VII.

Principles of Dental Surgery; exhibiting a New Method of Treating the Diseases of the Teeth and Gums; especially calculated to promote their Health and Beauty, accompanied by a General View of the Present State of Dental Surgery, with occasional References to the more prevalent Abuses of the Art: in Two Parts. By LEONARD KOECKER, Surgeon-Dentist, Doctor in Medicine and Surgery, &c. &c. pp. xxii. 445, London, 1826.

8vo.

Mr, KOECKER has divided his Work into two parts; and, as the arrangement is convenient, it shall be adopted in the present article, wherein we propose to consider generally this author's "doctrines," and to exhibit particularly a concise view of the principles which ought to guide the surgeon-dentist in his treatment of disease in the teeth.

PART I. CHAPTER I. General Observations on the Present State of Dental Surgery, and the Development of the Author's Method of Treatment. In the seventeen pages he assigns to this section, Mr. K. avers, that the doers of “dentistry" in Germany, France, America, and England, are bungling, unskilful, and injudicious operators; that the abuses of dental surgery are "quite the order of the day," and by no means confined to the practice of the lower orders of our body, but their effects are very frequently to be observed in that of dentists generally considered of the first rank, highly esteemed by the public, and held of good reputation even by the medical profession; that there is no branch of the healing art so little founded on scientific principles as the dental surgery, this having been so long in the hands of illiterate men whose names, he says, are loaded with high-sounding titles; that empirics are the natural offspring of the imperfection and novelty of a science, but the proper and most effectual remedy against empiricism, is an improved knowledge of the principles of the dental art, as a branch of surgery; and that the author does not hesitate in the least to assert it as his sincere opinion, that dental surgery, in the manner in which it is practised at present, is really a great positive evil. These comprehensive statements are illustrated by five cases which Mr. K. we doubt not, regards as being very instructive as well as impressive; for, he declares, their publication arose entirely from his great anxiety to promote the substantial interests of the profession and to put a stop, if possible, to the pernicious doings whereby it is so lamentably disgraced. Most willing, however, as we are to regard Mr. Koecker's manner as well as his matter with indulgence, it is every way requisite that, in admitting his having shewn this much, we require to be understood as having a perfect recollection of the relations which exist between unmeasured assertion and the kind of evidence that leads to inductive demonstration.

Each of the learned professions-we feel humiliated by the admissionhas ever been pestered by the intrusions and mischievous absurdities of quackery; but there would be great unreasonableness, and manifest injustice as well, in concluding, from this circumstance, that most, or even many, of its members should be considered as rude and Charlatanical pretenders, Entertaining this view of the case, therefore, and considering the "professors of dental surgery" fairly entitled to the benefit of being VOL VI. No. 11.

K

appreciated every one by his own merits, we cannot pass from reminding Mr. K. that his "reprobation" of his "professional brethren" is too indiscriminate, and his mode of determining an estimate of their art rather uncharitable and precipitate. Without adverting, on this occasion, to the systematic or elementary works on anatomy, physiology, and pathology, which necessarily include the subjects of dentition in most of their healthy and morbid relations, we might direct his attention to a multitude of monographs on the natural history, functions, and diseases of the teeth; many of which, besides exhibiting the clearest proofs of their authors' mechanical excellence, are distinguished, in a pre-eminent degree, by the philosophy of scientific observation and research. Our advice to Mr. K. therefore, and our request of our readers is, that they examine, among the rest, the writings of Strumard, (a) Hoffman, (b) Fauchard, (c) Lavani,(d) Schaeffer,(e) Jourdain,( Hunter,(g) Campani, (h) Blake, (i) Broussonnet, (k) Fox.(1) Tenon, (m) Batigger, (n) Duval,(0) Lavagna,(p) Gallette, (q) Laveille, (r) Miel,(s) and Serre,(t)* and compare impartially with theirs the number and value of Mr. Koecker's discoveries and improvements in dental

surgery.

In publishing this manual, the author has been partly influenced by the desire of proving that he is not unworthy of the confidence with which he has been honoured."- "The principles on which he has for many years practised this art, being essentially different from any hitherto known, and considering those which are commonly received as being founded on superficial views and pernicious errors, he has deemed it useful to give a detail of his peculiar ideas in such a manner as, he trusts, will not only be found to deserve some attention on the part of the professional reader, but also at the same time, calculated to prepare the public mind at large for their reception." P. vii.

