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 LIBRARY OF 
 
 Dr. carl F. W. BODECKER 
 
 1846-1912 
 
 The gift of 
 
 Dr. Henry and Dr. Charles Bodecker 
 
 1929 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 Columbia University Libraries 
 
 http://www.archive.org/details/irregularitiesofOOtalb 
 
IRREGULARITIES 
 
 OF 
 
 THE TEETH 
 
 TALBOT 
 
^fmM-^^tA^ 
 
 IRREGULARITIESoftheTEETH 
 
 AND 
 
 THEIR TREATMENT 
 
 BY 
 
 EUGENE S. Talbot, M. S., D. D. S., M. D., LL.D. 
 
 Professor of Stomatology, Illinois Medical College. Honorary President of the 
 Dental Section of the Tenth International Medical Congress, Berlin. 1890; 
 Honorary President of the Dental Section of the Twelfth International Medi- 
 cal Congress, Moscow, 1897; Member of the Thirteenth International Medical 
 Congress, Paris, 1900; Member of the Fourteenth International Medical Con- 
 gress, Madrid, 1903; Honorary Secretary of the Pan-American Medical Con- 
 gress, Washington, 1893; Honorary Secretary of Pan-American Medical 
 Congress, Havana. Cuba, 1901; Member of the American Medical Association; 
 Fellow of the Chicago Academy of Medicine; Member of the Chicago Pathologi- 
 cal Society; Member of the Chicago Medical Society; Secretary of the Section 
 on Stomatology of the American Medical Association; Member of the Chicago 
 Academy of Sciences; Fellow American Academy of Dental Science, Boston; 
 Honorary Member of the Odontologischen Gesellschaft, Berlin, Germany; 
 Membre Honoraire de I'Association Generale des Dentistes de France; 
 Honorary Member Sociedad Odontologia Espanola; Corresponding Member of 
 the Dansk-Tandlaegeforening; Author of "Irregularities of the Teeth and Their 
 Treatment"; Author of "Chart of Typical Forms of Constitutional Irregulari- 
 ties of the Teeth"; Author of "Etiology of Osseous Deformities of the Head. 
 Face. Jaws and Teeth": Author of "Degeneracy; Its Causes, Signs, and 
 Results"; Author of "Interstitial Gingivitis; or, So-called Pyorrhoea Alveolaris," 
 Etc.. Etc. 
 
 FIFTH EDITION 
 
 WITH 581 ILLUSTRATIONS 
 
 PHILADELPHIA 
 THE S. S. WHITE DENTAL MANUFACTURING CO. 
 
 1903. 
 

 ENTERED ACCORDING TO ACT OF CONGRESS 
 IN THE YEAR 1903. BY 
 
 EUGENE S. TALBOT, 
 
 IN THE OFFICE OF THE LIBRARIAN OF CONGRESS 
 AT WASHINGTON, D. C. 
 
 HAMMOND PRCS3 
 
 W. B. CONKEY COMPANY 
 
 CHICAQO 
 
DR. N. S. DAVIS 
 
 T^re 
 
 WHO BY TTTE foundation OF THE AMERICAN MEDICAL 
 
 ASSOCIATION HAS ELEVATED THE STATUS OF 
 
 DENTISTRY AND ALL THE MEDICAL 
 
 SCIENCES, THIS WORK IS 
 
PREFACE TO FIFTH EDITION. 
 
 Since the fourth edition of this work appeared, practically 
 no modifications of the general principles therein outlined 
 have been made. The laws by which deformities of the jaws 
 and irregularities of the teeth are governed had been worked 
 out on broad scientific lines, and hence made due allowance 
 for individual peculiarities. Rewriting of the work for this 
 edition was hence deemed unnecessary. It was thought best, 
 however, so to outline in an introduction the working of the 
 developmental principles governing heredity and environment 
 as to facilitate their application to the topics discussed in the 
 different divisions of the subject. 
 
INTRODUCTION. 
 
 More than thirty years ago, an extensive dental experience 
 convinced me that in developmental processes the face, nose, 
 jaws and teeth were more involved than the rest of the body, 
 and were, therefore, under the laws of economy of growth, 
 hence most involved in pathologic change. This, as now gen- 
 erally recognized, is underlain by developmental states, dis- 
 torted into excess or diminution. Evolution or development 
 proceeds from the indefinite simple to the definite complex 
 with a resultant saving in expenditure of force. As embryo- 
 logic development in man proceeds from the simple cell 
 to a union of cells forming structures, organs, and finally 
 the body which these unite to form, two processes take part 
 in it: degeneration of cell functions to secure greater special- 
 ization in the organs they form, and degeneration in these 
 organs for greater accomplishment by the body of certain 
 functions with less waste or force. Evolution of the body as 
 a whole is aided by these degeneracies. When degeneracy 
 diminishes lower structures for the advantage of the higher, 
 evolution is the type of progress; when degeneracy attacks 
 the higher structures for the benefit of the lower, as in para- 
 sites, degeneracy is the type of progress. 
 
 Evolution of this type strikes its roots deep and early in 
 Greek philosophy, where Empedocles, long before Aristotle, 
 outlined the doctrine of evolution and survival of the fittest. 
 Aristotle cleared up the relation of structures and organs to 
 each other, and the sacrifice of one to another for the benefit 
 of a single organ or the body as a whole. This principle, 
 which demonstrated the amount of nutriment which could be 
 assimilated, was limited, and that active organs must secure 
 most was cleared of obscurity first by Goethe in 1807, and still 
 more by Geoffroy St. Hilaire in 1818. Roux later applied it 
 to physiology and pathology. Upon it turn all biologic 
 processes. It explains all so-called freaks of nature, which 
 
INTRODUCTION". 
 
 are simple retroversions of evolution. The general trend of 
 the mixture of degeneracy and evolution constituting advance 
 is to the creation of checks on waste, constituted by a balance 
 secured by a more and more complex central nervous system. 
 The explosive motor expression of the ganglionic nerve sys- 
 tem is lessened as the central nervous system gains more 
 ascendancy in passing upward from the sea-squirt to man. 
 This ascendancy is shown in the reduction of nerve force 
 needed in sensation, motion or in nutritional processes. With 
 rise in evolution or with growth in human embryogeny, the 
 brain gains at the expense of the spinal cord and at the 
 expense of the structures of the face. More brain space is 
 needed, and the dermal bones which cover this space gain at 
 the expense of the vertebral structures entering into the skull 
 and face. The human face, with all its beauty, considered 
 from the standpoint of food-getting, chewing and combat, is, 
 as Minot has shown, assuming an embryonic type. The jaws 
 are needed less and less for the purpose mentioned, hence, 
 under the law of economy of growth, the resultant disuse 
 sacrifices them for the benefit of the growing brain and nerv- 
 ous system and the dermal elements of the skull. Under this 
 operation of the law of economy of growth has occurred the 
 aesthetic evolution of the face from the anthropoid to the 
 Apollo Belvidere type, which Camper has so graphically pic- 
 tured. The reverse phase of evolution, with which Camper 
 did not deal, is that of which the present work treats. This 
 phase of evolution underlies all pathology of the face, as well 
 as of the nose, jaws, alveolar process and teeth. The illus- 
 trations supplementing those of Camper portray this reverse 
 phase where symmetry of the body as a whole is sacrificed to 
 changes in the nose, jaws, alveolar processes and teeth, so as 
 to preserve brain gains. 
 
 The following illustrations, taken from photographs of 
 patients, accurately portray arrests of the face for the benefit 
 of the brain. The gradual recession of the face and the for- 
 ward development of the brain is a gradual continuation of 
 Figure 36 in the line of evolution. From the relations of this 
 face degeneration nearly all diseases of the nose, jaws, alveo- 
 
INTRODUCTION. 
 
 lar processes and teeth result. In many cases reverse evolu- 
 tion progresses still further till, owing to an unbalanced 
 
 6 ' 7 
 
 nervous system and movements of the lower jaw, atavism 
 results. Figure 8 and Figure 9 exhibit a greater exaggeration 
 of the lower jaw, a return to the anthropoid and lower negro 
 type. 
 
PREFACE. 
 
 The earlier editions of the present work were as remarked 
 in 1894 an outgrowth of researches which tended to oppose the 
 too prevalent theory (erroneous in its deductions and vicious 
 in its effects on practice) that irregularities of the teeth and jaws 
 were the result of local not constitutional conditions. In the 
 present volume in accordance with the general trend of medical 
 science, biologic data have largely been used in the explanation 
 of pathologic and teratologic results. This is nothing new in 
 dental science nor in general medical science since the sciences 
 separated from fetichism. At all times, lower animals have been 
 used as a means of solving pathologic and physiologic problems. 
 The close of the last century has, however, witnessed an attempt 
 to use such methods philosophically. The known structural and 
 functional differences between the animal and man have been 
 employed in control experiments. In the use of embryology in 
 explanation of physiologic and teratologic abnormality the pres- 
 ent work has merely followed the trend of clinical investigation. 
 An attempt has been made to control errors resultant on clinical 
 observation by analysis based on the general principles of physi- 
 ology and pathology. While the present work contains abun- 
 dant clinical evidence in favor of the views advanced, this 
 evidence has been critically analyzed from biologic, embryologic, 
 physiologic, pathologic and sociologic standpoints. Many of 
 the results obtained through researches elsewhere recorded 
 ("Degeneracy: Its Causes, Signs and Results," and "Interstitial 
 Gingivitis, or So-called Pyorrhoea Alveolaris") are used in the 
 present work as starting points. As embryology, biology and 
 teratology (science of deformities) are extensively used in cur- 
 rent dental literature in explanation of human dental processes, 
 no apology need be made for their employment in the present 
 volume. The present work is practical in the highest sense of 
 the term which means avoidance of "rule of thumb" theories 
 based on exploded obsolete charlatanish notions. 
 
Xll PREFACE. 
 
 The abnormal eruption of the teeth into facial cavities other 
 than the oral has rendered a discussion of these cavities abso- 
 lutely necessary for the purposes of the dental surgeon. Unless 
 the development, teratology and pathology of these cavities be 
 understood a clear, comprehensive conception of the relations 
 of irregularities of the teeth is unattainable. When the third 
 edition of the work was in the hands of the profession it became 
 apparent to the author from the opinions of reviewers and of 
 dental and medical journals, as well as from letters received, that 
 the prevalent conception of degeneracy as a factor of growth was 
 obscure and misleading. An extended and comprehensive exam- 
 ination into the subject seemed imperative and the result of this 
 examination was the production of the work upon "Degeneracy : 
 Its Causes, Signs and Results," published by the firm of Walter 
 Scott of London, England. This work has met with enthusiastic 
 commendation not only from biologists but likewise from con- 
 servative physicians, who, like the venerable Dr. N. S. Davis of 
 Chicago, are of a belief that "it has opened up a new field in 
 medical science." 
 
 To understand and appreciate the pathology of the alveolar 
 process both works (Interstitial Gingivitis, or So-called Pyor- 
 rhoea, Alveolaris and Irregularities of the Teeth) require com- 
 parative study. 
 
 The unwritten law in general medicine, "that to know the 
 cause is half the treatment," is also applicable in the treatment 
 of deformed jaws and irregularities of the teeth. Believing in this 
 law the author has devoted his time outside of office practice to 
 this particular department of the specialty. Without the knowl- 
 edge of etiology no one can successfully correct deformities as is 
 evident in the many failures by men who profess to make this a 
 specialty. In the preparation for the fourth edition, the entire 
 work has been re-written and re-arranged with plenty of new 
 material and new facts, the result of twenty-six years of constant 
 research. The etiologic views advanced in the third edition of 
 this work were not generally understood, probably because of 
 difficulty of harmonizing the various disorders of the body with 
 the law of economy of growth. 
 
 The author has indelibly stamped his individuality in the first 
 
PREFACE. XUl 
 
 part of his work, but still more is this the case in the second 
 part. He has confined himself entirely to his own appliances and 
 methods of treatment. "Systems" in the ordinary charlatan-like 
 sense are not accepted as guides. In the author's opinion the 
 practitioner should be familiar with the etiology of the case in 
 hand ; his knowledge of principles and mechanics should suggest 
 to him the most suitable appliances for the given case. Every 
 force has its place in the treatment of these deformities. The 
 appliances here illustrated have all been successful in the hands 
 of the author when used according to their indications. 
 
 For preparation of specimens discussed in Chapter on Pa- 
 thologic and Physiologic Changes, the author is under obliga- 
 tions to Drs. L. Hektoen, M. Herzog and F. Noyes. 
 
 For illustrations other than those that are original, the author 
 is indebted to The S. S. White Dental ^Manufacturing Com- 
 pany, The Ophthalmic Record, Medicine and other medical 
 periodicals. 
 
 103 State Street. EUGENE S. TALBOT. 
 
CONTENTS. 
 
 CHAPTER. PAGES. 
 
 1. History 1-17 
 
 2. Heredity 18-25 
 
 3. Congenital Factors and Maternal Impressions 26-29 
 
 4. Post-Natal Skull and Jaw Development and Periods 
 
 of Stress 30-39 
 
 5. Development of the Cranium and Face 40-47 
 
 6. Development of the Jaws 48-55 
 
 7. Development of the Alveolar Process 56-73 
 
 8. Development of the Vault 74-86 
 
 9. Development of the Peridental Membrane 87-92 
 
 10. Development of the Teeth 93-95 
 
 11. Social Consanguinity Near-kin, Early and Late 
 
 Marriage 96-101 
 
 12. Environment, Climate, Soil and Food 102-1 12 
 
 13. Race Admixture 113-119 
 
 14. Constitutional Disorders 120-126 
 
 15. Intellectual and ]\Ioral Defects 127-147 
 
 16. Inter-Operations of Causes and Predispositions. . .148-152 
 
 17. Developmental Neuroses of the Face 153-171 
 
 18. Developmental Neuroses of the Nose and Interior 
 
 Facial Bones 172-207 
 
 19. Developmental Neuroses of the Eye 208-213 
 
 20. Developmental Neuroses of the Bones of the Ear. . . 214 
 
 21. Developmental Neuroses of Jaws of the Seemingly 
 
 Normal 215 
 
 22. Developmental Neuroses of Maxillary Bones 216-235 
 
XVI CONTENTS. 
 
 CHAPTER. PAGES. 
 
 23. Developmental Neuroses of the Vault 236-289 
 
 24. Developmental Neuroses of the Palate 290-296 
 
 25. Developmental Neuroses in Teeth Position 297-322 
 
 26. Local Causes of Teeth Irregularities — Upper Jaw. .323-343 
 
 27. Local Causes of Teeth Irregularities — Lower Jaw. .344-357 
 
 28. Local Causes of Teeth Irregularities — Finger 
 
 Sucking 358-361 
 
 29. The Degenerate Teeth 362-382 
 
 30. Surgical Diagnosis 383-404 
 
 31. Pathologic and Physiologic Changes 405-426 
 
 32. Surgical Corrections 427-471 
 
 APPENDIX. 
 Tables 472-495 
 
 ANTERO-POSTERIOR AND LATERAL ILLUSTRA- 
 TIONS OF THE VAULT. 
 
 Illustrations 496-533 
 
Irregularities of the Teeth. 
 
 CHAPTER I. 
 
 HISTORY. 
 
 Dentistry was a very early specialty of medicine. The As- 
 syrians, according to recent investigations by Sayce and others, 
 early practiced tooth filling with gold and allied procedures. The 
 folklore belief that dental decay was due to a worm in the tooth 
 however exerted more influence then than it does now among 
 Aryan-speaking peoples other than in the Western Highlands of 
 Scotland, Ireland, Poland, Russia, France, Italy, South Germany 
 and Spain. The Assyrians did not reach a level in medicine and 
 surgery higher than that of the Chinese of to-day, who are pre- 
 sumably the inheritors of their science. In Egypt nearly every 
 branch of medicine had attained a relatively high status at the 
 time of Herodotus. Even earlier, as shown by the Ebers' papy- 
 rus, dentistry was a differentiated specialty of medicine. Gold 
 was employed by the Egyptians not merely for the purpose of 
 filling teeth but likewise to correct irregularities. Mummies are 
 found containing teeth held in place and directed by gold or 
 silver wires or plates. In Hindoo civilization dentistry early 
 reached also a high status as a specialty of medicine, albeit such 
 civilization fell later into decay when the folklore notion of dis- 
 ease due to the worm in the tooth resumed its prominence. In 
 the time of Hippocrates, caution was used in extracting teeth and 
 preserving them. Hippocrates attacked principally the fetichic 
 origin of disease. As this played a large part in compelling 
 unnecessary extraction of teeth he naturally was led to describe 
 the characters of teeth and the indications for their extraction. 
 A hundred and sixty years after him Erasistratus^ deposited in 
 the temple of Apollo at Delphos an odontogogue or leaden tooth 
 forceps, intimating that only teeth should be drawn which were 
 loose enough to be extracted with this instrument. This (an 
 ex-voto offering for recovery from disease) was probably in- 
 tended by Erasistratus as a popular lesson against too early 
 
 ^ Baas' History of Medicine. 
 2 
 
2 IRREGULARITIES OF THE TEETH. 
 
 extraction of teeth. So far as dentistry is concerned the Romans 
 were as much influenced by Etruscan as by Greek culture, al- 
 though this last had a very early influence. The Etruscans prac- 
 ticed dental procedures resembling but more complete even than 
 those of Greece. In Rome artificial teeth and dentures evidently 
 modeled on Etruscan types were made ere the period of the laws 
 of the "Twelve Tables." Celsus (A. D. 30) practiced dentistry 
 rather in rough surgical manner than by these conservative meth- 
 ods. Galen (150 A. D.) gave the canine teeth the present popular 
 term "eyeteeth," because he believed they were supplied by the 
 optic nerve. Greek, Etruscan, Roman and Arabian culture met 
 at the famous school of Salernum, which sprang up about 700 
 A. D. Under its influence dentistry was more practiced by sur- 
 geons and physicians, whereas it had been previously largely 
 confined to charlatans. Bruno of Lango-buro, about the middle 
 of the thirteenth century, described various operations upon the 
 teeth and antrum nearly four centuries before Highmore. In 
 the fifteenth century Giovanni d'Arcoli filled teeth with gold 
 and made attempts at corrections of irregularities. In 1618 the 
 famous anatomy of Helkiah Crooke was published. From this 
 Shakespeare drew many illustrations. It not only discussed the 
 brain and its membranes, but even variations in the numbers of 
 molars. Before this in France, Dionis and Verduc had made 
 contributions along the line of the correction of irregularities. 
 The first great French work on dentistry issued in 1728 by Fau- 
 chard was "Le Chirurgien Dentiste." Auzebi of Lyons soon 
 after wrote a similar work. In Germany the influence of the 
 French, Italian and English schools is demonstrated in the rec- 
 ognition of the dental specialty in Universities by creation of 
 special chairs. 
 
 Irregularities of the teeth were therefore very early recog- 
 nized, and, equahy early, attempts were made at their correction. 
 To the considerable extent of this recognition, in prehistoric 
 times, comparatively speaking the work of the Etruscans bears 
 witness. The same influences which have ever aided radical 
 surgery at the expense of conservative, were predominant in 
 dentistry. It was easier to remove teeth with the charlatan than 
 to preserve them with the dental scientist. 
 
HISTORY. 6 
 
 Crooke, discussing second dentition, remarks that : "the 
 shearing (i. e., incisors) teeth, when they do break forth, do 
 thrust the first shearers out before them and issue betwixt the 
 first two, the second and the dog tooth that is next unto them. 
 But if the former teeth will not fall or be not pulled out, or if the 
 latter issue before the first fall, then the latter make their way 
 through new sockets, and turn in the upper jaw outward, in the 
 lower jaw inward, so that there seemed to arise a new row of 
 teeth and this hath deceived many historians and anatomists 
 also." 
 
 The views of Crooke seem to have impressed later students of 
 "dentistry more than was first apparent. During the next two 
 centuries are found references to conditions produced by super- 
 numerary teeth on the one hand and narrow jaws on the other. 
 Barth Ruspini a century and a quarter after Crooke claims that 
 all teeth which exceeded thirty-two may be regarded as super- 
 numerary. In his opinion irregularities of the canines and 
 incisors were attributable to extreme narrowness of the jaws. 
 
 Half a century later Robert Blake- describes supernumerary 
 ind inverted teeth. A little over three decades later than Blake, 
 Joseph Harris^ and Joseph Winckworth remarked that irregu- 
 'arities were due to supernumerary teeth. 
 
 As the views of irregularities broadened, studies of their cau- 
 sation became imperative. For the same reason that local causes 
 assume undue prominence in medicine, they suggested them- 
 selves to dentists, studying irregularities of the teeth. Among 
 these causes (still in considerable favor among dentists, laryngol- 
 ogists and general practitioners) may be mentioned thumb-suck- 
 ing, mouth-breathing and enlarged tonsils. Although thumb- 
 sucking is claimed as a late nineteenth century explanation of 
 irregularities of the jaws and teeth, it was given as a possible 
 explanation by J. Imrie-* nearly six and one-half decades ago. 
 He remarks that "Irregularity is due to want of development of 
 jawbones, intemperance of various kinds combined with arti- 
 ficial modes of living introduced by civilizaton and sudden tran- 
 
 - Inaugural Dissertation, 1798. 
 
 3 A Familiar Treatise on the Teeth, 1830. 
 
 * Parent's Dental Guide, 1834. 
 
4 IRREGULARITIES OF THE TEETH. 
 
 sition from heat to cold to which the teeth are subject. All these 
 have a tendency to prevent development of the bones. Rabbit 
 mouth is due to keeping the thumb in the mouth for hours after 
 going to sleep. Underhung jaw is due to sucking the tongue by 
 throwing the under jawbone from its articulation. A similar 
 state of the teeth and jawbone is induced when attempts are 
 made by the inexperienced to regulate them by the extraction 
 of teeth in the upper jaw and neglecting to remove an equal 
 number of the lower." 
 
 J. Lefoulon^ is of opinion that the most frequent cause of 
 dental irregularity is the neglect of proper supervision of the 
 second dentition. \"ery often the temporary teeth are too precip- 
 itately removed and again the opposite error is committed by 
 suffering them to remain after the permanent have partly 
 appeared. From this results an error of relation between the 
 development of the palatine arch and the superior alveolar bor- 
 der, or of the two arches at once relatively to the size of the teeth. 
 Another cause is the bad habit of permitting children to suck 
 their thumbs and continually to be putting their thumbs into 
 their mouths. Another cause is the frequently repeated action 
 of the tongue in the pronunciation of certain syllables called lin- 
 gual, in which that organ striking against the anterior superior 
 teeth gives rise to anterior obliquity of the superior arch. This 
 deformity very frequently results among the English-speaking 
 from pronunciation of lingual syllables. 
 
 The same year Thomas Ballard charged that serrated teeth 
 and projecting jaws were the result of fruitless sucking. 
 
 According to Stockton^ "The comparative ease by which, 
 with pressure, the incisors or bicuspids may be made to alter 
 their position would naturally suggest the idea that the tongue, 
 lips, or cheek might in some measure influence their original 
 direction. But as these are pressed by everyone, while certain 
 individuals only have their teeth moved unevenly arranged, we 
 must look for some other accessory, and this may be found in 
 the form of the palate, certain peculiarities of which are found in 
 connection with similar forms of the dental arch. Irregularity of 
 
 ^ Theory and Practice of Dental Surgery, Bond's Translation, 1844. 
 ' Dental Intelligencer, 1845. 
 
HISTORY. 5 
 
 position is almost cxchisively confined to the five anterior teeth 
 on each side of the niecHal Hne, ])roui;ht al)ont by tlie pressure of 
 the tongue upon the hard palate in sucking or mastication." 
 
 According to Nasniyth' the projecting upper jaw often results 
 from the habit of sucking the thumb or finger in infancy. But 
 both projecting upper and projecting lower jaw arise from 
 arrest of development in the jaw when the expansion of the arch 
 is deficient. The prominent mouth, in his opinion, is most fre- 
 quent in civilized races. 
 
 The influence of thumb-sucking was still more emphasized 
 eight years later by H. H. Ross, who at the same time remarked 
 that as soon as there was an attempt at correction, there was 
 greater difficulty in keeping the teeth in position after they were 
 moved than in moving them. During the next twenty years 
 opinions as to the influence of thumb-sucking continued to grow 
 in number. In 1873 '^- ^^- ^^^ Lessert attributed great influence 
 to thumb-sucking and to enlarged tonsils. Thomas Salter^ 
 attributed irregularities to thumb-sucking and tongue hyper- 
 trophy. J. W. White was of opinion that protrusion of the lower 
 jaw was due to the habit of sucking the first and second fingers. 
 The weight of the hand and arm exerted an influence in causing 
 a protrusion of the lower jaw and teeth. 
 
 In Francis Fox's^ opinion the causes of irregularity were 
 "The want of proportion in the size of the teeth and the jaw- 
 bones or prolonged retention of temporary teeth, supernumerary 
 teeth, the habit of thumb-sucking, undue pressure from an hyper- 
 trophied tongue or heredity. 
 
 In Helkiah Crooke's summary of the opinions of his day 
 the influence of the temporary teeth in producing irregularities 
 had been pointed out. These views influenced not a few suc- 
 ceeding investigators. About a century and a half after the 
 appearance of Crooke's work Thomas Berdmore claimed that 
 the presence of supernumerary teeth or of a double row of teeth 
 is due to the fact that the milk teeth are never shed notwithstand- 
 ing the fact that the permanent teeth appear. Irregularity of the 
 
 " Development, Structure and Diseases of the Teeth, 1845. 
 
 ^ Dental Surgery, 1874. 
 
 ^ Irregularities of Teeth and Their Surgical Treatment, 1880. 
 
6 IRREGULARITIES OF THE TEETH. 
 
 teeth is due to the resistance offered by the permanent by the 
 temporary, which also occasioned snaggled, rough and indented 
 teeth. 
 
 According to Joseph Fox^^ the most frequent cause of irreg- 
 ularity is a want of simultaneous action between the increase of 
 the permanent teeth and the decrease of the temporary ones by 
 the absorption of their fangs, most commonly occasioned by the 
 resistance of the nearest temporary teeth. It also results from 
 the fact that the permanent teeth are too large for the space 
 occupied by the temporary. The growth of more teeth than 
 the natural number frequently occurs and is always the cause of 
 greater irregularity of the teeth. 
 
