 
Bureau of Vital Statistics of the Health Department, of the city 
of New York, shows:— 
New York, May 31, 1882. 
D. H. Goodavillie, M. D. 
Dear Doctor :—In reply to yours of May 28tli, I respect- 
fully inform you that in the year 1868, there were forty-one 
deaths—twenty-one male, and twenty female,—attributed to 
“teething” alone. Since I have been here I have returned all 
certificates where there was no other cause assigned than denti- 
tion for the reason that you state. 
' Yours truly, 
JOHN T. NAGLE. 
Alas ! A normal physiological process the cause of death. 
If first dentition in the child is the cause of death, why not 
carry it through the process of second dentition, which lasts to 
nearly adult age ? Perhaps it might he found that malaria, small- 
pox, or some of the other diseases, lie buried in the jaws. 
Facial neuralgia in a great majority of cases arises from— 
First.—Peripheral irritation of the dental nerve from exposure 
by caries or attrition of the dental tissues, or ossific deposits in 
the pulp-chamber, producing a very severe form of neuralgia. 
Second.—Decomposition of the dental pulp (that is, artery, 
vein and nerve, supplying the tooth) from chronic pulpitis 4 
ADDRESS ON ORAL SURGERY.* 
opening into the mouth, forming what is commonly called a 
gum-boil (alveolar abscess). 
Third.—Maxillary abscess, which may eventually open into 
the adjacent salivary glands, tonsils, nostrils, antrum, etc., caus- 
ing great trouble in these parts. 
Fourth.— Traumatic causes; namely, blows, excessive heat or 
cold, foreign substances pushed through the pulp canal into the 
jaw, certain drugs, etc. 
There are .also reflex irritations produced by disease of the 
teeth, that affect remote parts of the body. The following 
illustrative ease is_given by the writer in a paper read before 
the New York Neurological Society, on “Lesions of the 
Trifacial,” and published in the Journal of Nervous and Mental 
Diseases for April, 1876. 
Professor Zagus, of the University of Cuba, sent me the fol- 
lowing: “The child, in his own family, who is the subject of 
these observations, was born eleven years ago, of healthy par- 
ents ; she also was of healthy aspect and condition. When six 
months old, and without having suffered any previous disease, 
it was observed, when taking her from the bed in the morning, 
lifting her under her arms, that she cried, having a remarkable 
contraction of her features, as a child in great pain might do; 
and at the same time both her lower limbs were contracted. 
She presented at that time the symptoms which announce the 
proximity of the first teeth cutting the gums. It was remarked 
at the same time that she could not creep as do other children 
of the same age. In spite of her strong appearance, she could 
not master the contraction or extension of her limbs, and was 
obliged to creep, bearing the whole weight of her body on her 
arms alone. When eight months old, and when two or three 
teeth had appeared, it was observed that the region of the lum- 
bar vertebra} was projecting somewhat; but the curvature at 
that time was scarcely perceptible. So she continued crying 
painfully whenever she was lifted from the floor, or from her 
bed, though with intervals of ease. She began to walk when 
a year old; and when she had completed her second year, she 
had a most painful eruption upon the left thigh, which was a 
strongly characterized zoster with the acute pains which usually 
accompany this sickness. This limb was always more con- 
tracted than the other from the very beginning of her illness. W e 
may here remark the coincidence of the zona with the appear- ADDRESS ON ORAL SURGERY. 
5 
ance of this same sickness in other cases of nervous suffering. 
The child walked without difficulty, and even ran; but from 
time to time she would suddenly complain of acute pains in her 
limbs, and was forced to remain in bed one, two, or even three 
days, in a paralyzed condition; and then, as suddenly, she 
would rise, run or walk as usual, though almost constantly with 
her left limb contracted, and walking with her left foot on tip- 
toe. Her teething continued its regular course. Her general 
health was good; but the lumbar curvature became more 
apparent. 