Animadversion is not the sort of thing whereof we are particularly enamoured; nevertheless, since Mr. K. has chosen throughout his volume to be so very severe on others, he cannot object to our taking occasion, here and once for all, to remind him, that even the most generous examiner might find just reason to accuse him of what might be considered too indiscriminate censure. This much we feel ourselves obliged by every duty to say; but at the same time we add, with infinitely greater satisfaction, that Mr. K.'s book comprises much instructive matter, which we hope, one day, to see divested of all its cumbersome and offensive accompaniments. Since, however, by the advice of his friends, he has ventured to make public the "result of his experience" "for the advancement of the profession and the best interests of humanity," we shall, out of gratitude for his good intentions, inform him that from the "medical profession," he may be assured of the most compassionate indulgence; but that, from the "professors of dentistry," if they think of paying him in kind, he may expect more hard words than kindliness and candour: 'tis a good rule in all manner of speculation, especially in authorship-veniam quam petimus dabimusque vicissim.

CHAP. II. General Principles of Dental Surgery.-Mr. K. regards this as the "science" of preventing and curing the diseases, and of preserving the health and beauty of the teeth and of the parts connected with them: it includes also the "remedial treatment" of defects, or loss of parts injurious to health, general appearance, and to the power of distinct articula

• See notes at the end of this article. They were too long to be inserted in this place.-Ed.

tion, and, consequently, the practice of this "very useful art” should be established on a solid foundation. To obtain these important objects, he says it is indispensably necessary to have a minute and comprehensive knowledge of the natural history of the teeth and gums in their healthy state the diseases to which they are subject, the symptoms of these, and their remote as well as proximate causes, at the successive stages of their growth-the connexions, sympathies, and influences of the teeth, gums, sockets, periosteum and the maxillary bones, generally and individually, upon each other, in their sound and morbid states; and especially those of the first set upon the permanent teeth-the effects produced on the teeth and contiguous parts by disease of particular structures and disorder of the constitution, at different periods of their development-the medical and surgical remedies, and their proper application in treating unhealthy teeth -and the surgical and mechanical means required by the surgeon-dentist, with a general knowledge of the collateral mechanical arts.

This arrangement of “Principles" has the merit of being very distinct as well as judicious: it is followed, moreover, in the remaining six chapters of this part, with many sensible, although general remarks on each of these principles, in the form of explication and doctrine; but, as the author has entirely omitted all reference to the sources from which the particular philosophy of his favourite "science" can be drawn, our readers will perceive the value of the select bibliographical list which this article contributes to their service. Mr. Samuel Cooper would essentially promote the "advancement of his profession in connexion with the best interests of humanity," were he to introduce, into his most useful Dictionary, a section on the organization and diseases of the teeth: an article on these subjects would increase the value of that excellent work which, decidedly above all others, gives the best and most comprehensive view of the principles and practice of surgery.

CHAP. III. General Remarks on the Natural History of the Teeth and their Relative Parts, with Pathological Observations.-Our author confines himself, in this chapter, to such observations as are immediately subservient to his present inquiry, and refers the reader to the works of Hunter, Blake, and Fox, for a more extended examination of this “important study." At p. 37 he remarks

"From the rudiments of the temporary teeth those of the permanent are formed: at an early period of their formation both are firmly and closely attached to one another, and contained in the same socket; but, as they advance in their growth, the sockets become enlarged, a separation of the pulps and a division of the sockets take place, and a separate socket is formed for both in this state they remain intimately connected by the means of their membrane and the gums. From a due consideration of this fact, the great sympathy and influence between the first and second set of teeth become perfectly evident; a fact requiring a very comprehensive consideration in the treatment of children on the shedding of their teeth."

Mr. K. is of opinion that the teeth, notwithstanding they consist of the hardest and most solid bony texture, are nevertheless organized, vascular, and interwoven with nervous and arterial fibres. We do not dispute the accuracy of this doctrine, but we can admit it only as matter of analogical inference every thing that grows must have life and be organized; consequently the teeth are vital and composed of organic structure; if they were protected from the external air, and the influences of chemical and mechanical agents, and, when diseased, were cleaned and dressed as bones are, it might be inferred that they would regenerate their structure as other

organs do. Mr. K. has said, but not shewn, that the teeth are vascular ; but it is a fundamental rule in philosophy, never to assert what cannot be demonstrated his pathological observations are concise, but valuable.

CHAP. IV. General Remarks on the Diseases of the Teeth and their relative Parts.-Nature has destined the teeth to live and die only with the general constitution: Mr. K. infers this doctrine from the fact, that such is the case with the brute animals in which the teeth are not exposed to the same morbific causes that occasion the loss and destruction of these organs in man. We quote what follows as legitimate and ingenious reasoning:—

"If we see, for instance, (p. 45,) an individual after the age of thirty years, in a most delicate state of health, with a beautiful and perfect set of teeth, we may safely infer from this fact, and we will generally find it so, that Nature had originally given him a good constitution, and that, at an early period of life, he was not suffering from any disease of consequence; but, that some later causes or accidents must have impaired his naturally good constitution. If, again, we observe an individual, of a very robust constitution, possessed of a very diseased set of teeth, we may also frequently find that, at an early period of life, he must have been the subject of constitutional disorder, to the influence of which should be ascribed the actual imperfections or diseased state of his teeth. In these instances, however, much greater circumspection is requisite than in the former, inasmuch as no positive conclusion could be drawn, and no prognosis should be made, before we have positively ascertained the actual fact, that the diseased state of the mouth is not the effect of some mechanical or chemical cause, such as accidental violence, injudicious operations, or other malpractices, of incompetent dentists."