 Joseph Murphy'^^ regards irregularity as due chiefly to the 
 first teeth not having been shed in time. 
 
 In the opinion of Benjamin James^- proper attention to the 
 removal of the first teeth avoided irregularity of the second set. 
 
 Parmly^^ is of opinion that want of attention during the 
 period of shedding the first set of teeth is the great cause why 
 irregularity of the teeth, and consequent deformity of the mouth, 
 are apt to take place. When the permanent are large and growth 
 of the jaw does not proceed in a corresponding proportion they 
 are found to crowd and overlap each other. G. Waite^* found 
 that irregularities of the teeth are mostly occasioned by the pres- 
 sure of the temporary upon the permanent, throwing them in 
 the wrong direction. 
 
 According to S. S. Fitch^'"' irregularity is due to want of 
 simultaneous action between the increase of the permanent teeth 
 and the decrease of the temporary by the absorption of their 
 fangs, as well as to greater size of the permanent teeth in com- 
 parison with the temporary. This is an adoption of the views 
 and even of the language of Joseph Fox. 
 
 J. B. Garriot^*' is of the opinion that deciduous teeth by their 
 
 1" Natural History of Human Teeth, 1803. 
 
 11 Natural History of Human Teeth. 
 
 12 Management of the Teeth, 1814. 
 
 13 Natural History and Management of the Teeth. 1820. 
 
 " Surgeon-Dentist's Anatomic and Physiologic Manual, 1S26. 
 
 i"^ System of Dental Surgery, 1835. 
 
 18 Treatise on Diseases of the Mouth, 1843, Savier's Translation. 
 
HISTORY. 7 
 
 presence often prevent the permanent teeth from arranging 
 themselves in their proper position. Neglect to extract the milk 
 teeth and of other measures favoring good arrangement of the 
 permanent teeth, deformity (often very serious) may result. 
 
 One possible factor of dental irregularities which had been 
 very early considered was peculiar growth of the jaw. This 
 was discussed, as has been already remarked, by Barth Ruspini 
 in 1750. The great biologist, John Hunter, who paid some atten- 
 tion to this factor, states'^ '^ that the jaw grows at the posterior 
 edges and that an irregularity is often due to the ten anterior 
 permanent teeth being larger than the ten anterior temporary 
 teeth, while the corresponding part of the jaw is of the same size. 
 Therefore, in such cases the second set is obliged to stand very 
 irregularly. 
 
 From observations made on young pigs, G. M. Humphrey 
 claims that there is no interstitial growth. The five permanent 
 teeth occupy exactly the same position throughout life and all 
 other conditional teeth are added to the hinder end of the jaw. 
 This hind end is enlarged by the absorption of the anterior 
 coronoid edge and the deposition on the posterior edge. When 
 the molars are first formed they are under the coronoid process 
 and are frequently exposed. 
 
 Another factor which received considerable attention both as 
 a predisposing and exciting cause is premature extraction of 
 temporary teeth. 
 
 According to the work of L. Koecker. published in 1826, the 
 deformity which consists in shutting the under incisors and cus- 
 pidati over the upper has been produced by the injudicious ex- 
 traction of some of the teeth of the upper jaw without taking 
 proper care to secure due proportion between the upper and 
 under jaws. Irregularity also occurs when the temporary teeth 
 are not extracted in time and when too long persistence of these 
 occurs. 
 
 According to Thomas BelP'^ the most unusual cause of per- 
 manent irregularity is the actual want of sufficient room in the 
 jaw for the ultimate regular arrangement of the teeth. This may 
 
 1^ Natural History of the Teeth, 1771. 
 
 18 Anatomy, Physiology, and Diseases of the Teeth, 1829. 
 
8 IRREGULARITIES OF THE TEETH. 
 
 occur from disproportionate narrowness of the jaw (whether 
 from original formation or produced by too early removal of 
 temporary teeth) or from prenatural size of the permanent teeth. 
 
 In Joseph Scott's^" opinion, irregularities arise from, first, a 
 natural want of sufificient expansion in the jawbone at the time 
 of their protrusion ; second, from not extracting the temporary 
 teeth at the proper time ; third, from too early extraction of the 
 temporary teeth ; foiu-th, from supernumerary teeth. 
 
 John Nicholles"^ found that deformity may be due to too long 
 persistence of the temporary teeth, or may arise from some mal- 
 formation of the teeth or jaw entirely beyond the previous con- 
 trol of the dentist. 
 
 According to M. Maclean,^! due expansion of the jaw is pre- 
 vented by premature extraction of the temporary teeth. The tem- 
 porary teeth being not extracted, the permanent teeth are thereby 
 crowded and irregular. 
 
 E. Spooner-- has found that the first and most frequent 
 cause of irregularity is a want of simultaneous action between 
 the protrusion of the permanent teeth and absorption of the 
 fangs of the temporary. The second cause is a narrowness of 
 the maxillary arch or a want of proportion between the extent 
 of it and the size of the teeth. Another cause is premature 
 extraction of the temporary teeth. The jaw is liable to con- 
 traction and when the permanent come in there is not room in 
 the jaw for them, irregularity is due also to supernumerary teeth. 
 According to William Thornton-^ irregularities of the teeth 
 proceed from three causes. First, from a natural want of suffi- 
 cient expansion in the jawbones at the time of the protrusion 
 of the teeth ; second, not extracting the temporary teeth at their 
 proper time ; third, too early an extraction of the temporary teeth. 
 
 Mortimer about the same time expressed the opinion that 
 irregularities of the teeth arise from natural or accidental causes. 
 Natural causes arise from the bad conformation of the jaw so 
 
 1^ Art of Preventing Loss of Teeth, 1831. 
 
 20 Teeth in Relation to Beauty, Voice, and Health, 1833. 
 
 21 Treatise on Human Teeth, 1836. 
 
 22 Popular Treatise on the Teeth, 1836. 
 
 •^ Treatise on the Preservation of the Teeth and Gums, 1836. 
 
HISTORY. 9 
 
 that several tcctli arc over each other. h>om the teeth being 
 much larger than they should he. fn^ni coming out of order and 
 place, from teeth growing out of the palate or projecting out of 
 the luoiUli. Accidental causes arise from neglect or ignorance 
 in removing milk teeth too soon ; when the second teeth take a 
 direction inward or outward from some internal cause; under- 
 hung jaws arise from making faces. 
 
 According to Charles de Loude-^ irregularity is due to super- 
 numerary teeth, to second teeth being too large and maxillary 
 arch too narrow, and too early extraction' and too long persis- 
 tence of temporary teeth, and to shape of the maxillary arch, and 
 to heredity, where the child inherits the jaw of one parent and the 
 teeth of another. 
 
 About three years later Sam Ghimcs spoke of the underhung 
 jaw being due to the upper incisors extending inwards and in 
 closing the mouth they come in contact with the lower. This 
 makes the child inclined to protrude the lower jaw, which finally 
 becomes habitual and promotes the increase in the length of the 
 jaw itself. 
 
 Nessel--" attributes irregularity to the premature extraction of 
 temporary teeth. The alveoli form a bone scar in such cases 
 which constitutes an obstacle to the advancement of the perma- 
 nent teeth. In consequence the permanent teeth come before 
 the jaw is sufficiently expanded to receive them. Between i860 
 and 1880 niQUth breathing, especially during sleep, formed a 
 prominently discussed etiologic factor. 
 
 Tomes-" expressed the opinion that deformity of the jaw is 
 often caused by sleeping with the mouth open. This factor 
 Tomes had not mentioned in the 1848 edition of his work. Cat- 
 lin, the ethnologist, made a great popular propaganda in favor 
 of nose breathing. He ascribed many diseases to keeping the 
 mouth open. Malformations of the jaws and teeth were due to 
 keeping the mouth open, since civilized man is the only animal 
 who keeps his mouth open during sleep. This view still meets 
 
 -■* Surgical. Operative and Mechanical Dentistry, 1840. 
 -■'"' Compendium der Zahnheikunde, 1856. 
 -•^ Dental Surgery, 1859. 
 
10 IRREGULARITIES OF THE TEETH. 
 
 with much favor among dentists and laryngologists. It is, how- 
 ever, losing caste with the paediatricians. 
 
 W. Matthews-'^ sixteen years later than Catlin advanced 
 similar views. Irregularities were attributable to enlarged tonsils 
 which necessitate breathing being carried on with open mouth. 
 They were also due to heredity. The maxilla was smaller in pro- 
 portion than the teeth, owing to the lessened work of the jaws 
 and teeth among civilized races. Cross breeding played an im- 
 portant part, as did thumb-sucking and lip-sucking; retarded 
 shedding of the temporary teeth and too early extraction of the 
 first permanent molars. The congenital V-shaped jaw is that 
 formed where, previous to birth, the type of upper maxillae is such 
 that its cornua do not diverge posteriorly but are parallel. As 
 that portion of the jaw already formed never changes its form, 
 the newly added parts will pass off in divergent lines, forming an 
 angle with previously existing in order to correspond with the 
 increasing width of the base of the skull. The growing tendency, 
 exhibited from the time of Crooke, to assign constitutional fac- 
 tors important places in the etiology of the teeth and jaw irreg- 
 ularities, is especially observable in the work of Matthews. He, 
 while laying stress on local factors, was forced to recognize the 
 importance of constitutional factors. Constitutional factors, 
 hence, early began to assume considerable importance. John 
 Fuller, while attributing, in 1810, irregularity to long persistence 
 of temporary teeth, also remarked that the upper jaw is often too 
 small for the permanent teeth, this condition frequently resulting 
 in its irregularity. In Sigmond's-^ opinion, irregularity is due to 
 natural and accidental causes. Causes are natural : (i) when they 
 result from the jaw not expanding sufficiently to allow the teeth 
 to form a regular circle ; (2) when they are larger than the ordi- 
 nary dimensions ; (3) when they do not appear in their proper 
 order and place. Causes are accidental when due to negligence 
 or improper treatment at the time of growth. 
 
 According to Andrew Clarke,^^ that irregularity of the teeth 
 is occasioned by want of room in the jaw, and not from any 
 
 -~ London Dental Hospital Transactions, 1880. 
 
 -* Treatise on Disease and Irregularities of the Teeth and Gums, 1825. 
 
 -'' Practical Directions for Preserving the Teeth, 1825. 
 
HISTORY. 11 
 
 effect that the first set of teeth may produce upon them, is evi- 
 dent from the fact in all cases of irregularity there is not room to 
 admit of placing the teeth properly. 
 
 According to J. P. Clark-"^" irregularity may arise from too 
 premature extraction of temporary teeth. Disproportion be- 
 tween the teeth and jaws may be occasioned by a natural con- 
 formation of the parts or may be the effect of unnoticed accident. 
 For we seldom found any such disproportion and consequent 
 irregularity in the teeth of men and animals in a wild state. 
 
 According to William Robertson^^ deformity is due to in- 
 heritance of the contracted jaw of one parent and the large teeth 
 of the other. 
 
 According to David W. Jobson^- an irregularity is due to 
 smallness of maxillary arch and the great size of the permanent 
 teeth and their situation, part on inner and of others on outer 
 side of permanent teeth. 
 
 John Mallan^''^ remarks that the adult teeth being larger as 
 well as more numerous than the milk teeth, it is obvious that 
 they require a great deal more room, and when the absorption 
 of the latter does not progress equally with the growth of the 
 former, the new teeth are crowded up and aie apt to be forced 
 out of their natural position by the resistance of the old. Again, 
 if the permanent prove, as they sometimes do, disproportionately 
 large in comparison with their predecessors, the jaw may not be 
 sufficiently extended to admit of their being arranged in order, 
 in which case some overlap the others and considerable deform- 
 ity is occasioned. 
 
 According to Maury^-* prominence of the upper jaw is due to 
 narrowness of the arch; recession to the anterior teeth. Paul 
 Goddard^^ expresses the opinion that the most prolific cause of 
 irregularity is want of room in the dental arches. This arises 
 sometimes from congenital effects but more commonly from 
 
 30 A New Sj'stem of Treating Human Teeth, 1829. 
 21 Practical Treatise on the Human Teeth, 1841. 
 
 32 On the Teeth, 1834. 
 
 33 Practical Observations on Phj'siology and Diseases of the Teeth, 
 1835- 
 
 3^ Dental Art, 1842, Savier's Translation. 
 
 35 Anatomy, Pathology and Physiology of the Teeth, 1844. 
 
12 IRREGULARITIES OF THE TEETH. 
 
 early decay and loss of the temporary teeth which, failing to 
 keep up the alveoli, enable the jaw to contract and thus afford 
 too little room for the permanent set. 
 
 According to C. A. Harris^*' an infringement of the laws of 
 growth or disturbance of the organs of the face or head may 
 determine improper development of the jaws and bad arrange- 
 ment of the teeth. Irregularity of the teeth is due to narrowness 
 of the maxillary arch and sometimes to the presence of the 
 temporary teeth. 
 
 Arthur^''' states irregularities of the teeth may proceed among 
 other things from three principal causes : First, the presence of 
 the greater number of teeth in the mouth than is natural. Sec- 
 ond, a deficiency of space in the jaw. Third, a wrong direction 
 given to one or more at the time they make their appearance. A 
 deficiency of space may arise from a contraction of the jaws in 
 consequence of the too early extraction of the temporary teeth ; 
 or from some original malformation of the jaw, or from a great 
 excess in size of the second set over the first. 
 
 According to W. K. Brideman^s the tongue, lips and cheek 
 exert no influence in moving the teeth from their original direc- 
 tion. This is due to the shape of the jaw. 
 
 According to Sam Harbert^^ irregularities of the teeth are 
 due to premature extraction of the deciduous teeth and protru- 
 sion of the permanent before the absorption of a deciduous fang. 
 A projection of the lower jaw is attributable to neglect in second 
 dentition. Generally it is supposed to be due to elongation of 
 the jaw which is almost always an error. When the dental arch 
 becomes contracted at the medial line, giving to the mouth a 
 pointed appearance, it is often the result of premature extraction 
 of temporary teeth. 
 
 According to Alfred Canton*^ irregularity of teeth, as regards 
 shape, position, direction, crowded condition, etc.. is met with 
 more frequently than is supposed to be the case. The causes 
 
 ^^ Principles and Practice of Dental Surgery, 1845. 
 ^'' A Popular Treatise on Diseases of the Teeth, 1845. 
 3^ Causes of Irregularities of the Teeth, 1845. 
 
 ^^ Practical Treatise on the Operations of Surgical and Mechanical 
 Dentistry, 1847. 
 
 *" Teeth and Their Preservation, 1851. 
 
HISTORY. 13 
 
 are chiefly mechanical, depending either on the non-increase in 
 size of the jaw in proportion to the growth of the teeth to be 
 contained in the alveohir arch ; on the position of the permanent 
 teeth with reference to the fangs of their predecessor, and lastly, 
 on the increase in size of one jaw in preference to the other. 
 
 C. F. Delabarre^^ is of opinion that malformation of denture 
 may be occasioned by defective conformation of the jaw, by 
 simple arrest of development dependent upon the health of the 
 individual by excess in development of the teeth though the jaws 
 be in other respects well formed, by rapid development in the 
 dentition of one set and delay in that of the other by the too great 
 size of the teeth of one jaw which do not harmonize with those 
 that are opposite. Some forms of defective palatine arches are 
 hereditary. 
 
 According to J. R. Du\'al^- in a projecting chin, the alveolar 
 arch in which the incisors and canines are placed, has taken a 
 development upon a parabolic line — greater and more prominent 
 than that presented by the bone. This differs very little from a 
 similar one in the upper jaw which projects over the lower. Upon 
 attention to shedding of the temporary teeth depends the fine 
 arrangement of the lower. 
 
 GunnelH^ finds that protrusion of the lower jaw, while in 
 many cases hereditary, is often brought about in the following 
 manner. The incisors of the lower jaw are cut first, and when the 
 upper ones appear, the lower have nearly arrived at full growth. 
 In closing the mouth, they come in contact with the gum on the 
 inside of the upper incisors and for relief the lower jaw is 
 thrust out, which condition soon becomes permanent. 
 
 According to Samuel Cartwright, Jr.,-^^ irregularities of the 
 permanent are due first to non-absorption of the roots of the 
 temporary teeth in proportion to the rise of those of replacement. 
 Second, to the great difiference which commonly exists in the size 
 of the new teeth as compared with those of the first set. Third, 
 to contraction of the arches of the jaws and other malformations 
 
 *^ Treatise on Second Dentition. 
 
 ^2 The Youth's Dentist. 
 
 *3 Americal Journal of Dental Science, 1853. 
 
 ** British Journal of Dental Science, 1857. 
 
14 IRREGULARITIES OF THE TEETH. 
 
 of the maxillary and palate bones originating in hereditary, con- 
 genital and other causes. 
 
 In i860 extensive observations were made by Messrs. Mum- 
 mery and Nichols upon the teeth of primitive races.^^ They 
 found that irregularities of the teeth and contracted jaws were 
 rare. Observations of Messrs. Coleman and Cartwright on prim- 
 itive skulls found in Kent, England, showed that these had well 
 developed jaws and alveolar arches. The teeth still present were 
 remarkably regular. 
 
 In a paper read before the British Odontologic Society Sam- 
 uel Cartwright expressed an opinion in 1864 that irregularities 
 result from selective breeding; that they are both congenital 
 and hereditary ; that there is very little increase in the anterior 
 part of the jaw after eight or ten years. That if the temporary 
 teeth were to remain the jaws would not change from those of 
 childhood. That in all cases of irregularity the maxillae are more 
 or less altered in proportion of development whilst the teeth 
 maintain in regard to size an average development. 
 
 According to A. A. Blount,'*^ remote causes which produce 
 irregularity will be found in the commingling of all nations with 
 national and individual characteristics. The most frequent causes 
 are the result of accident, indiscriminate action of the deciduous 
 teeth and too early extraction of the permanent teeth. 
 
 According to H. SewelH''' protrusion of the incisors is appar- 
 ently due to an abnormal development of the maxillary bone. 
 Irregularities are due to retention of temporary teeth causing 
 permanent teeth to assume an unnatural position ; also to mal- 
 formation of the jaw, which is usually congenital and at the same 
 time hereditary. They may be due, however, to injury and to 
 accidental causes. 
 
 J. L. Down *^ founri '' excessive vaulting of palate is due to 
 arrest of developmc; of the sphenoid or defective growth of 
 the vomer. The defects are development defects and betoken 
 
 *s Jaws and Teeth of Semi-Barbarous Races. 
 
 *6 Orthodontia, 1866. 
 
 ^■^ Irregularities and Diseases of the Teeth, 1869. 
 
 *8 Relation of Teeth and Mouth to Mental Development. 
 
HISTORY. 15 
 
 a cause long anterior to the time when sucking the thumb is 
 practiced unless that habit be an intra-uterine one. 
 
 In the opinion of Hepburn'''' contracted maxillae and alveoli 
 are the result of artificial life and other causes attendant on civ- 
 ilization. Anthropologists afifirm that with the advance of civili- 
 zation there is decrease in the size of the facial and maxillary 
 bone. Cross-breeding also plays a part in producing deformity. 
 In the work of Kingsley, irregularities are attributed chiefly to 
 premature extraction of temporary teeth, marriage between 
 persons of different nationalities, heredity or disturbed inner- 
 vation. 
 
 S. H. Guilford^^ divides the causes into hereditary and ac- 
 quired. Colyer^^ summarizes the opinions of the previous writ- 
 ers into the statement that the causes which produce irregular- 
 ities of the teeth are general and local. 
 
 In i90i,W.Arbuthnot Lane^^" called attention to the associa- 
 tion of deformities of the alveolar process and constitutional 
 deficiencies (like those of the chest) referring the deformities to 
 the action of local factors and ignoring the underlying constitu- 
 tional element. 
 
 Ere the publication of Kingsley's work, I became convinced 
 of the importance of acquired constitutional as well as of factors 
 of hereditary origin. In 1887 I demonstrated before the Ninth 
 International Medical Congress the following propositions by 
 results the fruit of decades of constant research. The peculiarity 
 in the size and shape of the jaw bone may be inherited but the 
 manner of the eruption of the teeth is not transmitted, hence 
 irregularities of the dental arch per se are not inherited. The 
 muscles of the cheeks have nothing to do with the production 
 of the V or Saddle arch. The only tissues involved are the jaw- 
 bone on the one hand the teeth and alveolar process on the other. 
 The incisors in the V-shaped arch always protrude ; in the Saddle 
 arch never. The manner of the formation of the V and Saddle 
 arches is in the arrangement of the teeth. No matter what posi- 
 es Irregularities of the Teeth and Their Treatment, 1870. 
 
 so Orthodontia, 1898. 
 
 51 Irregularities of the Teeth, 1900. 
 
 siaThe Clinical Journal, March 20, 1901. 
 
16 IRREGULARITIES OF THE TEETH. 
 
 tion the teeth may take, the alveolar process is dependent upon 
 the teeth for its shape and position. There is a decided differ- 
 ence between the deformities produced by thumb-sucking and 
 those of the \ and Saddle arches. Arrest of development and 
 excessive growth of the maxillary bone result as follows : The 
 last but not least of the causes of arrest of development of the 
 maxillary bones is the influence of constitutional disorders and 
 the eruptive diseases. Debilitating acute diseases in children 
 are noticeably often followed by sudden overgrowth or under- 
 growth of bone. This process affecting the jaw accounts for a 
 certain proportion of those cases of pneumonia and measles fol- 
 lowed by dental irregularities and maxillary deformities. 
 
 The relation of this local osseous neuro-trophic change to the 
 neuro-pulmonary and neuro-cardiac effects of measles and pneu- 
 monia and to the extensive osteo-tropho-neurotic changes in the 
 pneumo-cardiac type of acromegaly later described by Marie, is 
 evident. Behind both lie the predisposing factor of an inherited 
 or acquired neiyropathic state evinced at the periods of stress 
 marked by dental evolution or involution. 
 
 In some cases the process is a low grade of inflammation 
 with secondary atrophy instead of hypertrophy. 
 
 Subsequently, I showed that irregularities of the teeth were 
 often due to two factors. Those of constitutional origin which 
 develop with the osseous system and those of local origin. Irreg- 
 ularities of the teeth cannot occur until they have erupted (as 
 nothing can exist except it be present) anu thus shown their 
 relation to each other and to the jaw. The deformity always 
 commences at the sixth year and is completed at the twelfth. 
 Forward movement of the posterior teeth produce the same re- 
 sult as arrest of development of the maxillae. It was also shown^^ 
 by a large number of measurements and actual cases in practice : 
 That the vault is not contracted by mouth breathing. That con- 
 tracted dental arches are as common among low vaults as high 
 and that they simply appear high because of the contraction. 
 That mouth-breathing (due to hypertrophy of the nasal bones 
 and mucous membrane deformities of the nasal bones, adenoids 
 
 52 Mouth Breathing Not the Cause of Contracted Jaws and High 
 Vaults, 1891. 
 
HISTORY. 17 
 
 or any pathological ccmdition producing" stenosis) does not cause 
 contracted jaws, but all these conditions are due to neuroses of 
 development. These views have met with considerable opposi- 
 tion, yet the clinical evidence in their favor has continually 
 grown. On, the continent of Europe their practical acceptance 
 has been shown in the recent translation by Max Bauchwitz^^ of 
 my work on the subject. 
 
 ^2 Die Entartiing der Kiefer des Menschengeschlechtes ; Eine Studie 
 von Eugene S. Talbot, Uebersetzt und Frei Bearbeitet von Max Bauch- 
 witz, Leipzig, 1898. 
 
CHAPTER II. 
 
 HEREDITY. 
 
 The individual that comes into the world is, as Liiys^ remarks, 
 but one link in a long chain which is unrolled by time and the 
 first links of which are lost in the dim past. He has not merely 
 two parents but the ancestors behind these. These two parents 
 may represent ancestors of very different type whose qualities 
 seemingly absent in the parent will appear in their descendant. 
 The relative functions of the sexes in heredity are moreover a 
 potent factor to be taken into consideration in estimating its 
 influence. The original function of reproduction, that of cell 
 division, is the part of the female. The male in the lower types 
 of life (some plants and some infusorise) simply supplies the 
 female with nutriment. With a rise in evolution protoplasm is 
 dififerentiated. The female furnishes the type which is best 
 capable of development when properly nourished by a highly 
 developed male.- As the product of fructification is longest 
 under the nutritive influence of the female, her influence is most 
 potent in redeeming defects or producing them. 'Tt is, there- 
 fore," as Moreau (de Tours^) has well said, "an incorrect con- 
 ception of the law of heredity that looks for identical phenomena 
 in each succeeding generation. Some have refused to admit that 
 mental faculties were subject to heredity because the mental 
 characters of the descendants were not precisely those of the 
 progenitors. Each generation must copy the preceding. Father 
 and son must present the spectacle of one being, having two 
 births, and each time leading the same life, under the same con- 
 ditions. But it is not in the heredity of functions or of organic 
 or intellectual facts that the application of the law of heredity 
 must be sought, but at the very fountain head of the organism, 
 in its inmost constitution." 
 
 1 Maladies Mentales. 
 
 2 Geddes-Tliomson Evolution of Sex. 
 2 La Psychologie Morbide. 
 
 18 
 
HEREDITY. 
 
 19 
 
 Heredity, as I have elsewhere pointed out,'* is divisible into 
 direct heredity, indirect heredity and telegony/' The direct 
 heredity consists in the transmission of parental and maternal 
 ([ualities to the children. This form of heredity has two aspects : 
 The child takes after the father and mother equally as regards 
 both physical and moral characters, a case, strictly speaking, 
 of very rare occurrence ; (2) or the child, while taking after both 
 parents, more especially resembles one of tliem. Here again 
 distinction must be made between two cases. The first of these 
 occurs when the heredity takes place in the same sex from 
 father to son or from mother to daughter. The other, which 
 is more frequent, appears when heredity occurs between different 
 sexes from father to daughter or from mother to son. Rever- 
 sional heredity or atavism consists in the reproduction in the 
 descendants of the moral or physical qualities of their ancestors. 
 It occurs frequently between grandfather and grandson, as well 
 as between grandmother and granddaughter. Collateral or indi- 
 rect heredity, which is a rarer occurrence than the foregoing 
 and is simply a form of atavism, subsists, as indicated by name, 
 between individuals and their ancestors in the indirect line — uncle 
 or granduncle and nephew, aunt and niece. Finally there is 
 telegony or the heredity of influence (very rare from the physi- 
 ologic point of view), which consists in reproduction in the chil- 
 dren by a second marriage of some peculiarity belonging to a 
 former spouse. 
 