When five years of age, one evening at half-past seven, about 
three hours after her dinner (which time she had spent playing), 
she was seized with an attack of eclampsia which lasted about 
five hours, and in which she was in danger of death. That this 
attack was not caused by indigestion is clear from the fact that 
an emetic administered to the child immediately only brought 
up some remains of the dinner already converted into paste, 
but did not in any degree lessen the convulsions. Bromide of 
potassium, mustard plasters, and warm mustard baths had no 
effect on her; but a spoonful of chloroform caused the attack 
to cease immediately; arid after five hours of refreshing sleep 
she awoke well, though still complaining of the pains in her 
limbs. Neither sea-baths nor medicines of any kind produced 
any change for the better. Some time after a consultation of 
physicians was held, and they came to the conclusion that it 
was Potts disease; for the spinal curvature had increased greatly. 
They ordered the child cod liver oil. 
Being resolved to take the child to Europe, my attention was 
attracted by a strange coincidence. I observed whenever she 
would complain of her limbs her face would swell, and she 
would carry her hand to her face as often as to the painful limb. 
This fact I noticed several times, and at once concluded that all 
her ailments from the age of six months—the spinal curvature, 
zona, painful contraction of the limbs, and eclampsia—had 
their origin in the irritation of the buccal cavity. 
I examined her mouth, and found that she had a decayed 
tooth. The following day, notwithstanding the great pain she 
complained of in her limbs, I took her to a dentist and had the 
decayed tooth treated ; and twenty hours after all pain and con- 
traction had ceased. The only permanent derangement was that 
of the spine, the bones of which had suftered for so long a time 6 
ADDRESS ON ORAL SURGERY. 
the constant action of the muscles subjected to an abnormal 
contraction. 
Some time after, when that same tooth became again pain- 
ful, she complained once more of the same pains in her limbs, 
and as on previous occasions her face was swollen. I brought 
her again to the dentist and had the tooth extracted. All pain 
and contraction disappeared in the course of a few hours. 
The spinal curvature is to-day pretty nearly the same as it 
was three years ago. The child is strong and healthy. 
Clefts of the 'palate may he acquired or congenital. Differen- 
tial diagnosis is not difficult, but the treatment is important 
and varied to each case. 
In the former the producing disease must, in the first place, 
he entirely eradicated, and then the defects remedied, either 
surgically or hy an artificial appliance. 
Congenital clefts of hard and soft palate are of every variety. 
I have in my museum numerous varieties from a simple cleft 
of the uvula to a fissure of soft and hard palate, both sides of 
the intermaxillary including the lip. 
I cannot detain you at this time to present the treatment of 
each variety. Suffice it to say that the means of correction 
lies in the treatment, either surgically or by artificial appliances, 
or a combination of both. 
Believing as I do that these congenital defects should he cor- 
rected in infancy, I will only give you an outline of the opera- 
tion for closure of the hard palate and hare lip immediately after 
birth, reserving the full detail of my method to some other 
occasion when illustrative cases can he given. 
In many cases there is tissue enough developed, but there is 
a failure to unite, and the maxillary bones • are separated, 
making the diameter from side to side greater in proportion to 
other parts of the face. 
What is of special importance in this method is to restore 
the bones to the normal position without any loss of hard or 
soft tissue, except so much as would he required to freshen the 
edges of opposing parts. 
The cleft of the hard palate, and of the lip, if any exist, should 
be closed soon after birth, and before the child is two months old, 
to avoid injuring the developing teeth. 
The closure of soft palate, if it is to be by a surgical opera- 
tion, should be done, if possible, before the child begins to 
speak at about two or three years of age. ADDRESS ON ORAL SURGERY. 
7 
My method I will illustrate by a case represented in the wax 
model that I pass around, and which was taken from a cast of 
a child one week old, and also by diagrams. By its examina- 
tion you will see presented a cleft o*f the lip on the left side, and 
also a cleft through the left of the intermaxillary extending 
through hard and soft palate. 
Fig. 1. 
Bone development has been sufficient in amount, but there 
being a failure to unite the two sides in the process of growth, 
the hones became separated, and the intermaxillary attached 
to the right maxillary leaves the normal anatomical form of 
the anterior alveolus and becomes more or less straight; the 
free end of the intermaxillary protrudes forward into the cleft 
of the lip. (Fig. 1.) 8 
ADDRESS ON ORAL SURGERY. 