No doubt can be entertained of the general accuracy of these positions : they are exceedingly important, and ought never to be lost sight of in practice. Mr. K. thinks the diseases of the teeth and parts connected with them are not many, and the judicious management of them is not rendered difficult so much by their number as by their great varieties of situation, character, and stages, and a multitude of other perplexing circumstances, which obstinately resist their curative as well as preventive

treatment.

CHAP. V. General View of the Causes of the Diseases of the Teeth and their relative Parts, with their Mode of Action.-These causes are either general or local under the first head are classed constitutional diseases, constitutional changes, diet, climate, and medicine; under the second, diseases of the mouth, tartar, saliva, and external applications. All constitutional maladies, and such local diseases of important organs as affect the whole system, and, through it, individual parts, must be presumed, Mr. K. says, to extend their morbid influences to the teeth as well as gums: it also appears that, in consequence of the intimate sympathy subsisting between the teeth-supplied as they are with nerves of extreme sensibility, and with arteries at least not less irritable than arteries in other parts of the body—and the general system, that the diseases of the latter must be productive of more extensive effects upon the former than upon other parts generally, especially when affected by local disease: this fact, he declares, has been proved to him beyond any doubt, by repeated observations and long experience. In chronic diseases, the teeth generally assume a pale or milky-bluish appearance, and become more or less "opaque;" while, in acute fever, they acquire an "inclination" to a reddish hue. There is some originality and much instruction in this quotation :

"After death from violent fever, (p. 51,) I have found the blood in the blood-vessels of the lining membrane of the teeth sometimes very dark, so that the external appearance of the teeth was quite red: and, at other times, great parts of the bony structure had also turned considerably red, from the great injection of the blood, and from its coagulation in the minute vessels of these parts; this, by maceration during two or three months, I could not succeed wholly to extract."-"The gum-boil is a local disease produced by mortification in the socket, and suppuration and inflammation in the periosteum and the gum, originally and proximately occasioned by dead roots or teeth; and, though very small in its external appearance, is an affection of no little importance, it being constantly progressive in its nature, and totally destructive in its event: its real exciting cause is much more frequently indigestion than the action of cold."-" In persons having calculous affections, there is a remarkable tendency to deposition of tartar on the teeth, and it is always necessary to use powerful means to resist its re-accumulation after being perfectly removed."- -"The prevalent idea that consumptive persons have good teeth, because they are often delicately white, is altogether groundless: these subjects are generally young people, and such as have not lost their front teeth; and the diseased action, produced in them by the constitutional disorder, gives to them the opaque, pale, or bluish appearance, which is mistaken, by the inexperienced eye, for a symptom of health, while, in reality, it is an indication of a morbid state of the lining membrane; in fact, so far from finding good teeth in such persons, I have generally found them comparatively defective and diseased."

Mr. Koecker's remarks on constitutional changes are very limited, being chiefly confined to pregnancy: those on diet and climate are concise also: what he says on medicine will be found accurate and interesting: he finds himself authorised in considering all medicines, properly administered, to be as beneficial to the teeth as they are to the other parts of the animal system: he would not even except the most powerful preparations of mercury, arsenic, or the acids, when skilfully exhibited; but he thinks there is neither rashness nor uncharitableness in attributing a large proportion of the local and general diseases of the system, and consequently of the teeth, to the abuse of medicine.

Passing, with a short notice, the diseases of the mouth, the tartar and saliva, as local causes of disease in the teeth and gums, Mr. K. enlarges on the misapplication of external remedies; among which he ranks toothpowders, tooth-pastes, tinctures, essential oils, and mixtures of all kinds; tooth-brushes and tooth-picks. Of all external causes, however, none are more active and mischievous than the unskilful operations of cleansing, scaling, filing, cutting, plugging, and extracting the teeth: but, he adds, "the most cruel and destructive of all morbific causes known in dental surgery, are those recommended by Hunter, Fox, and others, namely, destroying the nerves of the teeth, replacing a tooth in its socket after its previous extraction, transplanting teeth from the mouth of one person into the mouth of another, applying the actual cautery for arresting hæmorrhages from the socket after the extraction of a tooth, using ligatures for retaining in their places artificial teeth, or such diseased teeth as are loose, or rather the sockets of which are destroyed by disease, and inserting artificial teeth, without the necessary surgical principles, and great judgment and skill." These are the ipsissima verba of Mr. Koecker, and we do think they call for serious consideration.

CHAP. VI. On the Morbid Effects of the Diseases of the Teeth and Gums