 The descendants of a victim of morbidity or abnormality do 
 not always exhibit the morbidity or abnormality of the ancestor. 
 Sometimes apparent morbidity or abnormality is wanting. In 
 other cases slighter abnormalities than those of the ancestor 
 are to be detected. Here occurs the operation of two interde- 
 pendent principles. The transmutation of heredity and the ata- 
 vism upon which it depends. Atavism at times tends to preserve 
 the type and offsets the influence of degeneracy. It underlies not 
 merely the production of the sound actions of degenerate stock, 
 but also those in whom the degeneracy affects the earlier and 
 not the later acquirements of the race. Manifestations of mor- 
 
 ■* Degeneracy : Its Causes, Signs and Results. 
 ^ Ribot Heredity. 
 
20 IRREGULARITIES OF THE TEETH. 
 
 bid heredity may not be inheritance of the whole effect but dis- 
 turbance of relations of structure, and hence of function, pro- 
 ducing a constitutional deficiency which takes the line of least 
 resistance. The extent and direction of this line of least resist- 
 ance depends upon the amount of healthy atavism which separate 
 organs and structures of the body preserve. What is true of 
 the organism as a whole is true of the cells forming its organs. 
 While cell life is altruistic or subordinated to the life of the 
 organ and through it to the life of the organism as a whole, still 
 this altruism is not so complete as to prevent entirely a struggle 
 for existence*^ on the part of the cells or the individual organs. 
 With advance in evolution this struggle decreases to increase 
 with the opposite procedure of degeneracy. From it result the 
 phenomena of arrested and excessive development. This strug- 
 gle for existence was very early pointed out by Aristotle,'^ who 
 showed that one organ was often sacrificed for the development 
 of another. This was more clearly pointed out and freed from 
 obscurity by Goethe in 1807 and St. Hilaire in 1818. The law 
 under which this struggle operates is known as the law of econ- 
 omy of growth. Its action sometimes aids, sometimes, when 
 regular, prevents, degeneracy. As has been pointed out by 
 Von Baer, the vertebrate embryo of the higher type has in it 
 all the potentialities for the organs and structures found in 
 lower types. Therefore in proportion as the ancestry is strength- 
 ened do these potentialities remain latent. On the other hand, 
 in proportion as the ancestry becomes a subject of nervous 
 exhaustion these potentialities gain nutrition at the expense 
 of the later acquired organs which are the ones likely to be 
 afifected by nervous exhaustion. All the organs of the body have 
 practically their own nervous system, which exercises a control 
 over their nutrition through its control over the blood supply 
 and the means of excretion. The excessive action of this local 
 nervous system is regulated by the central nervous system for 
 the benefit of the organism as a whole. Should the central 
 nervous system become weakened, the local nervous system, 
 given free play, first draws greater nourishment and increased 
 
 ^ Roux Dcr Kamp der Theile im Organismus. 
 ■^ Osborn, From the Greeks to Darwin. 
 
HEREDITY. 21 
 
 power at the expense of other organs. As a result of this 
 increased power the local nervous system becomes itself 
 exhausted and a struggle for existence occurs between its 
 parts. In consequence, as in the case of tumors and cancers, 
 cells take on the power of reproduction, which for a long time 
 they had lost, for the benefit of the organization as a whole.^ 
 This strugle for existence produces effects which are handed 
 down by heredity or are fought by atavism ("throwback," in the 
 language of the cattle breeders), as the tendency to return to the 
 type of a more remote ancestor is called. It is obvious, there- 
 fore, that these two factors in heredity may play beneficial as 
 well as injurious parts on the ofifspring. As a rule atavism plays 
 a beneficial part in correcting degenerate tendencies. This 
 part may either be complete in the shape of a perfect return to 
 a normal ancestor or may be so incomplete as to moderate in 
 in the ofifspring the extended nervous exhaustion which an ances- 
 tor has transmitted. 
 
 As shown by Moreau (de Tours), the biologic effects of 
 degenerative forces on heredity are as follows : First, absence 
 of conception ; second, retardation of conception ; third, imper- 
 fect conception ; fourth, incomplete products (monstrosities) ; 
 fifth, products whose mental, moral and physical constitution 
 is imperfect ; sixth, products specially exposed to nervous dis- 
 orders in order of frequency as follows : Epilepsy, imbecility, 
 idiocy, deaf-mutism, insanity, and other cerebral disorders ; sev- 
 enth, lymphatic products predisposed to tuberculosis and allied 
 disorders ; eighth, products which die in infancy in a greater 
 proportion than sound infants under the same conditions; ninth, 
 products which, although they escape the stress of infancy, are 
 less adapted than others to resist disease and death. These 
 varied results are due to the biologic law that, ?s Herbert 
 Spencer has shown, with increase in growth and specialization 
 must occur decrease in the explosive manifestations of life. 
 Among these explosive manifestations in early biologic history 
 is the function of reproduction which is common to all cells. 
 With advance in evolution the functions of cells become special- 
 ized and the extent of reproductive power is decreased. This 
 
 8 Degeneracy, Op. Cit. 
 
22 IRREGULARITIES OF THE TEETH. 
 
 specialization, Spencer designates individuation. In degeneracy 
 the organism returns to the lower type and consequently tends 
 to a reversion of individuation. In consequence first occurs 
 the absence of conception to which Moreau de Tours refers. 
 If the organism be less deeply affected, the plural and fre- 
 quently repeated births of degenerates occiu\ Abortions are 
 comparatively more frequent in plural than in ordinary preg- 
 nancies. Monstrosities of all kinds are commoner in plural than 
 in ordinary pregnancies. There are more dead born children 
 in plural ~ pregnancies, and the children born alive are more 
 difficult to rear. The proportion, according to Ansell,^ of infants 
 that are still born or die soon after birth is in the case of males 
 nearly five times and in the case of females nearly four times 
 greater in multiple than in single births. Pluriparity, accord- 
 ing to J. M. Duncan, is especially associated with idiocy and 
 imbecility, and it especially affects the sterile ages or the ages 
 of weakness of reproduction. According to Arthur Mitchell,^^ 
 among imbeciles and idiots a much larger proportion is found 
 to be twin-born than among the general community. Among 
 relatives of imbeciles and idiots twinning is very frequent. In 
 families where twinning is frequent, bodily deformities (of defect 
 and of excess) likewise occur with frequency. The whole history 
 of twin births is exceptional, indicates imperfect development 
 and feeble organization of the product and tends to show that 
 twinning in man is a dcpartiuT from the phvsiologic rule, and 
 hence injiu-ious to all concerned. Everything known concern- 
 ing triplets and quadruplets supports opinions derived from 
 twins. Valenta had under observation two epileptics (mother 
 and daughter), who illustrated this very decidedly. The mother 
 had thirty-eight children, six times twins, four times triplets and 
 twice quadruplets. The daughter, at the age of forty, had 
 thirty-two children : three times twins, six times triplets 
 and twice quadruplets. Ninety families of degenerates coming 
 under Kiernan's observation^^ averaged eleven children each. 
 Triplets, quadruplets and twins were more than ten times as 
 
 » Gaillard's Medical Journal, May I2th. 18,^3. 
 10 Medical Time'; and Gazette, Nov. 15th, 1862. 
 ^^ Alienist and Neurologist, 1901. 
 
HKREDITY. 23 
 
 frequent as among- the population taken as a whole. The 
 ocurrcnce of large families, as Kiernan remarks, should hence 
 be regarded not as an expression of advance but as an expres- 
 sion of degeneracy. Teachings entirely too prevalent as to status 
 in evolution being determined by progeny have cultivated a 
 factor of degeneracy which, when it occurs in a family, must 
 be regarded as merely a transformation of malign heredity.' - 
 
 From these conflicting factors it results that direct heredity 
 is rare and that acquired influences are apt to expend their 
 force upon unstable structures most subject to the struggle for 
 existence occurring within the organism. The skull, jaws and 
 teeth are predisposed to this struggle and hence peculiarly liable 
 to the ply of hereditary influences or acquired defects of an 
 ancestor. 
 
 Heredity hence usually furnishes in the case of the jaws and 
 teeth merely powder to be lighted up by factors locally applied 
 during the periods of stress after birth. Without these locally 
 applied excitants, the types usually ascribed to heredity by dent- 
 ists will not occur. Environment furnishes the match but it 
 makes a great difference whether, as Havelock Ellis says, the 
 match be thrown into a powder magazine or the sea. 
 
 No discussion of heredity is complete without reference to the 
 position of the biologist, Weismann,^^ who (basing his opinion 
 upon an alleged distinction between what he calls the body plasm 
 and the germ plasm), denies the inheritance of acquired defects. 
 An attempt, however, to transfer his position from the domain 
 of biology tO' that of pathology led him to encounter facts he 
 was obliged to explain in a manner inconsistent with his original 
 position. In his last work,^'* he advances the opinion that "the 
 origin of a variation equally independent of selection and amphi- 
 mixis is due to the constant occurrence of slight inequalities of 
 nutrition in the germ plasm. These variations are at first infini- 
 tesimal but may accunnilate, and in fact they must do so when the 
 modified conditions of nutrition which gave rise to them have 
 l-icfed for several generations. But although it is improbable 
 
 12 Degeneracy, Op. Cit. 
 
 13 Essays upon Heredity. 
 
 !■* The Germ Plasm. > 
 
24 IRREGULARITIES OF THE TEETH. 
 
 that individual variability can depend on a direct action of 
 external influence upon the germ cells and their contained germ 
 plasm must be very difficult to change, yet it is by no means 
 to be implied that this structure may not possibly be altered 
 by influences of the same kind continuing for a very long time. 
 Thus much may be maintained that influences which are mostly 
 of variable nature tending now in one direction, now in another, 
 can hardly produce a change in the structure of the germ plasm, 
 and this is the reason why the cause of inheritable individual 
 difference must be sought elsewhere than in these varying influ- 
 ences." "No one has doubted," he says, in response to Vir- 
 chow, "that there are a number of congenital deformities, birth- 
 marks and other individual peculiarities which are inherited." 
 But these are accjuired characters in the above sense. True, they 
 must have once appeared for the first time, but we cannot 
 say exactly from what cause ; we only know that at least a great 
 proportion of them proceed from the germ itself and must 
 therefore be due to alteration of the germinal substance. If 
 Virchow could show that any single one of these hereditary 
 deformities had its origin in the action of some external cause 
 upon the already formed body (soma) of the individual and 
 not upon the germ cell, then the inheritance of acquired char- 
 acters would be proven. Rut this no one has yet succeeded in 
 proving, often as it has been maintained. Weismann, however, 
 deals a coup de grace to his own position by admitting that 
 tuberculosis may produce what he calls a "habit in the ancestor 
 which may be transmitted to the descendants. This habit con- 
 sists in the formation of structural peculiarities such as narrow- 
 ness of the chest, etc." The admission of such a "habit" oflfsets 
 any denial of the inheritance of acquired characters. Some 
 recent investigations in the laboratory of the Naples Aquarium^ ^ 
 have destroyed the embryologic distinction between the germ 
 plasm and the body plasm. Weismann's claim that the first 
 division of the cell represented separation of body plasm and 
 germ plasm is contradicted by these experiments. Not only 
 when the cell has divided twice, but four times and even six- 
 teen times, can the separate cells, if dissociated from the group, 
 
 ^•^ Alienist and Neurologist, July, igoo. 
 
HKRKUITY. 
 
 pursue a separate existence and become well developed organ- 
 isms of the parent type. Experiments in the production of 
 double monsters by 1'^ C. Spitzka, Dareste and others,^'' had 
 long ago cast suspicion upon the embryologic position of Weis- 
 mann. His criticisms, however, have done undeniable good in 
 destroying loose notions as to direct heredity previously present. 
 ^•5 Lectures on Eniljrvologv, St. Louis Clinical Record, 1879-1881. 
 
CHAPTER III. 
 
 CONGENITAL FACTORS AND MATERNAL IMPRES- 
 SIONS. 
 
 Hereditary influences must be separated from factors occur- 
 ring during one pregnancy which affect the product of that preg- 
 nancy alone. Prominent among these factors are the "maternal 
 impressions or so-called mother's marks." 
 
 A striking illustration of "maternal impressions" among 
 animals was reported nearly two decades ago by T. C. Poole/ 
 of Mansfield, Texas. His sow gave birth (April, 1883,) to eight 
 fully developed pigs. The ninth had the appearance of an ele- 
 phant. It was destitute of hair, had dependent ears, a proboscis, 
 two eyes behind upper two thirds of proboscis, closely approxi- 
 mated, yet distinct, an abnormal superior maxillary, containing 
 three large teeth, with a long, thin upper lip of elephantine 
 shape and color. The sow's gestation lasts three months and 
 twenty days. On Christmas day, 1882, the boar was with her. 
 December 29th, a menagerie had an elephant staked about three 
 hundred yards from where the sow was and in full view. 
 
 J. G. Kiernan,- commenting on this case, pointed out that 
 the pig, descending from the proboscidse, has at one stage in 
 intra-uterine development a proboscis whose musculature is 
 still retained by the adult pig, in whom the nose plays to some 
 extent the part of a hand for rooting purposes. The case was, 
 therefore, due to arrested development at the period of pig intra- 
 uterine development when the proboscis existed. This arrested 
 development could have arisen from nervous shock to the sow, 
 alleged since these animals are easily upset during gestation. 
 
 Maternal impressions have (as Kiernan remarked in a dis- 
 cussion before the Chicago Academy of Medicine),-"^ been con- 
 sidered from one standpoint only and that is as to their supposed 
 cause and its method of action. As the supposed cause is 
 
 1 Gaillard's Medical Journal, Vol. 36, No. i, 1883. 
 
 2 Gaillard's Medical Journal, July 7th, 1883. 
 
 3 Medicine, May, 1900. , . 
 
 26 
 
CONGENITAL FACTORS AND MATERNAL IMTRESSIONS. 27 
 
 psychic and — in the conception of it usually adopted — imma- 
 terial in action, an absurd credulity respecting its powers, which 
 existed at one time among obstetricians, has given way to an 
 equally absurd skepticism. The subject has not been discussed 
 by either set of partisans, from a scientifically critical standpoint. 
 This skeptical spirit has evinced itself in denial of a case authenti- 
 cated by embryologists and ornithologists of unblemished repute 
 and further supported by teratologic specimens in the British 
 Museum. Spitzka had his skepticism as to maternal impressions 
 shaken by these specimens, which were newly hatched chicks 
 with a curved beak like a parrot and the toe set back as in that 
 bird. The hens in the yard where these monstrosities were 
 hatched had been frightened by a female parrot which, having 
 escaped, fluttered among them before the eggs were laid and 
 E^reatly frightened the hens from whose eggs the malformed 
 chicks were hatched. This would seem at first sight to confirm 
 the photographic theory of maternal impressions. These mal- 
 formations are, however, as in the case of the pig, simply arrests 
 of development. Birds are aberrant reptiles belonging to the 
 sauropsidge, and during their embryonic development pass 
 through a reptilian phase. It was at the end of this phase that 
 the chicks were arrested in development, producing the parrot- 
 like malformation. For lack of logical explanations like these, 
 modern obstetricians are skeptical. In a general way, alleged 
 maternal impressions may be divided into two classes : t. Those 
 in which an arrest of embryonic development has occurred, 
 which may or may not be traceable to the alleged impression. 
 2. Photographic impressions charged to a factor utterly inca- 
 pable of producing them because of the later period in embry- 
 onic life at which the impression is alleged to have acted. 
 
 The fact that mental shocks can only act on the organization 
 in a purely physical manner is equally ignored by opponents 
 and advocates of the psychic theory of mental impressions. All 
 that is known of the mind is known of it as related to purely 
 physical conditions. It is through pure physical conditions that 
 it must act, whether its action be initiated by conditions affecting 
 physically the various sense organs or not. 
 
 There is no doubt that the foetus is liable to mental effects 
 
28 IRREGULARITIES OF THE TEETH. 
 
 from the mother, since, as Fere* has shown, it often exhibits 
 very decided reaction to sensory impressions on the mother. 
 Women in the midst of an ordinary dream, producing but very 
 moderate excitations not generally interrupting sleep, are often 
 awakened by foetal movements. These dreams need have noth- 
 ing of the nightmare which would cause sudden contraction 
 under the influence of a terrifying idea with its resultant cardiac 
 disorder. They may be merely the ordinary phenomena of sleep. 
 Mental changes of the mother hence excite motor reaction in the 
 foetus and, as with sensorial excitations, these reactions are 
 stronger in the foetus than in the mother. The mechanism c 
 these motor reactions is obviously the unconscious and invol- 
 imtary movement of the uterine walls. A. Lagorio,-'' some sev- 
 enteen years ago, brought before the Chicago Medical Society 
 several cases in which maternal impressions had produced decid- 
 edly abnormal births with deformities resembling those feared 
 by the mother. In discussing these Kiernan pointed out that 
 they were all instances of checked development and advanced 
 the opinion that normal shock generally played the chief part 
 in maternal impressions through checking development and 
 causing either general or local reversion. Here the statistic 
 method can be applied. Of 92 children born in Paris during 
 its last seige, 64 had slight mental or physical anomalies. The 
 remaining 28 were all weakly; 21 were imbecile or idiotic and 
 8 were moraUy insane. These figures of Legrande du Saulle 
 justify the characterization by the working class of Paris of 
 children born in 1871 as "doomed children." In Berlin the 
 financial crisis of 1 875-1 880 was followed by an increase in the 
 number of idiots born. It must be remembered that profound 
 mental shock can alter nutrition so that the mother shall furnish 
 poisonous products in lieu of nutriment. That such poisonous 
 products would tend to check foetal development no one will 
 deny. 
 
 Therefore, while science rejects the photographic phase of 
 maternal impressions, it admits that a class of cases of arrested 
 
 * Sensation et Mouvement. 
 
 s Chicago Medical Journal and Examiner, 1883-84. 
 
CONGENITAL FACTORS AND MATERNAL IMPRESSIONS. 29 
 
 development exists, due to the effects of mental shock upon the 
 mother. 
 
 The inlUience of maternal impressions would he most strongly 
 exerted on structures variahle in evolution. This iniluence 
 must, hence, strongly affect nutrition of the dermal bone ele- 
 ments of the skull, face and jaws, and hence must affect the 
 teeth. The results of this will not always be obvious until the 
 periods of stress. 
 
 One expression of foetal senescence is the production of chil- 
 dren born with teeth. This often occurs, however, under the 
 law of economy of growth in connection with arrested devel- 
 opment elsewhere. Cyclops and similar grave types of degen- 
 eracy are frequently accompanied with premature eruption or 
 development of the teeth. The connection between degeneracy 
 and teeth at birth must have been very early observed, since 
 Shakespeare makes Richard III remark, 
 
 "The midwife wonder'd and the woman cried, 
 
 'O Jesu, bless us, he is born with teeth, . 
 
 And so I was ; which plainly signified 
 
 That I should snarl and bite and play the dog." 
 
 Ante-natal teeth are far from rare and as Gould*' remarks, 
 
 the significance of such eruption of teeth is not always that 
 
 of vigor, since many of the subjects succumb early in Hfe. Pliny, 
 
 Columbus, Van Swieten, Haller, Marcellus Donatus, Baude- 
 
 loque, Cazeaux, Soemmering and Gardien cite instances in which 
 
 children have been born with teeth already erupted. Haller has 
 
 collected 19 cases of children born with teeth. Polyderus Virgi- 
 
 lus describes an infant who was born w'ith six teeth. Louis XIV 
 
 had two teeth at birth. Bigot, a medical philosopher of the 
 
 sixteenth century, Boyd the poet, Valerian, as well as some 
 
 ancient Greeks and Romans, had this anomaly. There were two 
 
 cases typical of foetal dentition shown before the Academic de 
 
 Medecine de Paris. One of die subjects had two central incisors 
 
 of the lower jaw and the other had one tooth well through. Levi- 
 
 son saw a female born with two central incisors in the lower 
 
 jaw. 
 
 •^ Anomalies. 
 
CHAPTER IV. 
 
 POST-NATAL SKULL AND JAW DEVELOPMENT AND 
 PERIODS OF STRESS. 
 
 The assumption that the child is simply an immature man 
 or woman is, as has been shown by biologists, a far too prevalent 
 error. The child, with its relatively enormous head, its large 
 protuberant abdomen — "all brain and belly," as some one defines 
 it — its small chest, short, feeble legs, comparatively vigorous 
 arms, smooth, almost hairless skin, large liver, kidneys, thymus 
 and suprarenal capsules presents, as Havelock ElHs^ remarks, 
 a distinct anatomic picture. The facts of the child's physi- 
 ologic and psychic life are clear indications in the same direction. 
 The anthropoid apes at an early period of life often present 
 characters quite unlike those of the adult. While the young 
 anthropoid is comparatively human, the adult ape is compara- 
 tively bestial in character. The young ape has a smooth globular 
 head and relatively small face, like man. The profile is more 
 human with little prognathism. The base of the skull is formed 
 in a more human way than in the adult ape. The brain is rela- 
 tively very much larger than in the adult. In the gorilla, for 
 example, the foetus difTers from the adult by having relatively 
 a much larger head, a longer neck, a more slender trunk, shorter 
 thumb and great toe; while the head is more globular, the face 
 less prognathous and the hand more man like. In nearly all 
 these characters, the foetal gorilla approaches man. The adult 
 male ape rapidly develops into a condition far removed from his 
 early man-like state. The brain becomes relatively very small, 
 the receding skull becomes hideous with huge bony crests, sharp 
 angles and on its enormously enlarged facial portions, promi- 
 nent outstanding superciliary ridges, projecting jaws and reced- 
 ing chin, while the dark hairy body becomes more bestial in 
 character. The female ape remains midway between the infantile 
 and the adult male condition. So far as man is ape-like it is 
 the infantile and not the adult whom he resembles. Man in 
 
 1 Man and Woman. 
 
 30 
 
POST-NATAL SKUI.L AN'D JAW DKVKLOl'MENT. 31 
 
 the course, of his hfe [alls away more and more from the specific- 
 ally human type of his early years, but the ape in the course of his 
 short life goes very much farther along the road of degradation 
 and premature senility. The ape starts in life with a considerable 
 human endowment, but in the course of life falls far away from 
 it. Man starts in life with a still greater portion of human or 
 ultra human endowment and to a less extent falls from it in adult 
 life, approaching more and more to the ape. Up to birth or 
 shortly afterwards in the higher animals, such as the apes and 
 man, there is a rapid and vigorous movement along the line 
 upward in zoologic evolution. A time comes, however, wdien 
 this fretal or infantile development, ceasing to be upward, is so 
 directed as to answer to the life wants of the particular species. 
 Henceforth and throughout life there is chiefly a development 
 of lower characters, a slow movement towards degeneration and 
 senility, although one absolutely necessary to insure the preser- 
 vation and stability of the individual and species. 
 
 FcEtal evolution, which takes place sheltered from the world, 
 is in an abstractly upward direction. After birth further devel- 
 opment is a concrete adaptation to the environment without 
 regard to upward zoologic movement. The infantile condition in 
 both ape and man is somewhat alike and approximates to the 
 human condition. The adult condition of both also tends to be 
 somewhat alike and approximates to the ape-like condition. 
 
 The human infant presents in an exaggerated form the chief 
 distinctive characteristics of humanity, the large head and brain, 
 the small face, the hairlessness, the delicate bony system. By 
 some strange confusion of thought, this fact is usually ignored 
 and it is assumed that the adult form is more highly developed 
 than the infantile form. From the standpoint of adaption to 
 environment, the coarse, hairy, large-boned and small-brained 
 gorilla is better fitted to make his way in the w^orld than the 
 delicate offspring, but from a zoologic point of view anything 
 but progress occurs. In man, from about the third year on\vard, 
 further growth, though absolutely necessary adaption to the 
 environment, is to some extent growth in degeneration and senil- 
 ity. It is not carried to so low a degree as in the apes, although 
 by it man is to some extent brought nearer to the apes. Among 
 the higher human races the progress toward senility is less 
 
32 
 
 IRREGULARITIES OF THE TEETH. 
 
 marked than among the lower human races. The child of many 
 African races is scarcely, if at all, less intelligent than the Euro- 
 pean child. The African, as he grows up, however, becomes 
 stupid and obtuse and his whole social life falls into a state of 
 
 hide-lK)und routine. The European retains much of his child- 
 
 tig. I. 
 like vivacity. The highest human types represented in typical 
 men of genius are a striking approximation to the child type. 
 
 The contrast between the prophecy of development in the 
 child and its fulfillment in the adult is excellently depicted in 
 the above illustration (Fig. i) modified from Havelock Ellis. - 
 
 2 Man and Woman. 
 
POST-NATAL SKULI, AND JAW DEVELOPMKNT. 33 
 
 The great factors in the environment which interrupt race up- 
 ward progress are as Kicrnan-' points out, the periods of stress. 
 While even the last of these presents as its most obvious feature 
 dentitional evidences, still in all, important processes of nutrition 
 and reproduction are involved. 
 
 Every vertebrate, as I pointed out some years ago,'* is an 
 aggregate whose internal actions are adapted to counterbalance 
 its external actions. Hence preservation of its movable equi- 
 librium depends upon its development and the proper number of 
 these actions. The movable equilibrium may be ruined when 
 one of these actions is too great or too small and through 
 deficiency or need of some organic or inorganic cause in its 
 surroundings. Every individual can adapt itself to these change- 
 able influences in two ways, either directly or by producing new 
 individuals who will take the place of those in whom the equi- 
 librium has been destroyed. Therefore, forces exist preserva- 
 tive and destructive to the race. Since it is impossible that 
 these two varieties of force should counterbalance each other, 
 it is necessary that the equilibrium should re-establish itself in 
 an orderly way. Since these are two preservative forces of every 
 animal group — the impulse of every individual to self-preserva- 
 tion and the impulse to the production to other individuals — 
 these faculties must vary in an inverse ratio and the former 
 must diminish when the second increases. Degeneration con- 
 stitutes a process of disintegration. Hence if the term "individu- 
 ation" be applied to all the processes which complete and sustain 
 the life of the individual, and that of "generation," to those 
 which aid the formation and development of new individuals. 
 Individuation and generation are necessarily antagonistic, as 
 Herbert Spencer'^ has shown. 
 