By this straightening process the nose is carried to the right 
side as the anterior part of the nasal septum rests On the inter- 
maxillary, while the left alie is very much stretched to the 
left. 
Fig. 2. 
E, the normal perpendicular line of the nose. A and C, alveolar ridge to be united 
B, nasal septum. 
The usual practice is to only close the lip in infancy; hut in 
order to do so it is necessary to have the protruding end of the 
intermaxillary removed, either by cutting it away or crushing 
it, both of which is bad surgery. In the former the bone 
is removed with all the tooth germs; and in the latter, the 
germs are destroyed and the parts misshapen. 
The operation for the relief of the deformity the model 
represents in this case was made in the following manner: 
The child was placed under an anaesthetic, and by means of 
a small revolving knife and the surgical engine a small 
Y-shaped section was removed inside of the alveolar process of 
the intermaxillary (Fig. 3, E), also running up into the septum 
a very little (Fig. 4, D), and at the same time the edges of cleft 
of the hard palate are freshened by the revolving knife. 
Holes are also cut in either side of the hard palate for the 
purpose of passing suture' pin clamps to hold the maxillae 
together. ADDRESS ON ORAL SURGERY. 
9 
Just enough was taken away by the V-shaped section to 
allow the alveolus of the intermaxillary to resume its normal 
position. 
Fig. 3. 
Fig. 4. 
Now, by means of a-properly constructed forcep, the max- 
illary bones are forced together so as to close the cleft in the 
hard palate. Then a nasal forcep is passed into the nostrils, 
grasping the septum, and the nose drawn into perpendicular 
position, and at the same time the intermaxillary is forced into 
its normal place, closing up the V-shaped section made by the 
revolving knife. 
The alveolar ridge of the intermaxillary now connects with 
the maxillary of the opposite side. (See dotted line, Fig. 3.) 
They are now held together by the suture pin clamps which I 
have devised for the purpose, made of the very best steel and 
gold plated. 
The cleft in the lip is now closed hy first carefully applying 
the compression lip clamp on each side of the cleft lip to prevent 
hemorrhage. After the edges are pared, then carefully 
approximate both skin and mucous membrane by passing the 
first ligatures in the vestibule of the nostril and ending with 
the vermilion border, and then complete the operation by 
passing the suture pin clamps to take the stress off the sutures* 
In all simple or double clefts all bone tissue should be pre- 
served to prevent deformity in adult life. 10 
ADDRESS ON ORAL SURGERY. 
The advantages of this method are, namely : 
First.—The cleft in the hard palate is closed in all cases 
where there is the normal amount of bone developed. 
Second.—The alveolar ridge with the tooth germs are saved 
and brought into place, securing, as near as possible, the 
normal outline of the mouth and subsequent development of 
the teeth. 
Third.—The nose is brought into normal position and over- 
distended nostril restored. 
Fourth.—The normal appearance of the face is reclaimed. 
It is now nearly a quarter of a century since I saw, while a 
student in a foreign city, a world-renowned surgeon lay open 
the face, and extirpate nearly half of the superior maxillse, for 
a small benigned tumor, from the canine fossa, with all the 
periosteum. I cannot forget the intense feeling of disgust at 
the operation it produced in me, and sympathy for the patient, 
as I day after day met him on the street, with the indelible 
marks of the surgeon’s knife,—with a deformity on him for 
life. 
My blood has never ceased to boil over that case. But I am 
thankful that we have fallen in better times, surgically. 
The most efficient means of removal of diseased bones of the 
mouth and nose is the surgical engine, whereby revolving instru- 
ments, of various sizes and shapes, enable the surgeon to 
successfully remove diseased bone, while the periosteum is pre- 
served, and a new bone formation is secured, thus preventing 
deformity. 
Also for trepanning mastoid cells, maxillary abscesses, laying 
bare the superior and inferior maxillary nerves, exostosis of the 
ear, nose, or mouth, or, indeed, any other part of the body. 
It is quite necessary that the engine be sufficiently heavy and 
strong to carry the cutting instruments well. 