 Vertebrate embryos, all of common type at their origin, 
 assume, as Von Baer has demonstrated successively, a number 
 of common forms before definitely dififerentiating. Supernumer- 
 ary organs, as Dareste has shown, exist in these common forms 
 at one phase of embryonic life. This community of embryonic 
 
 3 Child Study Magazine, 1898. 
 * Degeneracy, Op. Cit. 
 ^ Principles of Biology. 
 4 
 
34 IRREGULARITIES OF THE TEETH. 
 
 types and this last fact, explains repetition of teratologic types 
 in vertebrates. This community of origin, moreover, indicates 
 that the higher vertebrate embryo contains in essence the organs 
 and potentialities of all the lower vertebrates, and that under 
 the influence of heredity or accidental defect an organ or struct- 
 ure or function constant in a species may be lacking in an indi- 
 vidual without the necessity of explaining the iihmediate effects 
 by distant atavism. 
 
 Varying conditions must stimulate these embryologic poten- 
 tialities at the expense of the later acquired and more typic 
 human organs. The Cohnheim theory of cancer is an application 
 of this principle.*^ From this results a struggle for existence 
 on the part of organs and structures which, early observed by 
 Aristotle, Goethe and St. Hilaire, was forcibly shown by Roux" 
 two decades ago, who, while admitting determination by hered- 
 ity, pointed out that there are always surrounding forces neces- 
 sary, not simply the condition of activity by an essential element 
 of the final product. He thus harmonizes the extreme views by 
 an internal or physiologic struggle for existence between the 
 organs, the cells and protoplasmic molecules of the organism. 
 This unsimilarity of parts makes it impossible to establish laws 
 of heredity which shall govern details of function as to the last 
 cell or molecule since in any army the commander-in-chief does 
 not give a special order beforehand affecting every private in 
 the ranks. Ther^ must be potentiality of adaptation to sur- 
 roundings, especially in details, which are more easily changed 
 than events on a larger scale. 
 
 The principle that lies back of all development of tissues and 
 organs is over compensation of what is used, a quality which 
 permits self-regulation and is rarely a necessary precondition of 
 life. Living matter presents an external continuity in spite of 
 change of condition. To effect this, assimilation must always be 
 in excess (over-stimulation) for if less than consumption, the 
 organism comes to an end itself. If equal conditions result, 
 change and nourishment will fail or injurious events will cause 
 
 ^ Kiernan (Editorial Journal of American Medical Association, Vol. 
 XXXI). 
 
 7 Op. Cit. 
 
I'OSr-NATAL SKUI-I, AND JAW DEVFI.OPMENT. 35 
 
 destruction. Continuance can only be assured when more is 
 assimilated than is consumed. Fire, for example, assimilates more 
 than it uses, i. e., it always has energy left over to kindle new 
 material. Fire would, like life, become external if it did not use 
 up material quicker than other processes can make them. In- 
 the same way organisms assimilate more than they can con- 
 sume, but they do not turn all they use to assimilation ; energy 
 remains over by which the process performs some thing. This 
 work product controls the excessive assimilation which other- 
 wise would come to an end by not having sufficient material to 
 assimilate. The more complex processes of life are, hence, 
 essentially as Colin A. Scott^ remarks, a radiation of assimilation 
 which, although not identical with combustion, is similar to it ; 
 the load which it carries favoring its continuity. This radiation, 
 load or over product becomes directed by natural selection to 
 keep up a supply of food primarily by moving the assimilating 
 mass. Performance of function over and above assimilation is 
 just as much a condition of continuous assimilation as assimila- 
 tion is of performance. On the other hand, there comes to be 
 an inverse relationship between growth and product (within 
 limits) and capacities result which, although they use up material, 
 do not in themselves increase assimilation. The course of devel- 
 opment consists in properly directing the work products. This 
 so far represents merely a continuous productibility of function 
 in connection with assimilation. But a productibility which is 
 stored up and discharged by an outer stimulus of environment 
 will be much more economic and will give rise to w^hat we find as 
 reflex excitability. When this reflex product dominates, accord- 
 ing to circumstances, function will sometimes be greater and 
 sometimes less. If, under these conditions, assimilation keeps 
 on continuously, there must sometimes be an overplus, some- 
 times a balance and sometimes an excessive function, death and 
 thus elimination. To avoid this last, it is necessary that assimila- 
 tion should depend upon use or upon a stimulus, which use calls 
 forth. From the psychic side stimulus is recognized as hunger. 
 This kind of process where stimulus is an indispensable factor 
 is more special and limited than the more general process of 
 
 8 American Psychological Journal, 1888. 
 
36 IRREGULARITIES OF THE TEETH. 
 
 assimilation plus movement, etc.. but has characteristics which 
 favor it greatly in the struggle for existence. Connected with 
 the most complete self-regulation of functionation is the greatest 
 saving of material. While those parts, according to their use, 
 are strengthened and grow, the unused degenerate and the ma- 
 terial for their substance is saved. This kind of process unites 
 the greatest economy with the highest functioning of the whole, 
 but at the cost of the independence of the parts. Senescence 
 becomes thus a result in differentiation in which the parts exist 
 merely on account of the function which they perform for the 
 whole. The senescing organs wither and may even descend in 
 this condition from generation to generation, a fact which often 
 allows a fresh start in development. During the course of life- 
 time the organism moves from a more general, more easily im- 
 pressible condition to one more perfectly mechanized. Through 
 a long period it becomes, through the continuous working of a 
 given stimulus, more completely adapted to itself and also more 
 differentiated and thereby more stable, so that an always increas- 
 ing opposition is formed to the additional development of new 
 forms and characteristics. The principle, known as the law of 
 economy of growth, holds good of man, as Dohrn^ has shown, 
 not only as an organic unit but as a compound organism. It has 
 been lately extended to sociolog}- by DeMoor.^*^ 
 
 Degeneracy, according to Ray Lankester,^^ is a gradital 
 change of structures by which the organism becomes adapted 
 to less varied and complex conditions of life. The opposite pro- 
 gressive process of elaboration is a gradual change of structure 
 by which the organism becomes adapted to more varied and 
 complex conditions of existence. In elaboration, there is a new 
 expression of form corresponding to new perfection of work 
 in the animal machine. In degeneracy there is a suppression 
 of form corresponding to the cessation of work. Elaboration 
 of some one organ may be a necessary accompaniment of degen- 
 eracy in all others. This is very generally the case. Only 
 when the total result of the elaboration of some organs and the 
 
 ^ Osborn, From the Greeks to Darwin. 
 1° Evolution by Atrophy. 
 11 Degeneration. 
 
POST-NATAI, SKUI-I. AND JAW DEVELOPMENT. 37 
 
 degeneracy of others is such as to leave the whole mass in a 
 lower condition, that is fitted to less complex action and reaction 
 in regard to its surroundings than is the type, can the individual 
 be regarded as an instance of degeneracy. 
 
 As Harriet Alexander'- has shown, since degeneracy is a 
 process of evolution, leading to alteration of form because of 
 cessation of inhibitions in certain directions resultant on dimin- 
 ished work, it logically follows that since diminished functioning 
 precedes change of structure increased functioning must check 
 the change of structure in its biochemic stage. Nay, more, it is 
 evident that structural elaboration due to degeneracy may be 
 retained w'hile the degenerate structures resume their higher 
 functions. Hence the degenerate race ranks higher in evolution 
 because of the utilization of the beneficial variations due to degen- 
 eracy. The influence of this principle is increased by the fact 
 that the majority of the children of degenerates inherit a ten- 
 dency to degeneracy rather than degeneracy itself. 
 
 Since, as Kiernan^^ points out, certain parts may disappear 
 in the evolution of organs and certain organs during the evolu- 
 tion of organisms and since the disappearance and developing 
 tendency must center around the time when certain functions 
 will be lost by the disappearing and others gained by the devel- 
 oping periods of stress must occur, around which the law of 
 economy of growth will center, the struggle for existence be- 
 tween the parts of organs and between the organs. Struggles for 
 existence on the part of the different organs and systems of the 
 body are hence most ardent during the periods of intra and 
 extra-uterine evolution and involution. During the first denti- 
 tion, during the second dentition (often as late as the thirteenth 
 year), during puberty and adolescence (fourteen to twenty-five). 
 during the climacteric (forty to sixty), when uterine involution 
 occurs in woman and prostatic involution in man, and finally 
 during senility (sixty and upwards), mental or physical defect 
 may, as I have elsewhere shown, occur a congenital tendency to 
 w'hich has remained latent until the period of stress. 
 
 When systemic balance, the result of evolution, is disturbed 
 
 12 Medicine, 1896. 
 
 13 Medicine, 1901. 
 
38 IRREGULARITIES OF THE TEETH. 
 
 by change in environment, the organs, as has been shown exper- 
 imentally by Jacques Loeb,^"* do not pursue their usual growth. 
 Such disturbances are peculiarly apt to occur during periods of 
 stress because of the then varying relations of dififerent organs. 
 
 During the first extra-uterine period of stress, between birth 
 and three months, the brain is one-fifth the weight of the body, 
 while in the adult it is but one-thirty-lhird. During the first 
 six months the brain doubles in weight. The efifects of stress 
 during this period would, under the law of economy of growth, 
 either be felt in diminution of the quality or quantity of the 
 brain or in the preservation of these at the expense of more 
 transitory structures. Here the teeth, alveolar process and jaws 
 would be affected. During the period between two years and 
 six the same factors to a lesser degree are present, while between 
 seven and fourteen the brain has quadrupled in weight. At 
 birth the heart is small relatively to the arterial system, but this 
 disproportion gradually disappears until at puberty, when, 
 according to Beneke, the relation is changed. The larger the 
 heart relatively to the vessels the higher the blood pressure and 
 the earlier, stronger and more complete is the development of 
 puberty. The weight of the heart from birth onwards, increases 
 twelve and a half times. During this period, strain interfering 
 with heart growth would either afifect it or under the law of 
 economy of growth, the more transitory structures for its benefit. 
 
 To a certain extent, as DeMoor^^ remarks, periods of stress 
 resemble ancestral stages. Moreover, when there is a recapit- 
 ulation of ancestral stages it often happens that evolution takes 
 place without leaving traces of the various stages. This is 
 especially the case in complex organs which have been produced 
 by many lines of evolution converging in a single structure — a 
 structure which, thus becomes the seat of a special function or set 
 of functions. 
 
 The neuron, for instance, the ganglionic cell of the cortex 
 of the human brain, passes successively through stages corre- 
 sponding to those which are to be foiuid in the adult fish, frog, 
 bird and mammal. Here development consists in an increasing 
 
 ^* Untersuch. zur Physiol. Morphologic. 
 1^ Evolution by Atrophy. 
 
POST- N AT A r, SKUI.L AND | A W I )i:V l.l.ol'M I'.NT. 
 
 39 
 
 complexity of the cell with no foimatiou of unnecessary rudi- 
 mentary parts. This is also the case when the development of 
 the brain of man is compared with the probable ancestral stages 
 as displayed in the vertebrate scries. 
 
 In Fish and 
 Batrachia 
 
 In Reptiles 
 
 In Mamm; 
 
 In the same 
 
 mammals 
 even of high- 
 er orders (e. 
 
 g., some 
 Hapalidae). 
 
 TIk' cerebral hemispheres In the liuman Same 
 do ncil cover the region of embryo of aspects, 
 
 tlie tbinl ventricle (Thala- the seventli 
 menceplialon) from which week. 
 
 the eyes arise. 
 
 'I'he henn'sphercs cover 
 the tliahimencephalon but 
 leave uncovered tlic region 
 of tlie optics lobes (mesen- 
 cei)ha]on ). 
 
 The !icniis]iheres cover 
 the thalaniencephalon, the 
 mesencephalon, sometimes 
 the mctcncephalon (cerebel- 
 lum and medulla), and the 
 olfaclorv lobes. 
 
 Tl 
 
 hemispheres are 
 smooth. 
 
 In the human Same 
 
 embryo of 
 the middle of 
 the third 
 month. 
 
 In the human 
 
 embryo of 
 
 the fifth 
 
 month. 
 
 aspect. 
 
 Same 
 aspect. 
 
 In the human Same 
 embryo of asnect. 
 
 the middle of 
 the fifth 
 month. 
 
CHAPTER V 
 
 DEVELOPMENT OF THE CRANIUM AND FACE. 
 
 The human skull has a double origin. There are really two 
 skulls (one inside the other). These were originally distinct, 
 but in the process of evolution the union between them became 
 more and more intimate. This development is summed up in 
 the changes which embryologically occur in man.^ The primary 
 skull, as I have elsewhere pointed out,^ is practically an exten- 
 sion of the vertebrae, which send out sidegrowths to cover the 
 brain as the backbone covers the spinal cord. The primary 
 skull extends in front of the notchord (the spinal cord of the 
 human embr}-© and the permanent spinal cord of the lancelet), 
 where it gives ofif two trabeculse cranii (front skull plates). Be- 
 hind, the primary skull or chondrocranium gives ofif two occip- 
 ital or rear skull plates. It also gives ofif two plates (midway 
 between the trabeculae and occipitals), which, as they gradually 
 enclose the primitive hearing apparatus (the otocysts, perma- 
 nent in fish and embryonic in man), are called periotic capsules. 
 This primary skull is at first cartilaginous, as in sharks. With 
 increase in the size of the brain in evolution and in human em- 
 bryolgeny this cartilaginous primary skull becomes insufificient 
 to roof over the brain and thus produces the gaps called fonta- 
 nelles (or soft places at the top. sides and back of the head of the 
 new born child). These are the results of this failure of ihe 
 chondrocranium (primary skull) to cover the gains of the nerv- 
 ous system in the struggle for existence. This deficiency, result- 
 ant on advance in evolution, would have been a long-standing 
 serious block to further advance were it not that the skin of the 
 mammal retained a bone-making function inherited from the 
 reptiles and bony fish. 
 
 These cavities were filled with dermal bones which, at first 
 serving merely as armor in the skin of the head, came ultimately 
 
 1 Minot Embryology, pages 465-467. 
 ' Degeneracy Op. Cit. 
 
 40 
 
DKVEI.OPMKNT OF THE CRANIUM AND FACE. 41 
 
 to be protectors of the nervous system. The following bones 
 represent these dermal bones in the embryonic human skull : 
 The frontals, whose sutures normally disappear in the adult so 
 that the forehead seems to be but one bone. This union may not 
 occur, when as in the case of the philosopher Kant, the frontal 
 suture remains during life. The sutures arc replaced by solid 
 Iwnc through synostosis. In the frontal bone, synostosis is nor- 
 mal and in the line of advance. Elsewhere in the skull it is often 
 an expression of a premature senility that may give rise to 
 various cranial states either absolutely degenerate in type or 
 degenerate only when present in certain races. The parietals 
 and interparietals are dermal bones so united l)y synostosis as to 
 form the parietals or side bones of the normal adult skull. The 
 nasal bones, which, together with the vomer, form the nose, are 
 likewise dermal bones and so are the pterygoids and palatines. 
 The maxillaries and pr?emaxillaries, which (with the mandibles) 
 form the jaws are dermal bones. The mandibles are in part 
 derived from the chondrocranium. 
 
 Owing to the head bend of the embryo the mouth cavity, as 
 Minot remarks, is brought between the forebrain and the heart 
 and upon the ventral surface. The development of the face 
 depends upon the enlargement and fusion of the mouth and nose 
 cavities, and upon the later partial separation of the nose and 
 mouth and nose cavities, leaving the posterior nose open. It 
 depends further upon the growth and specialization of the face 
 region, of which elongation is the most prominent indication, 
 and finally upon the development of a prominent external nose. 
 When the medullary tube of the notochord enlarges to form the 
 brain, the end of the head bends over to make room for that 
 enlargement. The bending of the head carries the mouth plate 
 (which is to be the mouth) over to the front of the head. Two 
 changes which develop the mouth cavity are the growth of the 
 brain and the increase in size of the heart cavity, which expand 
 to the front, leaving the mouth cavity between them. The mouth 
 cavity represents two gill-slitts united in the front line. The 
 nose is formed from two olfactory plates situated just in front 
 of the mouth and in contact with the forebrain. These olfactory 
 plates grow in size by the increase of tissue and the resulting 
 
42 IRREGULARITIES OF THE TEETH, 
 
 pits pass away from the brain. At first these pits (although 
 widely separated by what is called the nasal process) communi- 
 cate freely with the mouth. The nasal process includes the 
 origin of the future nose and of the future intermaxillary region 
 of the upper lip. 
 
 The nasal pits proper are developed by the upgrowth of the 
 ectoderm and mesoderm, around the olfactory plate. The up- 
 .growth takes place on the medial, upper and. lateral side of each 
 plate, and hence forms two pits with a partition (the future nasal 
 septum) between them. These nasal pits communicate along 
 their whole lower side directly with the mouth cavity. The 
 nasal pit is at first very shallow. In their growth there are two 
 principal changes : First, growth of the tissues occurs around 
 the olfactory plate, and then the pits migrate away from the 
 brain. The nasal pits are separated by a projecting mass of 
 tissue called the nasal process, which includes the partition 
 between the two nasal chambers, the outline of the future nose 
 and of the future intermaxillary region of the upper !ip. The 
 maxillary process extends between the mouth and eye toward 
 the nasal pit and by joining the rounded end of the nasal process 
 begins the separation of the nasal and butcal chambers and 
 completes the upper border of the mouth. As development pro- 
 ceeds, the lateral ridge grows forward and covers in the nasal 
 pit from the side forming the outline of the wing of the adult 
 nose. There are now two external nares. The nasal chambers 
 enlarge as the whole face enlarges and occupy an increasing 
 space opening widely into the mouth cavity above the palate 
 shelf. It is from the nasal pit proper that the so-called labyrinth 
 of the nose is formed. The development of the labyrinth begins 
 with the appearance (during the third month of embryonic life) 
 of three projecting folds on the lateral wall of each nasal cham- 
 ber. These folds are the upper, middle and lower turbinal folds. 
 They very early contain cartilage. The formation of labyrinth 
 advances by formation of outgrowths, which become the eth- 
 moidal sinuses, by the appearance during the sixth month of the 
 antrum Highmorii or expansion of the nasal cavity into the 
 region of the superior maxillary and finally by evaginations to 
 form the sphenoidal and frontal sinuses, which, however, do not 
 
DEVELOPMENT OF THE CRANIUM AND FACE. 43 
 
 arise in man until after birth. \he separation of the olfactory 
 plate from the brain does not take place until the olfactory 
 ganglion develops from the epithelium. The fibers lengthen, 
 the olfactory and neural epithelium separate and finally the osse- 
 ous cribriform plate is developed between them. 
 
 'Jlie external nose develops toward the end of the second 
 month of embryonic life by a growth of the nasal process. It is 
 at first short and broad, having (at the third month of embryonic 
 life) very nearly the shape which is permanent in certain negro 
 races. The external nares and wings of the nose are carried 
 forward with a general nasal upgrowth. 
 
 As soon as the external nose is separated from the mouth 
 there is a partition between the nasal pits and the mouth. The 
 partition in which the intermaxillary bone is differentiated later, 
 is supplemented by another partition, the true palate, which 
 shuts off the upper part of the mouth cavity from the lower, thus 
 adding tlic upper part to the nose chambers. The palate is a 
 secondary structure which divides the mouth into an upper res- 
 piratory passage and a lower lingual or digestive classes. The 
 palate arises as two shelf-like growths of the inner side of each 
 maxillary process, and is completed by the union of the two 
 shelves in the median line. These so arch as to descend a certain 
 distance into the pharynx. In the pharynx, however, their 
 growth is arrested, though they may be still recognized in the 
 adult. In the region of the tongue, which includes more than 
 the primitive mouth cavity, the palate shelves continue growing. 
 At first they project obliquely downward toward the floor of the 
 mouth and the tongue rising between them seems in sections, 
 which pass through the internal nares, to be about to join the 
 internasal septum. As the lower jaw grows, the floor of the 
 mouth is lowered and the tongue is thus brought further away 
 from the internasal septum. At tjie same time the palate shelves 
 take a more horizontal position and pass toward one another 
 above the tongue and below the nasal septum to meet in the 
 middle line, where they unite. From their original jiosition the 
 shelves necessarily meet in front toward the lip first, and unite 
 behind toward the pharynx later. In the human embryo, union 
 begins at eight weeks and by nine weeks is completed for the 
 
44 IRREGULARITIES OF THE TEETH. 
 
 region of the future hard palate and by eleven weeks for soft also. 
 The palate shelves extend back across the second and third 
 branchial arches. The uvula appears during the latter half of the 
 third month as a projection of the border of the soft palate. Soon 
 after the palatal shelves have united with one another, the nasal 
 septum unites with the palate also, and thereby the permanent 
 or adult relations of the cavities are established. 
 
 The fact that the human face is modified backward from 
 the vertebrate type excellently illustrates the degeneracy of a 
 series of related structures for the benefit of the organism as a 
 whole. The progress of development of the vertebral face is 
 checked in man because, as Minot remarks, the upright position 
 renders it unnecessary to bend the head as in quadrupeds, and 
 because the enormous cerebral development has rendered an 
 enlargement of the brain cavity necessary. This has taken place 
 by extending the cavity over the nose region as well as by 
 enlarging the whole skull. Third, because development of the 
 face is arrested at an embryonic stage. The production of a long 
 snout is really an advance of development, which does not occur 
 in man. 
 
 Upon variations in th-e dermal bones depend not only the 
 race variations in skull and jaw types but also the variations 
 produced by agencies acting on the individual during the periods 
 of bodily stress and by the degenerative influences. 
 
 Craniologists generally assume two fundamental skull types, 
 dolichocephalous or long horizontally, that is, from back to front, 
 and the brachycephalous or approximately round horizontally. 
 The types are determined by the so-called cephalic index, which 
 is determined by the relation of the antero-posterior diameter 
 (measured from the glabella to the farthest point of the occiput) 
 to the transverse diameter from side to side.^ The former being 
 taken at lOO, the latter will range from about 60 to 95 or even 
 more, increasing with the greater degree of brachycephaly and 
 vice versa. Excluding artificial deformation, the extremes appear 
 to lie between 6i'9 (Fijian, measured by Flower) and 98.21 
 fa Mongolian, described by Huxley). This last approaches the 
 perfect circle, which is never presented by the normal head, 
 
 3 Keane Ethnology. 
 
DEVELOPMENT OF THE CRANIUM AND FACE. 45 
 
 though exceeded (103-105) by pathologic, teratologic or 
 deformed specimens. Most peoples are now mesaticephalous and 
 hence of mixed descent. This race intermingling began in 
 neolithic times. Speaking broadly, the horizontal index is now 
 applicable less to the primary than to the secondary divisions of 
 mankind. The alleged normal dolichocephaly of African Negroes 
 has numerous exceptions. The Eskimo, who seemingly ought 
 to be brachycephalic are extremely dolichocephalic. 
 
 To meet the endless transitions between the two extremes 
 Broca proposed the following five-fold division : 
 
 1. Dolichocephali with index No. 75 and under. 
 
 2. Sub-dolichocephali with index No. 75-10 to 77.77- 
 
 3. Mesaticephali with index No. 77-78 to 80. 
 
 4. Sub-brachycephali with index No. 80.10 to 83.83. 
 
 5. Brach.vcephali with index No. 83.34 upwards. 
 
 Under this classification races may be ranged thus : 
 
 I. DOLICHOCEPHALI. 
 
 Kai-Colo (mean) 65 Neanderthal 72(?) 
 
 Australian 71-49 Hottentot and Bushman 72.43 
 
 Eskimo (Greenlander) 71-77 Kaffir 72-54 
 
 W. African Negro 73-40 Low-Caste Calcutta 74-17 
 
 Cro-Magnon 73.34 Berber 74.63 
 
 Nile Nubian 1Z7^ Langerie Basse 74-85 
 
 Algerian Arab 74-o6 Baumes Chaudes (Lozero) . . 75 
 
 2. SUB-DOLICHOCEPHALL 
 
 Dolmens N. of Paris 75-01 Anglo-Saxon 76.10 
 
 Guanches (Canaries) 75-53 Polynesians (some) 76.30 
 
 Old Egyptians 75-78 Copts (Modern Egj-ptians) . . 76.39 
 
 Ainus (some) 76 Basques of Guipuzcoa 77.62 
 
 Tasmanians 76. 1 1 Chinese 77.60 
 
 3. MESATICEPHALI. 
 
 Ancient Gauls 78.09 Hawaiians 80.0 
 
 Mexicans (normal) 78.12 Afghans 79 to 80 
 
 Dutch 78.89 Ossetians 80.0 
 
 Prussians 78.90 Petit Morin (Marne and 
 
 others from Neolithic 
 
 caves and dolmens 80.0 
 
 S. Americans 79- 16 
 
 N. Americans 79-25 
 
46 IRREGULARITIES OF THE TEETH. 
 
 4. SUB-BRACHYCEPHALI. 
 
 French Basques 80.25 Italians (North) 81.80 
 
 Low Bretons 81.25 Andamanese 81.87 
 
 Mongols (various) 81.40 Finns 82.0 
 
 Turks (various) 81.49 Little Russians 82.03 
 
 Javanese 81.61 Germans (South) 83.0 
 
 5. BRACHYCEPHALL 
 
 Indo-Chinese , . . 83.51 Burmese 86 
 
 Savoyards 83.63 Armenians 86.5 
 
 Croatians 84.83 Solutre 88.26 
 
 Bavarians 84.87 Peruvians 93.0 
 
 Lapps 85.07 Huxley's Mongol 98.21 
 
 Some value has jjcen attached to the vertical index (high and 
 broad) which, when it rises to or exceeds 100 determines the 
 so-called hypsistenocephaly characteristic of the Maliclos and 
 other Melanesians. 
 
 No cranial measurement is more important than that which 
 determines the varying gnathism or greater or less projection of 
 the upper jaw, which depends upon the angle made by the 
 whole face with the brain cap. The more obtuse the angle the 
 greater will be the maxillary projection (Prognathism), the more 
 vertical the face the less the projection (Orthognathism) : Hence 
 gnathism (best seen in profile) as indicated by the facial angle, 
 is accepted by anthropologists as a race criterion. Its evo- 
 lution (intimately associated with the dentition and change from 
 raw to cooked food) has been from the extreme projection of the 
 higher apes and of primitive man to the seemingly vertical posi- 
 tion of the Mongolic and Caucasic groups. Prognathism is, 
 hence, characteristic of the lower orthognathism of the higher 
 races. The profile of the Calmuck face is almost vertical, the 
 facial bones being thrown downwards and under the forepart of 
 the skull. The profile of the face of the negro is differently 
 inclined ; the front part of the jaws projecting far forward beyond 
 the level of the fore part of the skull. In the former the skull 
 is orthognathous or straight-jawed, in the latter it is prog- 
 nathous. 
 
 Combining this feature with eurygnathism (that is lateral 
 projection of the cheek bones) Geoffrey Saint-Hilaire found that 
 the Caucasic face is oval with vertical jaws, the Mongolic broad 
 
DEVELOPMENT OK THE CRANIUM AND FACE. 47 
 
 (eurygnathous), the Negro prognathous and the Hottentot both 
 pro- and eurygnathous. 
 
 Topinard distinguishes between a superior and anterior facial 
 angle. The former (general facial gnathism) is fallacious as a 
 guide. The latter (that is sub-nasal gnathism) being trust- 
 worthy. Anthropologists have erred in giving so much im- 
 portance to the projection of the whole maxilla or of the whole 
 face. There is no uniformity of results in any given series. The 
 most flagrant contradictions occur between averages in allied 
 races. Sub-nasal or true prognathism, however, furnishes of 
 itself the dilTerential character of the various human types. Sub- 
 nasal gnathism is determined by the angle formed by a line 
 drawn from the nasal spine (sub-nasal point) to the anterior 
 extremity of the alveolo-condylean plane. This plane, which 
 gives the total projection of the skull, is about parallel with the 
 horizontal line of vision coinciding with a line drawn from the 
 alveolar point (medium point of the alveofar arch) at right angles 
 to a perpendicular falling from the occipital condyles. Topinard 
 has had the following results : 
 
 TRUE OR SUB-NASAL PROGNATHISM. 
 
 Individual extreme? 891051.3 Merovingians 76-54 
 
 White races 821076.5 Finns and Esthonians 75-53 
 
 Yellow races 76 to 68.5 Tasmanians 75-28 
 
 Black races 69 to 59.5 Tahitians 75 
 
 Gaunches 81.34 Chinese ^2. 
 
 Corsicans 81.28 Eskimo 71-46 
 
 Gauls 80.87 Malays - 69-49 
 
 Dead Man's Cave 79-77 New^ Caledonians 69.87 
 
 Parisians 78. 12 Australians 68.24 
 
 Toulousians 78.5 W. African Negro 66.91 
 
 Auvergnats 77- 18 Namaquas and Bushmen .... 59.58 
 
 From this it is evident that absolute orthognathism does 
 not exist. All races are more or less prognathous, the European 
 least, the Negro most, the Mongol and Polynesian intermediate. 
 In Europe the most orthognathous were the Gauls, Corsicans 
 and Neolithic men. The Finns were the least. Orthognathism, 
 as the term is used in anthropology, simply applies to the sub- 
 nasal type of gnathism. In teratology, the relation of the inferior 
 maxilla must likewise be taken into consideration, since around 
 this turns the struggle for existence between the jaws and teeth. 
 
CHAPTER VI. 
 
 DEVELOPAIEXT OF THE JAWS. 
 
 The vertebrate mouth belongs primitively on the under side 
 of the head and is at first a simple transversely expanded orifice. 
 The position of the face or oral region is, as already shown, 
 originally determined by the head bend. The embryologic rela- 
 tionships of the mouth area and the hypophysis already cited 
 serve to explain why constitutional disorders and infectious dis- 
 ease influence growth and development of the maxillae, especially 
 the lower. The changes about the face so common and char- 
 acteristic of acromegaly are extreme illustrations of this. 
 
 To determine the nature of the evolution resultant on these 
 influences and others found in the jaws of modern races, I made 
 numerous measurements (Table I) anent these changes. The 
 measurements of early as well as modern peoples were made 
 on skulls obtained from the museums and crypts of churches 
 in Europe, in which last large collections of skulfs are found. 
 
 Measurements were made across the upper jaw from the 
 outer surface of one first molar to the outer surface of the cor- 
 responding molar of the other side (Fig. 2). These points were 
 
 48 
 
DKVKiroi'.MKN r OF Mil. JAWS. 49 
 
 taken because these molars are first of the permanent set to 
 develop, hence because developing posterior to the temporary 
 ones, they erupt independently and are not interfered with by 
 any in the jaw. The point of the jaw where these teeth are 
 situated is the widest normally developed not influenced by local 
 causes. This furthermore was most accessible. Measurements 
 were made in persons over twenty-five years of age, because at 
 or near this period growth is complete. After this period devel- 
 opment is very slow. At thirty to thirty-five years it ceases alto- 
 gether. 
 
 From analysis of these measurements of crania and living 
 individuals, which have extended over years, the human jaw is 
 clearly diminishing in size as the usual control experiments were 
 made to eliminate error. 
 
 Differences in measurements of the antero-posterior and lat- 
 eral diameter resulted since in many cases the antero-posterior 
 diameter was taken from the first and second molars instead of 
 from the third. y\ll such measurements were rejected. 
 
 • Diameter of the jaw, hence, depends to a great extent upon size 
 of the skeleton. A small person usually has a small jaw, a large 
 person a large jaw. Exceptions, however, occur. Small people 
 with large jaws and large people with small jaws are frequently 
 observed in limestone countries, from resultant excessive or 
 arrested development of the maxillae. Alarked sexual differ- 
 ences occur. Difference (ranging from .02 to .16 of an inch) 
 occurs in living individuals and in ancient races. 
 
 The lateral diameter of jaws of existent races in Europe 
 is greater than of the same races in America. The jaws of Amer- 
 ican Indians are much larger than jaws of American Europeans. 
 The jaws in older parts of the United States are smaller than 
 jaws in the newer. The differences between jaws of the residents 
 of Boston and those of Chicago are thus in evidence. 
 
 Alarked differences usually exist between jaws of dispensary 
 and charity patients and jaws of the wealthier classes. 
 
 In Chinese jaws the range is only from 2 to 2.44, with one 
 measurement at 2.52; peoples of India, 1.94 to 2.37; Negro, 2.07 
 to 2.50; Marshpee Indians, 2-to 2.50. In Swedes the range is 
 from 1.88 to 2.63, and in the Danish colony, Dublin, from 1.88 
 
50 
 
 IRREGULARITIES OF THE TEETH. 
 
 to 2.50; in London, from 1.88 to 2.44, while the range of the 
 white people in America is from 1.75 to 2.63. The diminution 
 of the jaws is evident on comparison of measurement of the jaws 
 of the same peoples at different periods of culture. The jaws of 
 primitive races are larger than those of the civilized. 
 
 In most cases, size and shape of the jaws are commensurate 
 with the osseous structure of the individual. Bushmen (small 
 in stature) present the smallest range in the size of the jaws — 
 2.12 to 2.37 inches. 
 
 The range of ancient races is 2.12 to 2.62 inches, while that 
 of modern is 2.12 to 2.87 inches. Only three modern races. 
 
 Fig. 3. 
 
 however, have a minimum of 2.12, while the minimum of all 
 ancient races is 2.12 inches. The maximum of ancient races is 
 less than that of the modern. 
 
 The anterior posterior diameter is from the alveolar process 
 at a point between the central incisors extending backward in 
 the median line and meeting a line drawn at right angles to the 
 posterior surface of the third molar (Fig. 3). 
 
 The principle holds good for the development of the antero- 
 posterior diameter as laid down for the lateral diameter. The 
 antero-posterior diameter of the jaws of the female is less than 
 that of the male by from .02 to .24 of an inch. This disparity 
 compared with that of the lateral diameter is a natural one. After 
 
pKVKI.Ol'MKNT OK THK JAWS. 51 
 
 temporary teeth are all in place natural development of the jaw 
 is in an antero-postcrior direction. The changes in evolution 
 of the face and jaws consist of shorlenins;- of the antero-postcrior 
 diameter. Marked difYcrences arise often from the entire arrest 
 of development of the jHisterior part of the body of the jaw. 
 This always occurs when ])crmanent molars have been extracted, 
 allowing" the third molar to come forward, or when the indi- 
 vidual has' inherited the large jaws of one parent and the small 
 teeth of the other parent, or when the jaws have become arrested 
 in development. In comparing antero-posterior diameter of the 
 jaws of one people with those of another skull characters must 
 be taken into consideration. In brachycephaly occurs the broad . 
 jaw and in dolichocephaly the long jaw. This difference occurs 
 chiefly in relatively pure races. It is evident by comparing 
 external condition of the head and skull with the jaws. No 
 type of skull could be determined from examination of a thousand 
 plaster casts of the mouth of mixed classes of people. Local 
 conditions often modify the shape of the jaw of mixed races. 
 Correlation between the shape of the skull and jaw, which occurs 
 in relatively pure races, does not -appear. As the jaw develops 
 from before backward, were it not exercised by mastication or 
 were any permanent teeth extracted or had the third molar failed 
 to appear, the length required would necessarily be much less 
 than that needed by a jaw full of teeth or well exercised. Under 
 the law of economy of growth only the posterior parts of the jaw- 
 actually necessary develop and thus resulted the short lower 
 jaw. 
 
 The jaws of people whose ancestors have lived in the United 
 States show that there is not such a great difference in the width 
 of the jaws. Thus in private patients in Burlington, Vt., Bos- 
 ton and Chicago, there is only about .9 in women and in men 
 about .03. 
 
 By comparing these measurements with those of the ancient 
 Britons made by 1\I nunnery and Coleman there is found a dififer- 
 6nce of about .36. The difiference between ancient Romans is 
 about the same. The difference between the ancient Britons 
 and the English of to-day is about .24 and of ancient Romans 
 and present Italians of Southern Italy, .31. The antero-posterior 
 
52 IRREGULARITIES OF THE TEETH, 
 
 diameter of the present size of the jaws is about as low as the 
 lowest of any of the measurements. 
 
 On comparing measurements of New England stock with 
 those of ancient Britons there is found a difference from .21 to 
 .36, between ancient Romans and New England stock .32. Be- 
 tween the so-called Anglo-Saxons and New England stock, .27. 
 and between New England stock and present English, .09. 
 
 A much greater difference w^ould be evident in the width 
 of the jaws of New England stock and the jaws of early races 
 had the measurement been taken from the first or second 
 bicuspid region since the contraction is anterior to the first 
 permanent molar. 
 
 The wisdom tooth grows smaller with rise in evolution. In 
 the gorilla the third molar is in every respect a well developed 
 tooth sometimes even larger than the first or second molar. 
 Instead of an imperfect crown it has a crown on which the 
 cusps are arranged according to the typical pattern. The wis- 
 dom tooth (in primitive races) has ample space to range with 
 other teeth and is a characteristic molar. In higher races the 
 lower wisdom tooth exceptionally has the four cusps distinctly 
 developed. According to Mummery the third molar among 
 African tribes is always present in the lower jaw. According 
 to Allen the third and fourth molars in Australians often show 
 a tendency to the bicuspid type. Still more marked differences 
 are found between primitive and civilized man than between 
 the primitive man and the mammals. 
 
 The alveolar process is a transitory structure. Bone is rela- 
 tively permanent. The alveolar process depends entirely upon 
 the wedging of teeth against each other for size and shape. 
 In primitive races although the wisdom tooth does not present 
 the variation found in more advanced races still it is far inferior 
 to the teeth of the anthropoid and lower apes. In them is 
 found the primitive indication of degeneracy and subsequent 
 disappearance of this tooth. The tooth in all is, however, as 
 serviceable as other molars. Among monkeys the third molar 
 may be of equal size to the first and second or it may be larger 
 or smaller. 
 
 These teeth according to Charles Darwin are rather larger 
 
DEVELOPMENT OF THE JAWS. 53 
 
 than the other two molars in the orang and chimpanzee. In 
 macaques (Tomes) the third molar is larger than the first two 
 and is quinqnicuspid below and quadriciispid above. In man 
 as a rule, the molars decrease in size from before backward. 
 The first molar is largest while in the anthropoid apes the con- 
 trary is the case. There are, however, notable exceptions ; in 
 the Australian as in the chimpanzee the second and third molars 
 are not smaller than the first. In the anthropoid apes the wis- 
 dom tooth is generally as large as other molars, is not very 
 variable and comes into place almost simultaneously with the 
 canine. The diameter of the jaw is frequently much smaller 
 laterally and antero-posteriorly than the diameter of the teeth 
 and alveolar process. In man's evolution the loss in number 
 of the teeth is not in harmony with the arrest of development 
 of the jaw. 
 
 In the evolution of luan from the extreme dolichocephalic 
 and brachycephalic to the mesophalic skull, there is a natural 
 recession of the jaws in the antero-posterior and lateral direc- 
 tion. 
 
 Disuse of the jaw as a weapon (evident in the large canine 
 of the male anthropoid apes) exercised an influence in reducing 
 the size of the jaw and the teeth. The Neanderthaloid jaw is 
 allied in type to that of the anthropoid apes. The scanty 
 weapons of the Neanderthal man indicates that biting (as among 
 rowdies to-day) played no small part in battle and particularly 
 in duels for female favor. With development of weapons this 
 employment of the jaw rapidly fell into disuse. 
 
 One of the chief factors conductive to arrest of development 
 of the jaws which acts in a three-fold ratio is want of maxillary 
 exercise. This under the law of economy of growth produces 
 the following results : By lack of exercise, blood which nourishes 
 the bones is not carried to the part. Blood does not carry 
 sufficient material to the teeth, hence, the enamel formed is 
 defective as a result early decay occurs. By lack of lateral 
 motion mechanical development of the alveolar process is want- 
 ing. The jaw is steadily growing smaller. Early races lived 
 upon coarse food ; roots, herbs, corn and uncooked meats. 
 Such food required considerable mastication in order to secure 
 
54 IRREGULARITIES OF THE TEETH. 
 
 chemical changes necessary before assimilation. As a result 
 of use the muscles of the jaw were dense and hard. When 
 contraction took place they stood out upon the sides of the 
 head like large cords. The bones were well developed and 
 of dense, hard structure. The processes for the attachment of 
 muscles \vere prominent and large. The teeth were large and 
 deep set in the alveolar process. 
 
 The upper jaw is a fixed bone. The blood supply is small 
 owing to a lack of stimulus from movement, hence, arrest of 
 development is marked. On the other hand from the lower jaw 
 being movable more blood flows to the part which thus 
 becomes increasingly developed. In neurotics and degener- 
 ates the slightest assistance to circulation will cause the lower 
 jaw to become excessively developed. Some dentists miscon- 
 strue this condition and call the procedure for its correction 
 "jumping the bite." 
 
 The teeth upon the upper jaw are more subject to decay 
 than those upon the lower despite the fact that environment of 
 the teeth upon the lower jaw, especially the bicuspids and molars, 
 should render them most subject to decay. Teeth are not 
 equally subject to caries. The upper are more frequently 
 attacked than the lower according to Magitot in the proportion 
 of 3.2 or according to Hitchcock in the ratio of 1.9;! or very 
 nearly two to one. 
 
 Taste has been so far cultivated that it now rcijuircs the 
 skill of cooks to produce dishes free from peculiarities pre- 
 sented in the early days of cooking. Thus all coarseness has 
 been removed from food. Cereals are reduced to the finest 
 flour while the hulls which contain the phosphates essential 
 to bone building and 'necessary for mechanical grinding by the 
 jaw are entirely excluded- — the growing inclination of the 
 race is to use food which requires little if any mastication. A 
 society fad (etiquette in mastication), whereby the lips are closed 
 and the motion of the jaws in chewing is barely perceptible does 
 not conduce to strength and vitality, Imt to atrophy or arrest 
 of development. The evolution of the face from prognathism 
 to orthognathism is thus accelerated. 
 
 When the teeth push their way into place they crowd one 
 
DKVELOPMKN'J' OK THE JAWS. 
 
 55 
 
 another laterally. By so doing the dental arch enlarges and 
 the alveolar process develops and grows about the teeth. The 
 lateral movement of the lower jaw in the act of chewing assists 
 greatly in producing the enlargement. The constant movement 
 of the lower against the upper teeth causes them (in many 
 cases or irregularities) to arrange themselves in their proper 
 places. Thus a want of mastication may cause arrest of devel- 
 opment of the jaw and consequent irregularity of the teeth. 
 
 The jaws and teeth may exist in each parent in perfect 
 symmetry. In one parent the jaws and teeth may be large ; in 
 the other parent small, but each is normal. If now the small 
 jaw of one parent and the large teeth of the other appear in 
 
 Fig. 4. Pig. 5. Fig. 0. 
 
 the offspring deformity is sure to follow. By examining the 
 figures of the dolichocephalic (Fig. 4), Sarmatic brachycephalic 
 (Fig. 5), and the Turanic extreme brachycephalic (Fig. 6) types 
 it will be seen at a glance how entirely different must be the 
 single measurement not only of the skull generally, but the face 
 and particularly the superior maxillary bones. 
 
 Suppose, for example, that a person with one form of cran- 
 ium (Fig. 4) be married to one with another (Fig. 6), perfectly 
 harmonious blending of cranial differences would scarcely be 
 possible, even were both parents in perfect health and were 
 the offspring to remain in perfect health throughout the periods 
 of stress. 
 
CHAPTER YII. 
 
 DE\'ELOPMENT OF THE ALVEOLAR PROCESS. 
 
 The alveolar processes are situated tipon the superior border 
 of the inferior maxilla and upon the inferior border of the 
 superior maxilla. These bones are considered a part of the 
 maxillary bones, and are so described by anatomists. They 
 .'■hould, however, be considered and described as practically 
 separate and distinct bones. Their structure, embryology 
 r.nd functions differ completely from the structure and func- 
 tions of the maxillary bones. The superior and inferior maxillae 
 are (unlike the alveolar processes) composed of hard, compact 
 bone-structure. The large, powerful muscles attached to them 
 indicate that powerful work is to be accomplished. When fully 
 developed they retain their full size through life. The alveolar 
 processes are composed of soft and spongy bone of a relatively 
 cancellous structure. As early as the eleventh week of intra- 
 uterine life, calcification of the deciduous teeth commences, 
 and by the twentieth week calcific material is quite abundantly 
 deposited. Ossification is also rapidly progressing about the 
 dental follicles. At birth the sacs are nearly or quite enclosed 
 in their soft, bony crypts, and the crowns of the teeth upon their 
 outer surface are composed of enamel, which is dense and hard. 
 
 The embryologic phases of the dental shelf elsewhere cited, 
 further illustrate this development. 
 
 The alveolar process, being soft and spongy, molds itself 
 about the sacs containing the crowns of the teeth and about 
 their roots after their eruption, regardless of their position in 
 the jaw. While the alveolar processes' have grown rapidly, 
 they have, up to this time, developed only sufficiently to cover 
 and protect the follicles while calcification proceeds. When 
 the crowns have become calcified and the roots have begun 
 to take in their calcific material, absorption of the borders of 
 the processes takes nlace in the order of the eruption of the 
 teeth. When the teeth have erupted, the alveolar process devel- 
 ops downward, and iioward wi'.h the leeth until it attains 
 
 56 
 
DKVKLOPMKNT OF THE ALVEOLAR PROCESS. 
 
 57 
 
 the depth of the roots of the teeth, which extend in most 
 instances into the superior maxillary bone, in the anterior part 
 of the mouth at least and the upper and lower teeth rest at a 
 ])oint in harmony with the rami. The depth to which they 
 penetrate the bone differs in different mouths. This depends 
 upon the length of the roots and the alveolar process. This in 
 turn depends upon the length of the rami. The incisive fossa, 
 the canine eminence and the canine fossa give evidence of this 
 externally. These sockets are Hned with extensions of the pro- 
 cess, thus making its upper border irregular. The fact that some 
 of the teeth are fixed in the bone as well as in the alveolar process 
 makes the correction of some forms of irregularity more difficult, 
 for not only does the process have to be reshaped, but the bone 
 as well. This is quite noticeable in correcting irregularities 
 
 Fig. 7. 
 
 (jf the teeth in the lower maxilla. The crypts of the permanent 
 teeth are located at the apices of the roots of the temporary 
 teeth. The permanent teeth have large crowns which touch 
 each other, forming a line to the posterior part of the jaw. 
 These teeth, as they erupt, entirely absorb the alveolar process 
 which surrounded the temporary teeth, and, as the new set come 
 into place, a new process is built up about them for their sup- 
 port. The permanent teeth require a deeper alveolar process 
 to support their roots, which are much longer than those of 
 the temporary teeth. Hence the difference in the depth of the 
 vaults of the first and second sets of teeth. 
 
 The alveolar process of each superior maxilla includes the 
 tuberosity, and extends as far forward as the median line of 
 the bone, where it articulates with the process upon the opposite 
 
58 IRREGULARITIES OF THE TEETH. 
 
 side. It is narrow in front, and gradually enlarges until it 
 reaches the tuberosity, where it becomes rounded. 
 
 If the two articulated superior maxillary bones be exam- 
 ined it will be seen that the anterior part is curved, while 
 the posterior part gradually diverges from the central line 
 of ossification of the maxillary bones. The shape varies in 
 different individuals. Some arches are small and others large ; 
 the arch is parabolic in some cases and circular in others. 
 
 The process is composed of two plates of bones, an outer 
 and an inner, which are united at intervals by septa of can- 
 cellous tissue. These form the alveoli for the reception of the 
 roots of the teeth. In some cases the buccal surfaces of the roots 
 of healthy teeth extend nearly or quite through the outer bony 
 plate and are covered only by the peridental and mucous mem- 
 branes. 
 
 This plate is continuous with the facial and zygomatic sur- 
 faces of the maxillary bone. The inner plate is thicker and 
 stronger than the outer, and is fortified by the palate bones. 
 The external plate is irregular upon the outer surface, prom- 
 inent over the roots of the teeth, and depressed between the 
 roots or interspaces. 
 
 The prominence over the canine teeth, called the canine 
 eminence, is very marked, and decidedly modifies the expres- 
 sion of the face. The sockets of the central incisors are conical 
 and round; those of the lateral incisors conical and slightly flat- 
 tened upon their mesial and distal surfaces, and not so large 
 as the central sockets. 
 
 The pit for the cuspid is conical and much larger than any 
 of the other sockets. The sockets for the bicuspids are flat- 
 tened upon their anterior and posterior surfaces, and near the 
 apex they are frequently bifurcated. The sockets of the molars 
 are large at the openings, but at about the middle of their 
 length they are divided into three smaller sockets for the recep- 
 tion of the roots. In the case of the third molar the number of 
 sockets ranges from one large cavity to three or four of smaller 
 size. 
 
 The alveolar process of the inferior maxilla extends from 
 the ramus of one side to the same point on the other. The 
 
DEVELOPMENT OF THE ALVEOLAR PROCESS. 59 
 
 outline is similar to that of tlic superior process, the anterior 
 portion being much thinner. 
 
 The description given of the structure of the superior process 
 applies also to the inferior. The outer plate of bone opposite 
 to the molars and bicuspids is thicker than the inner plate, while 
 the inner plate opposite the canines and incisors is thicker than 
 the outer. 
 
 The alveoli arc arranged along the Ijurder of the bone for 
 the reception of the roots of the teeth. They correspond in 
 form to the roots which they acconnuodate. The alveoli fOr 
 the central incisors are smaller than those for the lateral. They 
 are conical in shape, and flattened upon their mesial and distal 
 surfaces. Those for the lateral incisors are larger, and com- 
 pressed on their mesial and distal surfaces. The sockets, for 
 the canines, cuspids, or stomach teeth, are larger, deeper and 
 less compressed than those for the incisors. 
 
 The sockets of the bicuspids are considerably flattened 
 upon their lateral surfaces, and are sometimes divided into two 
 cavities. The sockets for the anterior roots of the molars are 
 broad and flattened laterally, while those for the posterior roots 
 are round. The third molar, being naturally of variable form, 
 has sometimes one pit, and again three or four. Each alveolar 
 pit or socket is divided from its neighbor by a small wall or 
 septum, which is made up of cancellated bone, extending about 
 one-eighth of an inch above the inner and outer plate. 
 
 The dental septa assist in keeping the teeth firmly in their 
 places. The septa are very thin at the margin, and gradually 
 increase in width to the middle of the jaw. where they become 
 thicker, and are finally lost in the substance of the jaw. Some 
 septa are thicker than others, and where two teeth 'are widely 
 separated, the width of the repta naturally corresponds to the 
 space between the teeth. 
 
 In the evolution of the jaws with arrest of development, 
 there is. in most cases, a high vault. This new condition tends 
 to lengthen the alveolar process. It becomes much thinner. 
 What is true of the change in the size of the jaws and the alveolar 
 process is also true in respect to the shape of the crowns of 
 the teeth, \\'hile they are not growing smaller in proportion to 
 
60 
 
 IRREGULARITIES OF THE TEETH. 
 
 the size of the jaws, they are changing shapes. Once they 
 were relatively bell shaped, giving considerable space between 
 the roots for a thick alveolar process, thus rendering support 
 to the peridental and mucous membranes, now the shape has 
 changed. The proximal surfaces are almost straight, lessen- 
 ing the width and thus allowing only for a thin septum, with 
 barely sufficient surface to support the tissues. 
 
 The sockets are lined with a thin plate of compact bony 
 substance, extending from the outer and inner plate of the 
 alveolar process to the apex, where there are small openings 
 for the entrance of nerve and blood-vessels for the nourish- 
 ment of the teeth. 
 
 
 k4- 
 
 J 
 
 
 
 Fig. 8. 
 
 This bony plate has upon its inner surface the elastic peri- 
 dental membrane, which acts as a cushion for the teeth, while 
 upon the inner surface it is surrounded by spongy bone. 
 
 The teeth are held firm in their alveolar sockets by a union 
 called gomphosis, which resembles the attachment of a nail in 
 a board. Teeth with one conical root, and those with two or 
 more perpendicular roots, are retained in position by an exact 
 adaptation of the tissues. Teeth having more than one root, 
 and those bent or irregular, receive support from all sides by 
 reason of their irregularity. The teeth are also held in position 
 by the peridental mernbranes. In Fig. 8 is seen the position of 
 
DEVF.LOPMENT OF THE ALVEOLAR PROCESS. 
 