What is of great importance is properly prepared and effi- 
cient instruments for cutting, sawing, drilling, etc. A few 
days after the dental engine was first completed, I used it in a 
case of necrosis of the jaw, and became convinced by that trial 
that, by some modification and improvements, it was destined 
to inaugurate a new era in some surgical operations at least. 
The following cuts will represent some of the instruments 
found to be most efficient from a somewhat extended experi- 
ence with them. ADDRESS ON ORAL SURGERY. 
11 
In December, 1872, the writer devised and made use of single 
and multiple revolving knives, saws, and trocars, for operations 
upon the hard and soft tissues of the mouth and nose, the 
revolving power being supplied by the surgical engine. This 
consists of a fly-wheel, set in motion by the foot, a driving- 
pulley, and a communicating cord. On the top of the upright 
movable shaft the pulley is connected to a flexible wire cable 
inclosed in a flexible sheath. This cable is connected to the 
hand-piece, in which can be put any revolving instruments. 
The flexibility of the wire cable allows the instrument in the 
hand-piece to be freely used at any angle. The hand-piece, 
held in hand as you hold a pen, is under perfect control. The 
instruments are securely fastened in the hand-piece by means 
of a spring catch. 
The single revolving knife (Fig. 5) is circular and sharpened on 
the edge (a), and has a protecting sheath (b) to cover up the 
part of the knife left exposed. 
Fig. 5 
Under a velocity of two or three thousand revolutions per 
minute, the single revolving knife, in cutting soft, sensitive 
parts, gives little or no pain. 
The multiple revolving knives (Fig. 6) are arranged around the 
end of a shaft in an acute angle, and cut as they revolve, and 
Full size. 
Fig. 12 
ADDRESS ON ORAL SURGERY. 
do not scrape as the dental burrs. These instruments have a 
protecting sheath (Fig. 7), to be used when necessary. 
Fig. 7.—Knife (a) within the sheath. 
Saws, like the single knives, are circular, and have teeth on 
the edge and sides, and are of all sizes. ' - 
The trocars are of different forms and sizes, and they are 
intended to make an opening, and then to enlarge it. Fig. 8 
shows two of the most efficient ones: the spiral cutting edge, 
and the other flat, with two straight cutting edges and double 
edges on the point. 
Fig. 8. 
INTER-NASAL AND SUBPERIOSTEAL EXTIRPATION OF BONES OF THE 
NOSE AND MOUTH. 
Case I.*—Mrs. C. T., aged 35; born in New York; 
married November 25, 1868. Up to this time quite healthy. 
Four months after marriage had syphilis, for which she 
received treatment by her family physician. Up to present 
time has had four births. Her first child still-born at six 
months; second child born at full term, and lived a week; 
third child still-born at eight months; fourth child born at full 
term, and lived ten months. 
In 1872 had syphilitic laryngitis, and was salivated. She 
came under my care in November, 1874. On examination, I 
found necrosis of the vomer, lower portion of the ethmoid, 
vault of the hard palate, and inferior turbinated bones of both 
sides, and alveolus of the intermaxillary bone. There was a hole 
* Medical Record, July 12, 1879. 13 
ADDRESS ON ORAL SURGERY. 
in the hard palate a half-inch in length. Front teeth quite 
loose from necrosis of the maxillary bone. These were at once 
removed. Rhinoscopic examination very difficult to make, as 
the uvula and soft palate were much swollen. Large ulcers on 
the pharynx. To combat the specific poison the patient was 
put ftpon iodide of potassium, two grammes, and increased to 
four grammes a day, with tonics and nourishing food. 
April 29, 1875, operated for the extirpation of the necrosed 
bones. There were present Drs. A. C. Post, J. T. Darby, 
Leonard Weber, L. B. Bangs. All the necrosed bones were 
removed by the revolving multiple knives through the opening 
in the palate and through the nostrils. The necrosed palatal 
vault, both inferior turbinated bones, and a small portion of the 
vomer, were removed through the opening in the palate; through 
the nostrils, all the necrosed portion of the maxillary bone, and 
the anterior portion of the vomer and ethmoid. 
The posterior portion of the vomer was now seized with the 
forceps, and removed. By this means the soft parts covering 
the vomer were left intact, so that by a rhinoscopic examination 
the posterior part of the septum was seen as before the opera- 
tion. In this case there appeared to be a reproduction of 
bone in this part of the vomer, and, to some extent, of the hard 
palate. 
A few days after removed by the knives some small necrosed 
portions of the intermaxillary, after which the parts healed 
rapidly. The voice somewhat nasal in tone until the opening 
in the palate was closed. 
In October, 1875, about six months after the extirpation of 
the necrosed bones, uranoplasty was performed for the closure 
of the opening in the hard palate, which was now three-fourths 
of an inch in length. After removing the mucous membrane 
from edges, an incision is made on each side of the fissure 
through the soft parts and newly formed bone of the hard 
palate. 
The soft parts were cut through by means of a galvano- 
cautery knife, and so had no bleeding. The bone is now 
pierced by the drill, and the bone separated by a chisel after 
the method of Sir William Ferguson; or it may be sawed 
through, and then they are sprung together and the fissure 
thus closed. In this case four horse-hair sutures were used to 
hold the flaps together. 14 
ADDRESS ON ORAL SURGERY. 
These side-incisions must be kept open by packing them, or 
removing the granulations each day, to prevent healing until 
the edges of the fissure are united. A gutta-percha splint is 
now fitted and worn over the palate. This prevents the food, 
fluids, and air from causing disturbance to the healing process. 
I present wax models of this case, taken from casts of it 
before, during, and after completion of the operation. 
It will be seen that the external appearance of the nose has 
not altered in shape, notwithstanding the nasal septum and 
bony palate upon which it rests, are gone. Have never seen 
the nose fall in, except when the cartilage or nasal or maxillary 
bones were involved,—in other words, the bridge of the nose. 
Case II.—Mrs. F. C., aged 21; born in Hew York State, 
was sent to me by Dr. J. Marion Sims. She was married in 
1865; then quite healthy; has had three stdl-born children, 
and one now living. 
In January, 1872, had inflammation of the brain, which was 
afterwards followed by inflammation of the bowels. In 1873 
of a severe neuralgic pains on the bridge of the nose, centre of 
the hard palate, and left side of the face. This was followed 
by a swelling of the centre of the hard palate, and all the: 
upper teeth were extracted. In December, 1873, when she- 
came under my care, her condition was as follows: Her phy- 
sical powers were very much reduced; constant pains in her 
head; a hole in the left canine fossa; great discharge from the 
nose and mouth. By rhiuoscopic examination, and by a probe 
through the hole in the canine fossa, I discovered necrosis of 
the nasal septum and turbinated bones of both sides. 
The specific origin of disease being recognized, she was put 
upon iodide of potassium, tonics, cod-liver oil with phosphates. 
December 26, as there was a good deal of pain and swelling of 
the nasal septum, it was lanced, and bled freely, and gave her 
great relief. January 4, 1876, lanced the nasal septum again. 
February 3, periostitis of the left nasal bone externally appeared; 
applied a leech. February 4, swelling and pain gone. Feb- 
ruary 9, patient having improved in strength, but still suffering 
lntense pain, removed all the necrosed bone by the revolving 
knives. In this operation removed the vomer, lower portion 
of the ethmoid, inferior and middle turbinated, maxillary walls 
of both right and left antrum, and a good portion of the hard ADDRESS ON ORAL SURGERY. 
15 
palate. Present, Drs. George A. Peters, E. L. Keyes, F. R. 
Sturgis, and G. H. Fox. February 10, found the patient going 
about the house attending to some of her household duties ; no- 
pain since the operation. February 13, removed small pieces 
of the intermaxillary bone. March 6, had some swelling of the 
left side of the nose, extending under the eye. 
Feeling herself so much better after the operation, she had 
neglected to take the potassium as ordered, and this is the pen- 
alty of such disobedience. Ordered a leech, and increased the 
dose of the iodide of potassium to four grammes per day. 
March 8, swelling very much reduced and pain nearly gone. 