 ()1 
 
 ihc teeth in the jaws, 'ihe peridental nienihrane which hnes 
 the alveohLs and eovers the roots of the teetli is a fibrous tissue, 
 that achnits of shs^ht nu)tion of the teeth, and acts as a cushion 
 to protect the jaws from sexere l)h)\vs and concussions while 
 tearing' and j^rindint;- iood. 
 
 After renunal of the permanent teeth the alveolar process 
 is entirely ahsorl)ed. In l'"i^'. t) is shown lu)w absorption takes 
 place. The teeth have all been removed from the superior 
 maxilla, as has also the alveolar process. The molars on the 
 lower jaw have ben extracted, and absorption of the alveolar 
 process has resulted, showing a marked contrast in conection 
 with the anterior alveolar process, which remains intact and 
 
 Fig-, i). 
 
 holds the teeth firmly in place. It is evident, from the changes 
 which occur from the first development of the teeth to their 
 final extraction, that the alveolar process is solely for the pur- 
 pose of protecting the teeth in their crypts during development 
 and after eruption. When the temporary teeth are in place the 
 alveolar process remains unchanged (except a gradual enlarge- 
 ment in harmony with the growth of the maxillary bones) 
 until about the sixth year, wdien the second set of teeth appears. 
 The crowns of the permanent teeth require more space than 
 those of the temporary set ; and the alveolar process must 
 necessarily enlarge to accommodate them. This enlargement 
 of the alveolar process is caused by the formation of the crowns 
 
G2 
 
 -Ari 
 
 'h. 
 
 irregulAritpes of the teeth. 
 
 of the permanent teeth before eruption, and to a Hmited extent 
 by the growth of the maxillary bones, which may cease develop- 
 ing at any period of life, or continue to develop as late as the 
 thirty-sixth year. The diameter of the crowns of the permanent 
 teeth forming a larger circle than that of the maxillary bones, 
 the alveolar process must necessarily increase its diameter. It 
 is often forced outside' of the superior maxilla by the crowns 
 of the permanent teeth crowding and wedging themselves into 
 positions anterior to the first permanent molar teeth. This 
 enlargement of the alveolar process usually takes place anterior 
 to the first permanent molars. The process corresponds in size 
 to the jaws. In Fig. lo shows a superior maxilla, comparatively 
 
 Fig. 10. 
 
 small in proportion to the inferior. This is the result of arrested 
 development, the arrest including the bones of the face. To 
 allow for the defficiency in bone-structure, and to allow the 
 upper teeth to extend over the lower, the upper teeth have 
 forced the alveolar process forward. The space shows where 
 a tooth was extracted after all the teeth were in position. The 
 teeth of to-day have not varied in size in proportion to the jaws. 
 To compensate for this difference, the alveolar process has to 
 expand, or enlarge, to allow the teeth to come in evenly. If 
 the teeth antagonize uniformly the arch will enlarge around 
 evenly. If the molars are fixed the alveolar process will expand 
 
DKVKLOl'MKNT OK THK ALVKOl.AR PROCESS. 
 
 63 
 
 anteriorly. If the teeth shouhl not aniaj^onize evenly, a break 
 will take plaee at that point, pnxincin^- a \' or saddle arch. 
 
 In Fig. 9 all the npper teeth have been removed and absorp- 
 tion has entirely obliterated the alveolar process. The relations 
 of the superior maxillary bones to the alveolar process and 
 teeth on the lower jaw are well illustrated. When the alveolar 
 process and teeth were intact they presented an appearance 
 seen in Fig. lO. 
 
 The position and shape of the processes and their relation 
 to each other are governed entirely by the location and size 
 of the teeth and roots, and not by the shape of the jaw-bone 
 proper. The dental follicles containing the crowns may be 
 located upon the outer border of the jaw-bone on one side, in 
 
 Fig. n. 
 
 which case the alveolar process will be situated upon the outer 
 border, and assume an irregular arch. If the crowns of the 
 teeth are located upon the inner border, or if one jaw be smaller 
 than the other, the teeth \\ill articulate and the process will 
 form a smaller circle than the jaw-bone proper. Such a case 
 is illustrated in Fig. 1 1 . The superior maxilla is much larger 
 than the inferior, and, as a result, the articulation of the teeth 
 and the muscles of the cheeks and lips have carried the teeth 
 and alveolar process on the upper jaw inward. The teeth on 
 the lower jaw are regular and appear to have sufficient room, 
 while those upon the upper jaw are crowded and overlap each 
 other. The teeth on the left side of the upper jaw are more 
 
64 
 
 IRREGULARITIES OF THE TEETH. 
 
 regular than those on the right side. Upon examining the 
 mouth, or model, the arch on the left side will be found full 
 and regular, while the arch upon the right side has a perfect 
 semi-V-shape. 
 
 The alveolar prQcess on the right side extends consider- 
 ably over the border of the maxillary bone, and the teeth 
 (especially the cuspid) have taken quite an incline in order to 
 articulate with the teeth upon the lower jaw, thus crowding the 
 alveolar process to the inner border of the maxillary bones. 
 
 The process is solely for retaining the teeth, and if for any 
 reason the dental folHcles should not be present and the tooth 
 should not erupt, or if it should have been extracted early, the 
 process would not be developed at that point. In my collection 
 of models may be seen cases of arrested development of the 
 
 Fig. 12. 
 
 alveolar process, caused by the lack of bicuspid and lateral 
 incisor germs, and by the extraction of the deciduous and per- 
 manent teeth. 
 
 If one or more teeth should not antagonize, the alveolar 
 process would extend beyond the natural border, carrying the 
 teeth with it. A marked illustration of this is seen where the 
 molars are decayed to the gum and the roots remain. The vas- 
 cularity of the process is such that its development results. 
 Excessive development of the alveolar process is frequently 
 observed by every practitioner in connection with the anterior 
 inferior teeth. \\'hen the articulation is normal, occlusion of 
 these teeth never takes place. It is frequently found (espe- 
 
DKVKLOl'MKNT OK THK, ALVKOLAK I'KOCKSS. 05 
 
 cially in patients from six to twelve years of age) that these 
 teeth extend to and occhide with the mucous membrane of the 
 hard palate, making one of the most difficult forms of irregu- 
 larities to correct. Such a case is illustrated in Fig. 12. This 
 model is taken from the jaw of a person thirty-seven years of 
 age, but this excessive development [)r(j1)ably took place between 
 the ages of six and twelve, because at that period the vascularity 
 of the tissues is more vigorous and the development of the 
 process more formative than at any period subsequent to the 
 development of the first permanent teeth. 
 
 In a case in which the incisors and cuspids, together with 
 their alveolar process, were situated upon the external surface, 
 while the bicuspids, molars and their alveolar process are 
 located upon the inner border of the jaw. In another case the 
 alveolar process failed to cover the roots of the bicuspids and 
 molars upon the outer surface, the teeth having forced them- 
 selves into a larger circle through the alveolar process by the 
 contact of the crowns. The roots in this case can be easily 
 outlined by the finger through the mucous membrane ; the 
 outer plate of the alveolar process barely, if at all, covering 
 them. Tomes illustrates a case of faulty development of the 
 outer plate of the alveolar process exposing the crowns of all 
 the temporary teeth. The case was a child who had suffered 
 from hydrocephalus. I have a number of models showing the 
 anterior alveolar process projecting beyond the normal position 
 by the forward movement of the molars. This may be due to a 
 natural movement of the molars forward, or the process may 
 be forced forward by the improper occlusion of the jaws. The 
 teeth are moved from one position to another simply by the 
 force consequent upon absorption and deposition of bone. This 
 is noticeable in the spaces between the centrals, when the 
 alveolar process develops to a larger circle than is necessary to 
 accommodate the teeth. The alveolar processes are influenced 
 in one direction or the other by the pressure of articulation. 
 This abnormal condition is the result of inharmonious develop- 
 ment of the jaws. The teeth may come together in such a 
 manner as to throw the alveolar processes either to the right 
 or left, thus producing a full round arch upon one side of the 
 
66 IRREGULARITIES OF THE TEETH. 
 
 jaws and a perfectly flat or straight arch upon the other. (Fig. 
 ii). The greatest deformity is that in which the teeth of the 
 upper jaw and alveolar process are forced forward, causing a 
 protrusion of the anterior superior part of the mouth. Occa- 
 sionally both upper and lower alveolar processes are carried 
 forward in the same manner. The alveolar process upon the 
 lower jaw is more liable to be found upon the inner border of 
 the jaw than is the upper alveolar process, as the inferior max- 
 illa is larger and more dense than the superior, and when the 
 teeth are once in position upon the lower jaw they are not liable 
 to subsequent change. As the jaws become smaller and more 
 delicate, the anterior alveolar process becomes thinner and less 
 liable to resist the forward movement of the molar and cuspid 
 teeth, thus producing anterior protrusion and V-shaped irregu- 
 larities. Owing to this fact the teeth of the superior maxilla do 
 not form so great a circle, causing the teeth upon the sides of 
 the jaws to conflict and the lower teeth and alveolar processes 
 to be carried in, while the anterior teeth of the lower jaw are 
 held inside of the superior anterior teeth, thus carrying the 
 alveolar process inward. 
 
 The teeth are continually changing their positions in the 
 mouth. This is as often beneficial as it is detrimental. That 
 the teeth may perform their full function, they should not 
 only remain firmly fixed in the alveolar process, but should also 
 antagonize. The teeth may be compared to the bricks in an 
 arch ; remove a brick and the arch falls to pieces. It is fre- 
 quently found that the teeth do not articulate properly, and by 
 cutting away the approximal surfaces a better articulation may 
 be secured. When this operation is performed the teeth move 
 in their sockets by absorption and deposition of bone, demon- 
 strating the fact that the process changes in shape and substance. 
 
 The tendency of the alveolar process to develop between 
 the sixth and twelfth year (two periods of stress) is something 
 marvelous. This seems to be its period of greatest activity. 
 
 Physiologic development, however, is governed entirely by 
 the eruption of the teeth. The air passages may become filled 
 by excessively developed bones or mucous membrane, by 
 
DEVELOPMKNT OK THF, ALVKOLAR I'ROCF.SS. 67 
 
 adenoid vegetation or other causes ; as a result mouth-breath- 
 ing will take place. 
 
 The lower jaw drops, and the pressure is taken away from 
 the teeth. 
 
 In idiocy, and imbecility, and other degenerate conditions, 
 mouth-breathing is very common. In these cases a long, thin 
 alveolar process occurs. The teeth continue to erupt, and the 
 alveolar process elongates. Occasionally when the mouth is 
 closed the six anterior teeth will elongate, and the lower incisor 
 will penetrate the superior alveolar process. In such cases the 
 superior incisors protrude and separate. This deformity will 
 continue until the upper incisors cease to develop, owing to 
 the pressure of the alveolar process upon the lower incisor 
 teeth. 
 
 The first thing to do to correct this deformity is to place a 
 plate in the mouth, to allow the lower incisors to rest upon the 
 plate. 
 
 In this manner the pressure is taken from the bicuspids 
 and molars. In two or three months' time the posterior teeth 
 and alveolar process will elongate from .12 to .16 of an inch; 
 thus showing the possibility of the development of the alveolar 
 process in a short time by removing the pressure. 
 
 In some cases excessive development of the alveolar process 
 goes on very rapidly, especially in epileptics. 
 
 This, however, takes place at the time of the development 
 of the first teeth. 
 
 From what has already been said of the vascularity of the 
 alveolar process, it is evident that hypertrophy of the tissue 
 ensues from simple irritation of varying degree. The irritation 
 consequent upon the eruption of the teeth, together with the 
 excessive blood-supply are both primal cases of over-building 
 of tissue, i. e., hyperplasia. 
 
 The ragged roots of the temporary teeth, produced by 
 absorption, the gases from the putrescent pulps, and the pressure 
 of the permanent crowns against the tissues, produce sufficient 
 stimulation to excite physiologic action. Tissue-building gen- 
 erally is seen in connection with the teeth posterior to the cuspid, 
 rather than with the teeth anterior to that tooth. It seems 
 
68 
 
 IRREGULARITIES OF THE TEETH. 
 
 accountable only from the fact that the incisors have sharp 
 cutting-edges, the roots of the teeth are single and nearly always 
 shed before the permanent teeth are in place, and they erupt 
 at an age when there is less vitality. Per contra, the crowns of 
 the teeth posterior to the cuspid are broad, the roots of the 
 temporary teeth posterior to the cuspids are more numerous 
 than those anterior to them, and, with the exception of the 
 first permanent molars, they erupt at the age of greatest vitality. 
 Epileptics most often possess these stigmata. Excessive devel- 
 opment of the alveolar process is unusually common among 
 them, as is also the case with the muscles of the body. The 
 
 Fig. 13. 
 
 process becomes unnaturally thick, the bicuspids and molars 
 are carried in one direction and another, effecting a variety of 
 irregularities. I have frequently observed hypertrophy in con- 
 nection with epilepsy. This is due to unstable tissue-building, 
 often found among degenerates. A common form is shown 
 in Fig. 13. Similar irregularities are also seen in Cole's "Deform- 
 ities of the Mouth," Figs. 12, 13, and 27; and in Tomes' "Dental 
 Surgery," Fig. 90. These deformities all take the contour of 
 the saddle-shaped arch. This may be accounted for from the 
 fact that the permanent molars, being the first teeth to erupt, 
 become fixed before the deposit commences. The crowns of 
 the bicuspids are also held in a small circle by the retention 
 
DEVELOPMENT OF THE ALVEOLAR PROCESS. 
 
 69 
 
 of the temporary molars. When these teeth do not antagonize 
 they are Hahle to be carried inward. 
 
 Tlie cuspids, witli tlicir long roots, meet resistance either 
 in connection with the teeth adjoining or with those upon the 
 opposite jaw. and are thus held in position. It will be observed 
 that, in all these cases, the enlargement seems to be associated 
 with the inner plate of the alveolar process. In most of these 
 cases the imicr plate is the part of the alveolar process affected. 
 The outer plate, although quite irregular from the arrangement 
 of the teeth, is usually normal in thickness. This disparity in 
 
 Fig. 14. 
 
 the two plates of the aveolar process may be accounted for from 
 the fact that the inner plate of the alveolar process possesses 
 a large blood-supply — the posterior or descending palatine 
 arteries furnishing the ossific material. I have observed cases 
 where the hypertrophy has extended to and included the outer 
 plate. When the outer plate becomes involved the alveolar 
 process assumes a very thick condition. Occasionally, hyper- 
 trophy will affect one side only or one distinct locality. In 
 Fig. 14 is seen such a case. In this case the enlargement is 
 upon the left side and extends from the first bicuspid posterior 
 to, and including, the maxillary tuberosity. Instead of the force 
 
70 IRREGULARITIES OF THE TEETH. 
 
 being directed inward, as is generally the case, the process is 
 forced outward and backward. This enlargement occurred pre- 
 vious to the development of the second and third molars. The 
 alveolar process extends downward and occludes with the teeth 
 upon the lower jaw, thus preventing the molars from erupting. 
 
 Under the microscope, two systems of Haversian canals are 
 seen in the alveolar process. 
 
 These Haversian canals, according to Kolliker,^ are of two 
 kinds. One with the regular lamellae system surrounding it, 
 and the other, the so-called Volkmann's canals, containing the 
 
 Fig. 15. 
 Section of Bone showing Blood Vessels of V. Ebner. 
 
 perforating vessels from Von Ebner, which have no surrounding 
 lamellae, but simply penetrate through the layers of bone. Volk- 
 mann's canals are present in all tubular bones in old and young. 
 While especially present in the outer basal lamellae, they occur 
 also in the interstitial leaflets and in the inner chief lamellae 
 as well as in the periosteal layers of the skull bone. Here their 
 number is very variable (Fig. 15). They run partly transversely 
 or obliquely, and also partly longitudinally through the lamel- 
 lae. Many of these canals open in the outer or inner surfaces of 
 
 1 Handbuch der Gewebelehre, page 272. 
 
DEVELOPMENT OF THE ALVEOLAR TROCESS. 
 
 71 
 
 the substantia (compact substance), and also here and there in 
 the Haversian canals, and form altogether usually a wide-meshed 
 irregular net-work. In their structure they are sometimes 
 smooth and sometimes furnished witii dilatations and angles 
 projecting in and out in profile. The widest has a diameter 
 of lOO micrometers or more, and the narrowest not more than 
 lo or 20 micrometers, and there are still narrower ones which 
 are altogether obliterated, appearing like rings or circular- 
 
 
 
 Fig. 16. 
 
 Section of Bone (higher magnification) 
 
 showing Blood Vessels of V. Ebner. 
 
 formed structures without any lumen, or like those far from 
 rare obliterated true Haversian canals first described by Tomes 
 and de jMorgan. The contents of the A'olkmann canals are the 
 same as the Haversian canals. 
 
 Fig. 15 is a cross section of the medulla of a calcified human 
 humerus slightly enlarged. The outer lamellge contains a large 
 number of \'olkmann"s canals running longitudinally and trans- 
 versely and extending through the outer plate of bone into the 
 periosteum. Fig. 16 the cross section of the section seen in 
 
72 
 
 IRREGULARITIES OF THE TEETH. 
 
 Fig. 15 shows these canals more highly magnified. The Haver- 
 sian canals are large round spaces (Fig. 17), containing a single 
 artery and vein. The fine hair-like spaces running from these 
 large spaces are canaliculi. The dark spots encircling each 
 Haversian canal are the lacunas. The canaliculi run from one 
 
 Fig. ir. 
 
 Transverse section of the Diaphysis of the Humerus 
 
 magnified 350 times, a, Haversian canal. Dark 
 
 spaces Lacunae. Hair-like spaces 
 
 Canaliculi. 
 
 lacunae to another or into a Haversian canal, or they anastomose 
 with each other. The lacunae seem to be about uniformly dis- 
 tributed throughout the bone. The spaces between the lacunae 
 and canaliculi are filled with lime salts. 
 
DEVELOPMENT OF THE ALVEOLAR PROCESS. 73 
 
 A longitudinal section of bone (Fipc. i8) is similar in appear- 
 ance to the cross section. Instead of the lacuna: being arranged 
 in rows around the Haversian canals they are parallel. It will 
 be noticed that the Haversian canals run in different directions 
 
 «" * £ 1, ^ f 
 
 
 '%^m 
 
 Fig. 18. 
 
 Longitudinal section of Bone magnified 100 times, 
 a, Haversian canals. 6, Lacunse seen from 
 the side, c, Canaliculi. 
 
 and communicate with each other at certain intervals. The 
 foregoing covers essentially the minute anatomy of the alveolar 
 process. 
 
CHAPTER VIII. 
 
 develop:ment of the vault. 
 
 The roof of the mouth has received several names as the 
 arch, another the dome, still a third the palate. The word arch, 
 although used in its proper place, is often likely to be so con- 
 founded with the dental arch as to create confusion. Thus V 
 or saddle-shaped arch is spoken of, but the reader is quite 
 unable to decide whether the writer intended to refer to the 
 dental arch or the roof of the mouth. In former papers I have 
 used the term vault in distinction from the dental arch, and 
 shall therefore continue its use in the present volume. 
 
 The vault of the mouth is made up of the hard palate, the 
 soft palate, and the alveolar process. The hard palate consists 
 of two horizontal plates of bone extending from the superior 
 maxillary bone upon either side and uniting at the median line, 
 and from the anterior alveolar process in front, it extends back 
 on an average of two inches, when it unites with the soft palate. 
 The hard palate is composed of six distinct parts ; two incisive 
 bones, two palate plates of the superior maxillae, and two hori- 
 zontal plates of the palate bones. The incisive bones, however, 
 become so firmly united to the maxillary plate of bone so early 
 in life that the suture becomes obliterated. The period of ossi- 
 fication of the median suture varies in different individuals, some- 
 times as early as the third and fourth years, and again as late 
 as the fifteenth and sixteenth year. 
 
 Widening the arch by means of a jack screw, has opened 
 the suture of the median line in fourteen children from twelve 
 to sixteen years of age. This was accomplished by very little 
 pressure, showing that union had not taken place. These were 
 all neurotics. 
 
 As a whole, the hard palate may be described as a horizontal 
 partition, or floor, separating the nasal cavity from the mouth. 
 The anterior part of the palate bone unites with and becomes 
 a part of the alveolar process. The upper surface of the hard 
 
 74 
 
DEVELOPMENT OF THE VAULT. 75 
 
 palate joins the floor of the nasal passages, which are divided in 
 the center by the union of the vomer. This bone, which is 
 quite thin at its middle portion and cartilaginous at the anterior 
 part, begins to thicken as it reaches the floor of the nose, at 
 which place it gradually produces a smooth appearance, divid- 
 ing the nostril into two rounded arches. 
 
 Upon the palatal surface it is very uneven. Along the 
 median line is frequently found a rough ridge of bone, resem- 
 bling a section of rope, running its entire length, about the 
 size of a slate pencil. Such a condition is frequently observed 
 in Peruvian skulls. Out of 228 examined at the Peabody 
 Museum, Harvard College, sixteen had this peculiar appearance. 
 In more modern skulls are often present knots, or rough lumps 
 of bone, at intervals along the suture. Again, a thick band of 
 bone from .25 to .50 of an inch in width, extending part way or 
 the entire length of the suture, occurs. This thickness, or 
 prominence, commences at the alveolar border and becomes the 
 widest at the second bicuspid and first permanent molar, where 
 it gradually narrows to a mere point at a line drawn across the 
 vault at the posterior surface of the second molar. 
 
 The hard palate varies in thickness in different localities 
 and differs in thickness in different individuals. Around the 
 edge where it unites with the maxillary bone and alveolar pro- 
 cess it is quite thick, and also at the median line ; while about 
 midway between these two parts the bone is as thin as tissue 
 paper. I have also observed it from .12 to .18 of an inch in 
 thickness. At the median line, and just back of the incisors, 
 is a fossa which transmits the anterior palatine vessels and 
 naso-palatine nerves. At the posterior surface upon either side 
 is a groove and an opening for the transmission of the posterior 
 palatine vessels and nerves. Both the upper and lower surfaces 
 of the hard palate are covered with mucous membrane, which 
 extends backward and unites to form the soft palate. Between 
 the two folds of mucous membrane are muscular fibres for the 
 purpose of moving the soft palate in different directions. The 
 shape and length of the soft palate depends upon the distance 
 between the oesophagus and the edge of the hard palate. If 
 the head of the individual be dolichocephalic, or long, the soft 
 
76 IRREGULARITIES OF THE TEETH. 
 
 palate will curve slowly backward, thus producing quite a long 
 space between the incisor and uvula. On the other hand, if the 
 person possesses a brachycephalic, or short head, the soft palate 
 will curve abruptly, thus allowing only a short distance in the 
 vault of the month. I have observed mouths where the head 
 was so short from front to back that the soft palate descended 
 almost straight down without the slightest curve. The vault, 
 taken as a whole, presents different shapes in different indi- 
 viduals. 
 
 The mouth of a child at the fourlh or fifth year, normally 
 
 
 <s 
 
 Fig. lil. 
 
 presents a well-developed jaw. The curves are all graceful in 
 outline, and the contour of the dental arch is well formed. 
 This could hardly be otherwise, for the reason that the jaw is 
 growing rapidly for the purpose of accommodating the per- 
 manent teeth, and the circle of the alveolar process is larger than 
 that of the teeth. Spaces exist between the teeth, and therefore 
 crowding cannot take place. 
 
 As a matter of course no two vaults are alike in height, width 
 or contour, although each is normal in itself. As is obvious 
 from the chapter upon the alveolar process, in the development 
 of the jaws are two structures, the hard, dense bone of the 
 maxilla and hard palate, and the soft, spongy bone — the alveolar 
 
DEVELOPMENT OF THE VAULT. 77 
 
 process. The maxillary bones develop and unite at the median 
 line. The contour of the top of the vault is now established. 
 It is held in position, on the sides, by the walls of the antrum, 
 supported by the malar process and by the anterior alveolar 
 process and maxillary bone. In this manner the vault is held 
 in its natural position. The maxillary bones, like all the other 
 bones of the head, develop in every direction in a general way, 
 until the growth is established. Between the period of birth 
 and two years (when all the temporary teeth are in place) and 
 twelve or fourten years (when all the permanent teeth are in 
 position) great changes take place in the shape of the jaw. 
 This change is nicely illustrated in Figs. 19 and 20. 
 
 Fiji. 20. 
 
 Fig. 19 illustrates the face of a girl, three years of age, the 
 bones of the' face and head all undeveloped. The bridge of 
 the nose is sunken, the upper lip is short, as well as the jaw from 
 the lower lip to the chin. How different the appearance of the 
 same girl at thirteen (Fig. 20). While the width from cheek 
 to cheek has not changed to any great extent, the length of the 
 face from the chin to the top of the head is very marked. No 
 part of the face has changed more than the lower — from the 
 nose down. This change is due partly to the change in the 
 angle of the lower jaw, and partly to the development downward 
 of the superior alveolar process. In young life, the lower jaw 
 
78 IRREGULARITIES OF THE TEETH. 
 
 presents an obtuse angle ; this gradually changes until at middle 
 life it assumes a right angle. In order that the alveolar process 
 and teeth may cofnpensate for this change as the second set 
 comes into position, the alveolar process lengthens with the 
 eruption of the teeth. This is proven by the location of the men- 
 tal foramen, which is situated at the superior border of the 
 lower jaw early in life, and at middle life just midway between 
 the upper and lower border cf the bone. The same changes 
 take place in the upper jaw. This is quite noticeable on the 
 sides of the alveolar process at the roots of the first perma- 
 nent molar soon after it has eru]^ ted. When the crowns of the 
 bicuspids are ready to advance, and absorption of the roots of 
 
 Fig. 21. 
 
 the temporary molars take place, there is some irritation in 
 the alveolar process. The first permanent molar coming into 
 position advances further than the line of articulation of the 
 temporary molars, and the pressure of the jaws rests upon the 
 first permanent molars. This fact, together with the irritation 
 already mentioned, has a tendency to lengthen the alveolar 
 process, so that when the bicuspids come into place there is a 
 difference in the height of the vault. There are plenty of illus- 
 trations to show this development of the alveolar process, and 
 every practitioner of dentistry has observed this. 
 
 One of the most common illustrations is that when the 
 molar teeth upon the lower jaw have been extracted, the molars 
 
DEVELOPMENT OK THE VAULT. 
 
 79 
 
 upon the upper jaw (for want of antagonists) drop down by 
 the lengthening- of the alveolar process. The difference in the 
 height of vault when the temporary teeth are in place and when 
 the permanent teeth erupt is nicely illustrated in Fig. 21. This 
 cut shows the permanent incisors and first molars in place. Note 
 the lengthening of the alveolar process. In this manner the 
 differences in length of the face occur. In those cases where 
 the vault is very high, the alveolar process is always very long 
 and thin. '\'hv depth of vault is also governed by the angle of 
 (he jaw. Tlius, if from inherited constitutional disease, such 
 
 Fig. 2-2. 
 
 as consumption, syphilis, etc., arrest of development of the 
 maxillae should ensue, the angle would not change from an 
 obtuse to a right angle. It will be noticed that when the mouth 
 is opened the anterior part has to travel a greater distance 
 than the posterior part, hence either the anterior inferior alveolar 
 process will elongate so that the lower incisor will articulate 
 with the upper (Fig. 12), or the anterior superior alveolar process 
 will elongate to meet the lower incisor and bicuspid. Occa- 
 sionally this will take place in both jaws. In either case 
 the superior alveolar process becomes long and thin, 
 and the vault is quite high. In cases of arrest of development 
 
80 IRREGULARITIES OF THE TEETH. 
 
 of the bones of the nose and adenoid growths, when it is 
 impossible for the child to breathe through the nose, and mouth- 
 breathing is a necessity, the jaws are separated, and the teeth 
 not having a resting place, the alveolar process elongates and 
 a high vault is almost always noticed ; hence imbeciles and 
 degenerates who keep the mouth open, as a rule, have high 
 vaults. The high vaults and prominent teeth, and upper alveolar 
 process due to this cause, are nicely illustrated in Fig. 22, etc. 
 On the other hand, the jaws brought closely together are occa- 
 sionally noticed. This is due (i) to a short ramus; (2) to right 
 angles of the rami to the body of the jaw; (3) to arrest of 
 development of the alveolar process, and, (4) to teeth with short 
 
 Kig. 28. 
 
 crowns, or teeth not fully erupted. In such cases the vault is 
 low, the alveolar process thick, and usually the lower jaw is 
 quite broad. The lips pout, the face is short and broad. Fre- 
 quently the upper jaw is arrested, in its development ; the 
 muscles of mastication are very set and rigid. Such a case is 
 illustrated in Fig. 23. 
 
 The height of the vault, then, is not due to the roof's being 
 pushed or pulled up by a pressure exerted through the vomer 
 by the development of the sphenoid bone, nor does the shape 
 of the base of the skull in any way afifect it, as I have already 
 explained. The height is due entirely to a growth downward 
 of the alveolar process and teeth. The extent of the develop- 
 
DKVELOP.MKN r OK TlIK VAULT. 81 
 
 ment of the alveolar process depends upon equibalance of nutri- 
 tion, harmonizing" the jaws, alveolar process, and Icni^th of 
 teeth. That the distance in height is changed from a child to 
 a person of middle life is demonstrated by the following figures : 
 Thus in 317 children, under five years of age, before the develoj)- 
 meiU itf the first permanent molar and alveolar process, the 
 lowest vault measured .17; the highest .62, with an average of 
 .42. In the height of vaults in children at different ages, there 
 is a gradual advance in the height of the vaults until in 4,614 
 adult vaults, we have: lowest, .21, highest, .84, with an average 
 of .58. It will, therefore, be observed that the height of vault 
 develops about .25 to .33 in depth after the permanent teeth 
 commence to erupt. Fig. 24 illustrates an instrument invented 
 by me for the purpose of measuring these cases ; it also shows 
 the position of the instrument upon the model when the meas- 
 urement is made. 
 
 The height of the vauit in most cases is far below the average 
 of the present day. In 4,614 measurements of normal indi- 
 viduals, made by the author, it was found that the average height 
 of the arch was .58 of an inch; the measurement was made 
 from the alveolar border betv^^een the second bicuspid and the 
 first permanent molar to the height of the arch. The average of 
 two hundred and fifty-one skulls of ancient and modern Romans, 
 Indians, etc., was .56 ; allowing for the thickness of the mucous 
 membrane, the average height of the vault of the present people 
 would be a little below that of the Indians, negroes, ancient 
 Britons and Romans. In 908 measurements of the vaults of 
 ancient and modern Romans, Peruvians. Sandwich Islanders, 
 Mound Builders. American Indians, negroes, etc., the mini- 
 mum height of vault was .25, while the maxmium height was 
 .88; average, .53. On comparing these figures with those of 
 modern individuals, the lowest vault is found to be a little higher 
 — .04 — than in modern, and the highest a little higher — .04. The 
 average, however, is a little lower than in the modern vaults 
 by .05, thus showing that the ancient and race pure individuals 
 possess more uniform and lower vaults than modern. The 
 height of the vault hence depends upon the length of the face 
 from the chin to the top of the head. So far as the height of 
 7 
 
82 
 
 IRREGULARITIES OF THE TEETH. 
 
 the vault is concerned, no race, type, sect, or intellect can lay 
 claim to high, medium, or low vaults. 
 
 What are the elements of a normal vault is a difificult cj[ues- 
 
 FiK. 24. 
 
DRVF.T.Ol'MI'.XT OF THF, VAULT. 83 
 
 tion to answer. I possess six skulls, obtained under difficulties 
 from a medical college, and not selected for any particular 
 purpose. 
 
 The lateral measurement was made between the roots of the 
 second bicuspids, and the antero-postcrior measurement between 
 the central incisors at a point intersecting a vertical line dropped 
 from the posterior nasal spine to the posterior border of tlie 
 palate bone. The height of vault was taken from a horizontal 
 line extending from the alveolar process on -one side to the 
 alveolar process on the opposite side, just back of the second 
 bicuspid teeth. 
 
 The following measurements were taken (see Table VI) : 
 
 Nos. I and 5 possess very much the same contour of the 
 dental arch, while Nos. 4 and 6 are very broad, with square 
 dental arches. 
 
 The heights of the vaults are all different, although two are 
 flat, while the others are more or less rounding. Yet all are 
 normal, while no two are alike. 
 
 I have examined hundreds of plaster casts, where the teeth 
 were all in a fairly normal position, with similar results. 
 
 Of 372 skulls of Peruvians, California Indians, Mound 
 Builders, and American Indians, the lateral measurement varied 
 from 1. 12 to 1.75, and the antero-posterior from 1.75 to 2.75, 
 while the height of the vault varied from .24 to .75. 
 
 Oakley Cole made careful measurement of a number of 
 skulls, chiefly in the museum of the College of Surgeons, Lon- 
 don, England. The skulls examined fall into two series, viz. : 
 those of European origin, and those of mixed races, with the 
 following results (see Tables VII and VIII) : 
 
 In each of the cases that I have examined, the dental arch 
 was in a normal condition. I have also examined the skulls 
 mentioned by Oakley Cole, and I liave been unable to find but 
 few contracted arches in any of them. If, therefore, in the 
 examination of thousands of skulls having normal dental arches, 
 no two vaults are found to correspond, it is evident that a 
 normal vault is one where the dental arch is regular, and the 
 different outlines possess graceful curves, regardless of height, 
 width and length. 
 
84 IRREGULARITIES OF THE TEETH. 
 
 The width of the vault depends upon two factors : First, 
 the development of the jaw bone proper, and, second, upon the 
 development of the alveolar process. 
 
 Narrow jaws are rarely observed among pure races. In 
 the examination of the thousands of skulls of early races in 
 the museums of Europe and this country, very few, if any, con- 
 tracted vaults are found. If the brain is in a healthy condition 
 and the child properly nourished, the jaw-bone will develop 
 in size sufificiently to accommodate all the teeth when they 
 erupt. The teeth will crowd against one another as they come 
 into place, and a normal width of arch will be produced. If 
 the brain be defective, as the result of some of the constitutional 
 diseases, and the jaw becomes arrested in its development just 
 before sufficient room had been secured for the teeth, they will 
 crowd against one another, the arch will become broken, and 
 the V or saddle arch, or some of their modifications, will be 
 formed ; hence a narrow, contracted vault. The amount of con- 
 traction depends upon the size of the jaw'-bone proper; if the 
 bone has become arrested early, the jaw being small, the con- 
 traction is usually very great. The alveolar process depends 
 entirely upon the location of the teeth for its shape and size. 
 Occasionally the teeth (which are small) are inherited from 
 one parent, and the jaw-bone proper (which is large) from the 
 other parent. In such cases the alveolar process sometimes 
 contracts until teeth antagonize, when a small arch will be pro- 
 duced. V and saddle shape arches and their modifications are 
 observed as often among low vaults as among high ones in 
 normal jaws. The contraction is due to arrest of development of 
 the jaw at the time of the eruption of the permanent teeth ; the 
 vault may be high or low. What appears to be a high vault is 
 not in the height of the vault, but in the width. Having novv 
 explained the true cause of what appears to be a high vault, 
 what Clouston calls neurotic and deformed, are found to be 
 one and the same. Both are neurotic, but one is more con- 
 tracted than the other ; both are due to arrest of development 
 of the maxillary bones. There are high and low vaults among 
 the ignorant as well as the intellectual, among the colored as 
 well as the white, among the brachycephalic and mesocephalic 
 
DEVELOPMENT OF THE VAULT. 85 
 
 as much as among the dolichocephalic, among the deformed, 
 or contracted, as much as among the normal. The width of 
 the vault depends upon the development of the maxillary bones ; 
 if it develops to a size sufficient to accommodate all the per- 
 manent teeth, it will be a normal vault, regardless of height. 
 On the other hand, if arrest of development of the jaw takes 
 place, these deformities result in a V or saddle arch or some 
 of their modifications. How, then, shall vaults be classified? 
 In the measurement of the height of vaults of 8,654 ancient 
 and modern skulls in this country and Europe, the highest was 
 .88, the lowest, .25, with an average of .53. In the measurement 
 of 6,387 mouths of persons over twenty years of age, the highest 
 is .84, the lowest, .21, with an average of .58. In the measure- 
 ment of 616 insane at the Eastern Illinois Insane Asylum, the 
 highest is i, lowest .12, with an average of .54. 
 
 Taking these figures into consideration, it is safe to average 
 the height at .55. Allowing .15 of an inch in each direction, 
 vaults which measure below .40 may be called low vaults ; those 
 between .40 and .70, medium vaults ; those above .70, high 
 vaults. We could still classify those below .25 very low vaults, 
 and those above .85 very high vaults. The width of vault meas- 
 ured between second bicuspids and first permanent molars 
 
 In 8,654 ancient and modern skulls : 
 
 Maximum 1.63 
 
 Minimum 1. 13 
 
 Average 1.36 
 
 In 6,387 mouths of living persons over twenty years of age : 
 
 Maximum 1.50 
 
 Minimum 93 
 
 Average 1.19 
 
 In 616 insane people : 
 
 Maximum 1.87 
 
 Minimum 75 
 
 Average i . 16 
 
 The vast difference in the ancient and modern skulls of this 
 cotmtry and Europe, with those of living individuals, shows 
 conclusively that the jaws are diminishing in size. A standard 
 
86 IRREGULARITIES OF THE TEETH. 
 
 is necessary to compare the width of the vaults as they occur 
 to-day, excluding measurments of ancient and modern skulls and 
 deformed jaws. Taking the 1.19 as the average width of vault, 
 any jaw below i may be regarded as a narrow vault ; one 
 bewteen i and 1.40 medium width, and one which measures 
 above 1.40 a wide vault.^ 
 
 "While I believe that the views of Sergi (The Mediterranean Race) 
 are justified, still they have not as yet been widely accepted by 
 ethnologists and hence must be considered sub judice. His position in 
 regard to the division of skulls into Ellipsoides, Ovoides, Pentagonoides, 
 Beloides and Trapezoides is in my judgment justifiable and likely to 
 prove of great advantage in craniology, which has hitherto been rather 
 hampered by the paucity of its classifications. 
 
CHAPTER IX. 
 
 DEVELOPMENT OF THE PERIDENTAL MEMBRANE. 
 
 The peridental membrane, like the periosteum is composed 
 of fibrous tissue covering the roots of the teeth and lining the 
 inner wall of the alveolus. They are both derived from the 
 mesoblastic layer. For this reason there can be very little differ- 
 ence in the character of the structure of each, except so far 
 as the function is concerned. The periosteum is made up of 
 four different kinds of fibers. An outer layer of coarse, white 
 fibrous tissue, an inner layer of fine, white fibrous tissue, elastic 
 fibers and penetrating fibers (fibers of Sharpey). 
 
 The fibers of the periosteum are coarser than those of the 
 peridental membrane. The coarser fibers run parallel with the 
 alveolar process over the border and extend as far as the union 
 of the epithelial layer and the periosteum. 
 
 The finer fibers, as Black has shown,^ run in all directions and 
 enter the alveolar process at ever}^ point. If a section of the alveo- 
 lar process treated with acids or a section affected by halisteresis 
 or osteomalacia be placed under the microscope, the fibers are 
 seen to retain the original shape of the bone. 
 
 The fibers of the periosteum, therefore, are continued 
 throughout the process from the periosteum on the one side 
 to the peridental membrane on the other. This is also illus- 
 trated in the mouths of persons, where (after wearing artificial 
 dentures for a short time) heat produces absorption of the lime 
 salts, leaving the fibrous tissues intact. 
 
 The periosteum is abundantly supplied with blood-vessels 
 which anastomose w^ith each other and enter the alveolar pro- 
 cess at the Haversian canals. The plexus of blood-vessels is 
 much larger proportionately in connection with the alveolar 
 process than with other bones of the body, owing to its 
 transitory nature. 
 
 The peridental membrane commences at the margin of the 
 
 ^ Black: Dental Ligament. 
 
 87 
 
00 IRREGULARITIES OF THE TEETH. 
 
 epithelium at the neck of the tooth and is attached directly to 
 the cementum. This nicnibranc has various functions; First, it 
 fills the space between these two structures, forming a cushion 
 for the teeth to rest upon; second, like the alveolar process, it 
 is present only when the teeth are present and, therefore, devel- 
 ops with the alveolar process when the first teeth erupt, it is 
 entirely lost when the temporary teeth are shed, is restored with 
 the eruption of the second set and when the permanent teeth 
 are extracted it disappears with the alveolar process; third, it 
 furnishes the nourishment for the teeth while thev are in position 
 in the jaw and holds them in their sockets. 
 
 The fibrous tissue in its earliest stages comprises nearly all 
 or quite all of that portion of the jaw which eventually becomes 
 the alveolar process (Fig. 261). Calcification begins at the 
 center of the jaws and gradually closes in upon the fibrous mem- 
 brane until it becomes the thickness of a sheet of paper. In 
 young persons the membrane is much thicker than in old age, 
 since, as age advances, the osteoblasts on the one hand and the 
 cementoblasts on the other send out new material and each 
 wall closes in upon the meml)rane, which becomes very thin 
 in old age and almost lost. 
 
 The fibers which comprise this membrane extend in all 
 directions ; some crosswise penetrating the cementum, on the 
 one hand and the alveolar process on the other. In a general 
 way, since the fibers extend though the alveolar wall, they are 
 more closely adherent to the bone than to the cementum and 
 usually cling to the latter when the tooth is removed. It will 
 be observed that these fibers do not enter into the alveolar pro- 
 cess uniformly as claimed by Gray- and Pierce,'"' like tacks or 
 nails driven regularly into a board (the fiber of Sharpey), but 
 vary as to the quantitv in difTerent localities. In some localities 
 they penetrate in large quantities and almost surround a piece 
 of alveolar process, while a few fil)ers penetrate but a short 
 distance. In some jilaces, thev can be traced almost tlirough 
 the alveolar process. These fibers arc much finer in man than 
 in the lower anim:!ls. In connection with the fibers which pass 
 
 - Anatomy. 
 
 ^ American Sy: tern of Dentistry, page 668. 
 
DKVI' '..or.Ml'.N r OK 'lllK I'KKlDEN'rAL MKMBKANE. 
 
 89 
 
 into the alveolar process arc numerous blood-vessels. Others 
 run dias;onally, and still others lcnt;th\vise, all making up a 
 tissue which holds the tooth in positi(jn in the jaw. The fibers 
 enter the i)cridcntal membrane at all points of the process, from 
 its maro-jn to tlic ajH-x of the roots. Tbc elasticity of this mem- 
 
 Fig. 25. 
 
 Cross-section of Root, Peridental Membrane and Alveolar Process. 
 Radiation of Fibrous Tissue. (Noyes.) 
 
 brane is so great that in correcting irregularities a tooth may 
 be turned from one-fourth to one-half around without breaking 
 the fibers, Fig. 25. The elasticity is greatest in youth. As 
 age advances the membrane grows thinner and thinner until, 
 late in life, there is almost a bony union between the tooth and 
 
90 
 
 IRREGULARITIES OF THE TEETH. 
 
 the alveolar process, thus preventing stretching of the fibers. 
 At the upper border, under the gum tissue these fibers extend 
 over the edge of the alveolar border and unite with the fibers 
 of the periosteum on the outer border of the process, forming 
 the interstitial tissue. 
 
 Fig. 26. 
 
 X300. No. 2. Projective Ocular D.D., obj. Zeiss. Absorption of Alveolar 
 Process. I, Fibrous Tissue, originally Bone. O, Lacunar Absorption. 
 
 If absorption of the inorganic substance of the alveolar pro- 
 cess occur, the fibrous tissue retains the shape of the process. 
 The same results when inflammation of the peridental mem- 
 brane takes place at the gum margin or at the apex of the root 
 of the tooth, What was once alveolar process is now peridental 
 
DEVELOPMENT OF THE PERIDENTAL MEMBRANE. 1)1 
 
 membrane or fibrous tissue, Fig. 26. When pressure is applied 
 in regulating teeth, the lime salts are absorbed and the results 
 are obtained. 
 
 Two kinds of structures are present in the alveolar process, 
 a dense, compact, hard structure (composed of lime salts) and 
 a fibrous tissue ; either alone will retain the shape of the alveolar 
 process. 
 
 Blood-vessels permeate this membrane throughout from the 
 gum tissue at the neck of the tooth through the alveolar walls 
 to the end of the roots. They are most abundant in youth. 
 Capillary blood-vessels (vessels of von Ebner) enter the bone 
 and Haversian canals through the process and into the peri- 
 dental membrane. Many of these blood-vessels extend the 
 entire length from the gum margin to the apex in straight lines 
 and vice versa. A great supply of blood-vessels penetrates the 
 membrane through the alveolar walls. These vessels unite and 
 anastomose with the arteries which traverse lengthwise, forming 
 a complicated plexus. According to some writers the vascular 
 supply of the peridental membrane is situated in the center of 
 the structure. This has not been my experience. All of my 
 slides as well as those here presented show the blood-vessels 
 to be situated nearest the alveolar process. It is quite natural 
 that this should be so, since very little blood is required for the 
 nourishment of the cementum, while the largest amount is 
 required to supply the alveolar process. The system of blood- 
 vessels situated in the peridental membrane and showing their 
 relation to the surrounding tissue can be well shown in injected 
 specimen from healthy dogs."* The vessels seen in the mem- 
 brane anastomose very freely with those at the gum margin, 
 showing the membrane to be well nourished in all its parts. 
 Should one part become involved by disease the other parts are 
 over-nourished in consequence. 
 
 These blood-vessels enter the alveolar walls with the fibrous 
 tissue through the Haversian canals and these in turn permeate 
 the entire bone. As age advances, however, the bone becomes 
 more dense and the Haversian canals become smaller and 
 (Under certain conditions) cease to exist. When disease takes 
 
 •* Interstitial Gingivitis, page 40. 
 
92 IRREGULARITIES OF THE TEETH. 
 
 place, either at the gingivus or at the apex of the root, the 
 supplv of blood being thus cut off, the tissues receive sufficient 
 nourishment through the alveolar wall. Since the structures are 
 in a transitory state, being destroyed and repaired so frequently, 
 it is evident why the blood supply is so rich. 
 
 As I have elsewhere shown an inflammatory process goes 
 on not merely in the slightest movement of the teeth in regu- 
 lating, but likewise in the eruption of the teeth as well as in 
 absorption of the alveolar process after extraction. There is 
 great individual variation from many causes in this particular. 
 The amount of tension will, therefore, in a measure depend upon 
 the individual idiosyncrasy. The operator must decide upon 
 the extent of force to be applied in a given case. The influence 
 of bending the alveolar process must depend to a greater or 
 lesser extent upon the resultant absorption. 
 
CHAPTER X. 
 
 DEVELOPMENT OF TPIE TEETH. 
 
 The teeth, as Minot remarks, were primitively organs of the 
 skin and widely developed over the surface of the body. They 
 played an important part in the development of the skeleton. 
 The dermal bones, which form part of the skull, were originally 
 teeth. The placoid scales, which were dermal teeth in the shark, 
 helped out the deficiencies of brain case. This was cartilaginous 
 and essentially the chondrocranium or primitive cartilage skull of 
 the human embryo, formed from the vertebrje, but insuf^cient 
 to cover the brain, ever increasing with evolution. The tooth 
 is a papilla which projects into the epidermis and, ossifying (cal- 
 cifying) in a particular way, changes into ivory around the 
 soft core or pulp. To the papilla the epidermis adds a layer of 
 enamel. The tooth proper departs from the primitive method 
 of development since it does not arise on the surface but deep 
 down. The dentiferous epithelium grows down into the dermis 
 forming an oblique shelf, which is a special tooth forming organ. 
 On the under side of the shelf the teeth are developed in the 
 same way as over the skin although they are very nuich larger. 
 The teeth are, however, in various stages of development and 
 only one is fully exposed. When, as happens in time, it falls, 
 the next tooth behind replaces it. Since the production of new 
 tooth germs goes on in adult life, replacement of teeth in the 
 shark's jaw continues indefinitely, hence sharks are termed poly- 
 phyodont. Mammals have but two sets of teeth and are called 
 diphyodont. The teeth proper unite with a small plate of dermal 
 bone at its base. By a modification of the jaws, the epidermis 
 first grows into the dermis and the dermal tooth papilla is 
 developed. The first indication of tooth germs in mammals is 
 a thickening of the epithelium covering the jaw. This thick- 
 ening, which appears as a ridge during the sixth w-eek of embry- 
 onic life, forms on the under side of the epithelium. This curv- 
 ing ridge expands into an outer portion (the outline of the 
 
 93 
 
94 IRREGULARITIES OF THE TEETH. 
 
 groove between the lip and the gum) and an inner portion, the 
 dental shelf which grows obliquely inward. The papilla for the 
 milk teeth are formed on the under side of the shelf and it is 
 thus possible to continue growing toward the lingual side so 
 that the second set of germs is thus developed for the permanent 
 teeth. - The end of the shelf, toward the articulation of the jaws, 
 is prolonged without retaining the direct connection with the 
 epithelium and from this prolongation arise the enamel organs 
 for the three permanent molars. Wherever a tooth germ arises, 
 the dental shelf is locally enlarged and the local enlargement 
 constitutes an enamel organ which projects from the under side 
 of the shelf. Mammal teeth pass in evolution from the simple 
 types of the oviparous edentates to those of the indeciduous an- 
 cestors of the sloths and armadilloes and their descendants, inclu- 
 sive of the dolphins and whales, whose teeth (in the foetal Green- 
 land whale and adult Sperm whale) preserve this old type. 
 While, as in the edentates, these teeth may be few, they may 
 also, as in the insectivorous mammals, approximate those of the 
 reptilia in number (sixty or seventy on a side) and characteristic 
 location. 
 
 The evolution of this primitive tooth to the bicuspid and 
 molar type results from, as I have elsewhere shown, concres- 
 cence and differentiation. The human lower molar with its low 
 quadritubercular crown has evolved by addition of cusps ajid by 
 gradual modeling from a simple high crown pointed tooth. 
 
 The tooth has, as Havelock Ellis^ points out, been but little 
 considered from anthropologic and ethnologic standpoints. 
 Flower, however, has constructed a dental index by multiplying 
 the dental length by lOO and dividing by the basio-nasal length 
 (or length from the naso-frontal suture to the foramen magnum). 
 According to his results thus obtained the white or Caucasic 
 races are microdont (with small teeth and small dental index). 
 The yellow or Mongolic races are mesodont (middle teeth and 
 index). The black races are megadont (great teeth and index). 
 The anthropoid apes have still larger indices and teeth. 
 
 In addition to the rudiments of the enamel organs for the 
 milk and permanent teeth, there are addtional organs often 
 
 1 Man and Woman. 
 
DEVELOI'MKNT OF THE TEETH. 95 
 
 present in a very variable condition and number nearer the 
 external surface, and are exceedingly similar to the youngest 
 stages of the normal enamel organs. According to Kollmann 
 and Gegenbauer they are abortive rudiments, survivals from an 
 ancestral condition in which teeth are more numerous.^ Black^ 
 speaks of these as glands, while Ch. Robin and Magitot,-* who 
 were the first to describe them, claim they are epithelial debris ; 
 a view perfectly compatible with that of Gegenbauer and Koll- 
 mann. My own researches^ corroborate the results of Robin and 
 Magitot. 
 
 - DeMoor, Evolution by Atrophy. 
 3 Dental Cosmos, Feb., 1899. 
 
 * Genesis and Development of the Dental Follicle, Journal de Physiol- 
 ogic de Brown-Sequard, i860. 
 " Interstitial Gingivitis. 
 
CHAPTER XI. 
 
 SOCIAL CONSANGUINITY, NEAR-KIN, EARLY AND 
 LATE MARRIAGE. 
 