March 10, pain and swelling gone. There was a small amount 
of pus on the left side of the nose, which was drawn away with 
the aspirator. April 10, patient expresses herself as being 
nearly well. Iodide of potassium reduced to two grammes 
every other day. Cod-liver oil to be continued. June 23, 
1876, patient now quite well, and by a rliinoscopic examination 
no discharge was discovered. There now only remains the 
opening of the canine fossa to be closed. 
Case III.—Dr. F. FT. Otis, of New York, referred to me 
William II. G.,aged 27 years, of London, England, who, before 
leaving home, had been under the care of Dr. R. Living and 
Dr. W. J. Coulson. 
Two and one-lialf years ago had the specific initial lesion, 
and is now in the third stage. 
lie now has necrosis of the vomer and vault of the palate, 
with a small hole in it. Fetid discharge from the nose occa- 
sionally stained with blood from excessive granulations. Admin- 
istered iodide of potassium and cod-liver oil. Local treatment 
consisted in blowing into the nasal cavities iodoform and 
camphor triturated to an impalpable powder, with subnitrate ot 
bismuth and sulphate of potash to reduce the superabundant 
granulations, and so have less bleeding during the operation. 
By invitation of the late Professor James R. Wood, M.D., to 
deliver a clinical lecture on extirpation of bones of the mouth 
and nose, I operated on this patient at his clinic at Bellevue 
Hospital, January 15, 1880. Administered four ounces of 
whiskey before the operation, and kept him under the influence 
of nitrous oxide during the operation, which lasted about fifteen 
NECROSIS OF VOMER AND VAULT OF THE HARD PALATE, ETC. 16 
ADDRESS ON ORAL SURGERY. 
minutes. No external incision was made, and the necrosed 
vomer, lower portion of the ethmoid, both inferior turbinated 
bones and vault of the hard palate, were removed by the revolv- 
ing knives through the nostrils. 
No portion of the soft tissue on the hard palate was removed. 
On the completion of the operation, he was directed to blow 
his nose to free his nasal cavity of the cut-up necrosed bones 
and blood, and then he was positively forbidden to again blow 
his nose for the next twenty-four hours. After that time the 
clotted blood is carefully removed by the dressing nasal forceps, 
and the nasal cavity completely covered by blowing in the 
iodoform and camphor powder. 
On the second day a nasal douche is given before the appli- 
cation of powder. 
On the next day after the operation he was able to attend to 
his daily duties. 
The wax model illustrating his case shows the opening in 
the palate one-fourth inch in length before the operation. 
Atrophy of the nose before the operation, from the non-respira- 
tion and constant blowing of the nose, as seen in the right alie, 
and the development of the alie, as seen in the left side of the 
nose, after the operation. 
The other model shows the opening in the palate closed and 
a new deposit of bone over the palate. 
He is in perfect health at the present time. 
My time or your patience will not allow me to extend the 
subject farther, or to show that tooth disease may lead to necrosis, 
caries, abscesses in jaws, antrum, salivary glands, tonsils, cheeks, 
throat, and nose, producing naso-pharyngeal catarrh, amarosis 
otalgia, and disturbing the whole system in many ways. 
When we consider these many diseases, how important it is 
that they should receive proper attention. But it cannot be 
denied that there is a vast amount of ignorance in the profes- 
sion in regard to them. And it is also to be deplored that a 
great number of oral, nasal, eye, and ear troubles are often the 
result of unskilled dental operations. 
Out of such necessity comes a desire for instruction and 
improvement, hence the formation of this Section. 
I sincerely trust that the day is not far distant when we 
shall have endowed universities where every branch of the 
healing art and allied sciences will be theoretically and practi- 
cally taught. Private Hospital 
for treatment of 
Diseases of the Nose, Mouth and Throat. 
CONSULTING STAFF : 
J. R. Learning, M.D., F. N. Otis, M.D., Joseph W. Howe, M.D., 
R. P. Lincoln, M.D., D. R. St. John Roosa, M.D. 
Adults and Children Received. Trained Nurses Employed. 
For particulars, address 
D. H. GOODWILLIE, M.D., 
160 West Thirty-fourth Street, New York.