 From the general principles of heredity already laid down 
 it must be obvious that the influence of intermarriage in fam- 
 ilies has been over-estimated as a factor per se in producing 
 defect. The idea of the advantage of cross-breeding, which 
 seemingly appeared in the practice of exogamy (marriage outside 
 the tribe or more often outside those having the same totem or 
 coat-of-arms) arose, as I have elsewhere shown,^ from obser- 
 vation of deformities, following intermarriages contracted after 
 the killing of girls for economic reasons had led to exogamy. 
 The idea of incest- was of religious origin rather than innate, 
 since totemic relationship (which was chiefly prohibited) was 
 often far from being consanguinous. The totem was a mark 
 indicating descent from a supposed animal ancestor endowed 
 with occult powers. The children with the Bear totem of one 
 tribe could not marry those having the Bear totem of any other 
 tribe. From this practice sprang the medical, theologic and 
 legal notions anent the danger from marriages of consanguinity, 
 which, as D. Hack Tuke^ remarks, insisted upon from time to 
 time by medical writers, has been recognized by ecclesiastic 
 authority, civil law and by popular feeling. By ecclesiastic and 
 civil law, marriage of those very nearly related has been for- 
 bidden on other grounds than that of alleged danger to offspring. 
 At the same time the justice of such laws receives support from 
 medical observations, which tend to show that intermarriage 
 may produce degeneracy, idiocy and insanity. I have elsewhere 
 analyzed^ this evidence and shown for the facts there is more 
 than one explanation. The explanation pointed out by Strahan"* 
 underlies the chief danger in intermarriages. With a perfectly 
 
 ^ Degeneracy : Op. Cit. 
 
 - Durkheim Annee Sociologiquo, 1898. 
 
 3 Psychological Dictionary. 
 
 * Marriaee and Disease. 
 
 96 
 
SOCIAL CONSANGUINITY, KARLY AND LATH MARRIAGK. 07 
 
 healthy stock, as every breeder of animals knows, remarks 
 Strahan, "in-and-in breeding" may be practiced with impunity, 
 but where the stock is tainted with disease or imperfection, safety 
 is only to be found in "crossing." 
 
 The error of the old doctrine upon which was founded the 
 prohibition of consanguinous unions lay, as Strahan remarks, 
 not in asserting that disease and deformity were more often met 
 with in children of these than those of other unions, for such 
 is the fact, but in attributing these unhappy results merely to 
 parental blood kindred. Over and above the fact that these 
 consanguinous marriages are almost certain to transmit, in an 
 accentuated form, defect or tendency to disease already present 
 in the family, there is no physiologic reason why such marriages 
 should not take place. Breeders of prize stock frequently breed 
 "in-and-in" not only with impunity but with marked benefit. 
 But this fact, while going to prove that it is not the mere blood 
 relationship of the parents which induces the degeneration so 
 often found in the children of consanguinous marriages, can but 
 rarely be advanced as an argument in support of the marriage of 
 blood relations. The stock-raiser only permits the more perfect 
 members of his flock and herds to continue their kind ; for this 
 reason "in-and-in" breeding is innocuous just as it would be in 
 the human family under like conditions. 
 
 Recently acquired characters, whether physiologic or patho- 
 logic, are very liable to disappear when the individual bearing 
 such characters intermarries with another not having the same 
 character. The natural tendency in all such cases is to revert 
 in the offspring to the normal type, so that unless the new 
 character be very deeply impressed upon the parental organism, 
 it is almost certain it will not appear in the offspring of the 
 other parents having nothing of the character. But when both 
 parents are possessed of the character, whether it be physiologic 
 or pathologic, this natural tendency to revert to the original 
 is often overborne and the character is repeated in an accentu- 
 ated form in the offspring. 
 
 Now this accentuation of family characters is what must 
 always happen in the case of consanguinous marriages. If there 
 be taint in the family, each member will have inherited more or 
 
98 IRREGULARITIES OF THE TEETH. 
 
 less of it from the common ancestor. Take the case of cousins, 
 the descendants of a common grandparent who was insane and 
 of an insane stock. Here the cousins are certain to have inher- 
 ited more or less of the insane diathesis. Even if the taint have 
 been largely diluted in their case by the wise or more likely 
 fortunate marriages of their blood related parents, yet, still they 
 have inherited a certain tendency to nervous disease and if they 
 marr}- they must not be surprised if that taint appear in aggra- 
 vated form in their children. Some children of such parents 
 are idiotic, epileptic, dumb or lymphatic and the parents marvel 
 whence came the imperfection. In some cases the parents and 
 possibly grandparents of the unfortunate children have not dis- 
 played any obvious evidence of the tendency to disease which 
 they have inherited and handed on to their descendants. Not 
 looking farther back the parents boldly assert that such a thing 
 as insanity, epilepsy, scrofula, etc., is unknown to their family. 
 They, themselves, have never been insane ; why, then, should 
 their children? In like manner children may be epileptic, blind, 
 deaf-mute, lymphatic, cancerous, criminal, drunkards or 
 deformed from direct inheritance and yet the family line be hon- 
 estly declared to be healthy. The truth of Sir William Aitken's 
 maxim (that "a. family history including less than three gener- 
 ations is useless and may even be misleading") is hence obvious. 
 Similarity of temperament induced by a common environment 
 Vvhich Strahan calls "social consanguinity" is, hence, also a 
 potent factor in the production of all hereditary degenerations. 
 Living under similar customs, habits and surroundings, labor- 
 ing at the same occupation, indulging in the same dissipation, 
 tend to engender like diseases and degenerations irrespective of 
 any blood relationship. Hence, it not seldom happens that 
 persons not even distantly related by blood, are in reality 
 much more nearly related in temperament than cousins or even 
 nearer blood relations who have experienced widely different 
 modes of life. This "social consanguinity" is the great curse 
 which dogs every exclusive tribe and class and hurries them to 
 extinction. It has largely added to real or family consanguinity 
 in the production of the disease and degenerations which have so 
 heavily fallen upon the aristocracies and royal families of Europe. 
 
SOCIAL CONSANGUINITY, KARLY AND LATH MARRIACiK. 99 
 
 This "social consanguinity" appears likewise in the tendency 
 of the neurotic to intermarry, popularly expressed in the proverb 
 that "like clings to like." This likeness which is in mental char- 
 acteristics has been shown to be present by Roller, de Monteyel, 
 Kiernan, Bannister and Manning, so far as Germany, France, 
 the United States and Australia are concerned. Bannister puts 
 the statistic proof of this tendency thus forcibly : "There are in 
 Illinois, according to the most recent estimates, in round num- 
 bers, about 6,000 insane, or one to a little over 500 of the popu- 
 lation. Even if we double, treble or quadruple this frequency 
 to include all that have been or are to be insane, as well as 
 those insane at the present time, it would not appear that there 
 was much probability of two insane persons being married 
 according to any ordinary law of chances. In fact, we find four 
 out of the 104 with insane heredity had both father and mother 
 been insane. In one of these cases the insane heredity involved 
 both parents and grandparents on each side, though in the case 
 of the latter the histories show it only as collateral. Besides these 
 three patients direct paternal and collateral maternal heredity, 
 two had direct maternal and collateral paternal heredity and in 
 one case there was collateral heredity of insanity on both sides. 
 This makes altogether nearly 10 per cent of those with insane 
 heredity with it on both sides, maternal and paternal, and thus 
 favored with a double opportunity to inherit mental disease. If 
 to this be added the instances where with insanity of one parent 
 there is either epilepsy, hysteria, or drunkenness, brain disease, 
 nervousness, etc., of the other, the ratio of double inheritance 
 rises to over 20 per cent." 
 
 Since jaws and face are transitory structures, but relatively 
 little taint is needed in a family or community to cause degen- 
 eration of the face and jaws and irregularities of the teeth. The 
 influence of this factor of these neurotic and "social consanguin- 
 ity" tendencies in the production of deformities of the face and 
 jaws and irregularities of the teeth cannot well be over-estimated. 
 A test of these influences is alleged to exist in the Polynesian 
 populations of the Pacific Islands, where race admixture can be 
 excluded for a relatively long period. Concerning the ancient 
 
100 IRREGULARITIES OF THE TEETH. 
 
 Hawaiians, J. M. Whitney^ remarks : "Here is a people isolated 
 from all others for at least 1,400 years with no admixture of 
 races, yet irregularity of the teeth of both maxillae is almost as 
 common as it is among the mixed races of to-day." In social 
 consanguinity of the Polynesians must be peculiarly reckoned 
 their excessive and systematized licentiousness, shown in socie- 
 ties for practice of extreme sexual indulgence, like the Areoi.^ 
 Such societies undoubtedly create neurotic states and tendencies 
 and produce more marked degeneracy of the face, jaws and teeth 
 than intermixture of race or consanguinous marriage. The factors 
 of race admixture cannot, as Denniker'^ has shown, be completely 
 excluded from consideration among the ancient Hawaiians. 
 Since leprosy, like syphilis, may simply check development with- 
 out causing infection in utero, this factor has likewise to be 
 taken into consideration. Furthermore, as Alvarez,^ of Waialu, 
 Dahu, has shown, the mortality among Hawaiian babes is very 
 large. Hygiene is practically unknown to the mothers. Kava- 
 Kava (the fermented juice of the ava) is the great medicinal 
 agent of the Kahuna (sorcerer-medicine man), who is the chief 
 medical resource of the natives. Syphilis is very common, espe- 
 cially the non-venereal type. The habits of the natives aid the 
 spread of the disease. Under such conditions, irregularities must 
 result. The age of the mother at pregnancy is too much ignored 
 in dealing with defects. J. Mathews Duncan^ pointed out nearly 
 two decades ago that the offspring of early and senile marriages 
 were defective. Multiple and too nearly repeated pregnancies 
 were of frequent occurrence. Conger^*^ (whose results were 
 later corroborated by Joseph Workman^ ^ and Kiernan) points 
 out that in all degenerate forms, age of the parent must be 
 taken into consideration, since it alone often determines degen- 
 eracy. Conger found that the age of the mothers of degenerates 
 is often below twenty-five years. Korosi,^^ in an investigation 
 
 ^ The World's Columbian Dental Congress Transactions, page 109. 
 
 ^ Schultze : Fetichism. 
 
 ■^ Races of Men. 
 
 * Pacific Medical Journal, 1893. 
 
 ^ Sterility, Fecundity and Allied Topics. 
 
 "•11. Manicomo, May, 1886. 
 
 11 Alienist and Neurologist, 1887. 
 
 " Orvosi Hetilap, 1894. 
 
SOCIAL CONSANGUINITY, KARLY AND LATE MARRIAGE. 101 
 
 of the influence of the age of parents on the vitality of children 
 found that the proportion of deaths among children from 
 unhealthy constitutions or maladies traceable to the mother was 
 twice as large among the children of mothers under twenty 
 as among the children of mothers over thirty. The healthiest 
 ofTspring are born of mothers between twenty and thirty, united 
 to husbands between thirty and forty. Where either husband 
 or wife was under twenty, the offspring usually proved weakly. 
 This is particularly the case even in Hungary, where the girls 
 become women at thirteen. In that country in 25 per cent of the 
 number of marriages the brides are under twenty years of age. 
 Marro^^ finds that among all classes of criminals there is an 
 excess of immature parents (under twenty-five) or senile parents 
 (over forty-two). As I have elsewhere remarked, it is a well 
 known experience that the children of the aged readily show 
 degenerate types.^'* Arthur Mitchell arid Langdon Down have 
 recognized the influence of both premature and late marriage 
 in the production of idiocy. Factors capable of producing idiocy 
 may arrest foetal development at all stages. Kiernan^s has had 
 under observation a Nova Scotian family of Scotch extraction, 
 the mother of which continued to bear children until she was 
 sixty-three years old. There had been no pregnancy between 
 fifty and fifty-six. At fifty-six a son was born who had ear, 
 jaw and skull stigmata and became a periodical lunatic at twenty- 
 five. A son born a year after was a six-fingered idiot with 
 retinitis pigmentosa. Three of the next children were paralytic 
 idiots in infancy. One of the next children was a periodical 
 sexual invert female. The last child was an epileptic. The 
 children born before the age of fifty were normal and averaged 
 sixty years of age. 
 
 13 La Puberta, 1898. 
 1* Degeneracy, Op. Cit. 
 15 Detroit Lancet, 1882. 
 
CHAPTER XII. 
 
 ENVIRONMENT, CLIMATE, SOIL AND FOOD. 
 
 The influence of climate, soil, food and other factors of the 
 immediate environment was obvious to very early observers. 
 According to Hippocrates,^ "race is the daughter of climate." 
 The seeming modifications produced have made an impression 
 even on skeptical biologists like Weismann,^ who admits that 
 "the possibility is not to be rejected that influences continued 
 for a long time (that is, for generations, such as temperature, 
 climate, kind of nourishment, etc.,) which may afTect the germ 
 plasm as well as any other part of the organism, may produce a 
 change in the constitution of the germ plasm. But such influ- 
 ences would not then produce individual variations, but would 
 necessarily modify in the same way, all the individuals of a spe- 
 cies living in a certain district. It is possible, though it cannot 
 be proved, that many climatic varieties have arisen in this man- 
 ner. Possibly other phenomena of variations must be referred 
 to a variation in the structure of the germ plasm produced 
 directly by external influences." 
 
 The influence of climate depends upon more than the mere 
 range of temperature and meteorologic elements. Transferral 
 from a sub-temperate to a sub-tropic clime means not merely 
 a change in the necessity for adaptation to temperature altera- 
 tions, but also change in the ease with which food is produced 
 and the stress of the struggle for existence to which man has been 
 exposed. One of the most interesting changes apparently due 
 to the influence of soil and climate was that of the Wurtem- 
 burgers, who settled 82 years ago near Tifli>, Russian Georgia.^ 
 They originally had fair or red hair, light or blue eyes and 
 broad, coarse features. In the first generation, brown hair and 
 black eyes became the rule, while the lace acquired a noble, oval 
 
 1 Works Sydenham Edition. 
 
 2 The Germ Plasm. 
 
 ^ Keane, Ethnology, page 283. 
 
 102 
 
ENVIRONMF.NT, CLIMATE, SOIL AND FOOD. 103 
 
 foriiL Tliese changes were due entirely to the surroundings, as 
 no instance of crossing with Georgian neighbors was on record. 
 These Wurteniburgers continued to speak (icrinan uninfluenced 
 by local dialects. The Suabians, however, were a mixed race 
 in whom the surroundings in Wurtcmburg tended to develop 
 one type while those in Georgia tended to develop another. The 
 changes in the face, jaw and teeth consequent in these changes 
 in type became clearly evident. The original Wurtemburger 
 type had arrested facial development and prognathism, which 
 disappeared under the favorable conditions of Russian Georgia. 
 The instance illustrates very clearly the changes which have 
 produced the alleged transformation of the Britisher into the 
 Yankee, commonly cited in illustration of the supposed effects 
 of soil and climate. Over three decades ago,-^ ^ogt remarked 
 that American Anglo-Saxons or Yankees were instanced as illus- 
 trations of change of character. Already after the second gener- 
 ation, according to Pruner-Bey, the Yankee presents features 
 of the Indian type. At a later period the glandular system is 
 reduced to the minimum of its moral development. The skin 
 becomes like leather. The color of the cheeks is replaced by 
 sallowness. The head becomes smaller and rounder and is 
 covered with stifT, dark hair. The neck becomes longer. 
 There is greater development of the cheek bones and the mas- 
 seters. The temporal fossae become deeper, the jawbones more 
 massive, the eyes lie in deep approximated sockets. The iris 
 is dark. The glance is piercing and wild. The long bones 
 especially in the superior extremities are lengthened so that the 
 gloves manufactured in England and France for the American 
 market are of a peculiar make with long fingers. The female 
 pelvis approaches that of the male. According to Ouatrefages, 
 America has thus from the English race produced a new white 
 race which might be called the Yankee race. This hypothesis 
 has of late been strongly urged before the Chicago Academy 
 of Aledicine by F. W. Starr, Professor of Anthropology in the 
 University of Chicago, but no new facts favorable to it have been 
 adduced.-'' AMth improved conditions in New England this 
 
 * Lectures on Man, 1869. 
 
 5 Journal of the American Medical Association, Vol. XXXV. 
 
104 
 
 IRREGULARITIES OF THE TEETH. 
 
 accentuation, however, began to disappear. In place of the New 
 England type assuming increased Indian characteristics, the 
 reverse became the case. In the following illustration, four 
 generations of a New England family with a Scandinavian patro- 
 nymic are represented. The changes are as striking as those 
 which occurred in the Suabian before mentioned. The first 
 generation (born in 1761) is represented by a dolichocephalic 
 head (Fig. 27) with massive jaws and lips (especially the upper) 
 prominent. The nose is long. The eyes are set close together. 
 The forehead is very high and straight. In the second genera- 
 
 Fig. 27. Fig. 28. 
 
 tion (Fig. 28) the face is not so long. The lateral diameter is 
 larger. The forehead is more prominent. The eyes are a little 
 farther apart. The nose is about the same length. While there 
 is a general resemblance about the mouth and chin, the distance 
 from the front of the chin to the tip of the nose is not quite as 
 long. In this the shortening of the chin has played apparently 
 the chief part. In the third generation (Fig. 29) the forehead 
 is broader and less retreating than in the second. There is less 
 prognathism and less prominence in the supra-orbital region. 
 In the fourth generation (Fig. 30) appears a brachycephalic type 
 of head. It is nearly round. The forehead is full. The eyes are 
 
ENVIRONMENT, CLIMATE, SOIL AND FOOD, 
 
 105 
 
 set in the head to correspond with its width. The nose is broad. 
 The upper Hp is short. The lower jaw is much broader than in 
 the first generation and is evidently shorter in a perpendicular 
 line. These changes result from the formation of a protruding 
 forehead, receding chin and delicate features. 
 
 In the influence of climate must, however, be taken into 
 account, as already stated, modes of life. The distinction once 
 made by anthropologists between tropic and non-tropic races is 
 no longer tenable in a rigid sense. Experience of the British 
 in India and of the Hollanders in lava has shown that with 
 
 Fig. 29. 
 
 Fig. .30. 
 
 change of habits and food suited to the environment,^ Europeans 
 may not only live in the tropics with impunity but may improve 
 under the advantages these have over sub-arctic and temperate 
 zones. 
 
 These possibilities are the consequence of sound sanitation. 
 "The fairest laurel practical hygiene may boast of to-day is 
 doubtless the laurel acquired," Gihon'^ truthfully remarks, "in 
 ameliorating the sanitary conditions of the Europeans in tropical 
 climates." It proves the truth uttered a century ago by James 
 
 ® Degeneracy, Op. Cit. 
 "^ Sajous Annual, 1892. 
 
106 IRREGULARITIES OF THE TEETH. 
 
 Lind, "much more than to the climate, you are indebted to your 
 own ignorance and neghgence for the disease from which you 
 suffer in tropical climates." 
 
 Modern researches not entirely supporting the Hippocratian 
 declaration, tend to show that the vital resistance of the different 
 races in tropical climates depend more on external conditions 
 than on race. Acclimatibility of strong, healthy adult Europeans 
 of both sexes in tropical climates must be admitted without 
 reserve, provided that they assiduously observe hygienic rules. 
 Stokvis has disproved the allegation that the European is not 
 able to produce in tropical regions more than three or four 
 generations of true European blood, and that from the third or 
 fourth generation onward sterility is the rule. With the perma- 
 nent establishment of an American colony in the Philippines 
 these facts will be re-enunciated. 
 
 Among important factors to be considered in connection 
 with hygiene in the tropics are the questions of dietetics as well 
 as the effects of moist and dry heat. The two last produce, as 
 elsewhere shown, a neurasthenia with co-existing and complicat- 
 ing auto-intoxication. These^ two would peculiarly affect the 
 alveolar process.^ It is, therefore, not remarkable to find in 
 a recent report by General Otis, the case of Walter Fitzgerald, 
 Company C, twenty-eighth infantry, formerly of the Montana 
 volunteers, cited. This twenty-three year old man has been 
 in the Philippines for a year and seven months. He was one of 
 the first volunteers to reach Manila after the naval battle. Nine- 
 teen months' life in the tropics on the usual army rations has 
 resulted in the loss of nearly every tooth. While the climate 
 undermines nutrition of the alveolar process, and tropical 
 fevers have the same effect, improper diet increases the defect. 
 In the case of Fitzgerald, the teeth dropped out one by one, as 
 is commonly the case with Americans in the Philippines. 
 
 The English speaking race, albeit it is peculiarly representa- 
 tive of the upper temperate races, has shown itself able to endure 
 all climates. The type now forming in South Africa and Aus- 
 
 * Inter.stitial Gingivitis : Transactions, Section on Stomatology, Amer- 
 ican Medical Association, 1900, page 127. 
 ^ See Interstitial Gingivitis. 
 
ENVIRONMENT, CLIMATE, SOIL AND FOOD. 107 
 
 tralia recalls the early New England and Kentucky type of the 
 1 8th century, but will doubtless pass like it into a type resem- 
 bling that of the fourth generation illustrated. This race has in 
 its own home been peculiarly mixed. In its colonies it is still 
 more so, but despite this, preserves relatively permanent mental 
 and physical racial characteristics. The struggle to maintain the 
 mental state produces the variations in the teeth and jaws notice- 
 ably present in the English speaking races. The Scandinavian 
 nations, who resemble them in racial admixture and adaptability 
 to climate, have the same tendencies. 
 
 That climate does not exert the influence once claimed for it 
 is singularly well shown in Minnesota, where, thirty years ago, 
 government authorities claimed it was impossible for human 
 beings to live the whole year owing to extreme cold in winter. 
 Now not only is the soil cultivated throughout the entire state, 
 but still further north in Manitoba a large city has sprung up 
 surrounded by a very considerable farming population. The 
 influence of climate, therefore, can be guarded against by man 
 much more than any factor of his environment. 
 
 The influence of altitude on the physiologic characteristics, 
 while very obvious at times, is, however, frequently absent. 
 While as a rule residents at high altitude are strong, robust, 
 buoyant and of great mental and physical endurance, there are 
 numerous exceptions. 
 
 Hafner,^*^ of Zurich, has recently shown that "the engineers 
 and workmen on the Jungfrau railway obliged to remain a con- 
 siderable time at altitudes of about 2,600 meters above the sea 
 level are liable to a disagreeable complaint. After eight or ten 
 days they are seized with violent pains in several teeth on one 
 side of the jaw, the gums and cheek on the same side becoming 
 swollen. The teeth are very sensitive to pressure, so that masti- 
 cation is extremely painful. These symptoms increase in sever- 
 ity for three days and then gradually and entirely disappear. It 
 seems to be purely a phenomenon of acclimatization. All new- 
 comers pass through the experience and the disorder never 
 recurs." The influence of heat, of cold and of the barometric 
 pressure shown in a lesser degree in "mountain fever" produce 
 
 10 Die Natur, 1900. 
 
108 IRREGULARITIES OF THE TEETH. 
 
 systemic disturbance of metabolism which, causing- auto-intoxi- 
 cation, markedly affect the alveolar process, producing inter- 
 stitial gingivitis. 
 
 The effects of soil upon bone growth are best illustrated in 
 those associated with goitre and cretinism. Researches among 
 Indians on reservations tend to show the influence of high alti- 
 tudes ; climate or water containing excess of calcium-magnesium 
 salts, has been over-estimated. Among the Indians unsanitary 
 surroundings, depressing constitutional conditions, improper and 
 excessively nitrogenous diet, largely produce goitre and bone 
 changes often associated with it. 
 
 The influence of food in producing systemic changes which 
 involve interference with proper osseous development may be 
 divided into two factors. One involves the quality of the food 
 and the other its quantity and variety. One very emphatic illus- 
 tration of the first factor is the constitutional, skin, nervous and 
 mental disorder known as pellagra. This condition has received 
 much attention from French and Italian physicians. While 
 unhygienic surroundings play a part, pellagra^i is chiefly due to 
 spoiled maize taken as a food. The frequency with which jaw 
 and teeth stigmata are found with pellagra demonstrates how 
 potent is this factor of improper diet. Monotony of diet is 
 likewise a very emphatic cause of constitutional nervous dis- 
 order, such as distort osseous development. Monotony of diet, 
 as I have elsewhere shown,^- aggravated by monotony of sur- 
 roundings, has undoubtedly produced a large amount of degen- 
 eracy in the families of pioneers in the United States and of 
 farmers in secluded valleys in Norway, Switzerland and else- 
 where. Ray, Brigham of New York, Awl of Ohio, Patterson 
 of Illinois, and H. M. Stearns of Connecticut, have shown that 
 there is an unusual quantity of insanity in farmer's wives trace- 
 able to these conditions. A case reported by Kiernan, of Chi- 
 cago, is typical of those earlier described by the American 
 alienists just cited. The first generation was a woman of New 
 England stock, of tireless energy, to whom work was a pleasure 
 and rest an abhorrence and who lived on a farm miles from the 
 
 "Billed Pellagra. 
 
 12 Degeneracy, Op. Cit. 
 
ENVIRONMENT, CM M A TK, SOU, AND FOOD. 109 
 
 town. She did all her own work and brought up a large family, 
 chiefly on maize, potatoes and bread, pork being the meat diet. 
 At fifty this woman removed with her husband, who had grown 
 wealthy, to a small country town. Here she conducted the 
 entire work of the household without a servant. At fifty-two 
 she broke down with neurasthenia, which rapidly passed into 
 periodical gloomy spells, in one of which she committed suicide. 
 Her youngest daughter, who had an asymmetrical face, has the 
 periodical gloomy tendency of the mother alternating with 
 periods of restlessness, which evince themselves in doing unnec- 
 essarily the work of the servants and other labors inconsistent 
 with her huband's social status. She had at times suicidal and 
 homicidal impulses. She has three children; one exhibits no 
 special abnormality ; the eldest, a boy of eleven, dislikes to play 
 with boys because they are rough, plays with girls, to whom he 
 is at times mischievously cruel. He likes to sew doll's 
 clothing and purchase dolls, while there are other indications of 
 sexual abnormality. The youngest, a girl, has frequent attacks 
 of epileptic-like fury, although between these she is kind-hearted, 
 good humored and very affectionate. 
 
 The fungus on maize (ustilago) like the fungus on rye (ergot) 
 produces rather long lasting neuroses of epileptic character, 
 susceptible of transmission to the offspring of women poisoned 
 by the fungi. 
 
 The influence of vegetarian diet seems to be deteriorating 
 to the races who are restricted to it alone. These races are 
 usually cowardly, meanly cruel, extremely mendacious, untrust- 
 worthy, weak in stamina and readily yield to morbid influences. 
 
 The influence of potato diet in degenerating the Irish Celt 
 in comparison with the Scottish Celt under the same conditions 
 is difficult at present to determine for lack of data. Certainly 
 the descendants of this class of Irish Celts rapidly regain a 
 handsome, healthy status under mixed American diet, even 
 though the hygienic surroundings in the great cities be not the 
 best. He who has to treat a class of neurasthenics in whom 
 starch digestion is impaired finds that a diet of potatoes 
 (undoubtedly through the auto-intoxication it produces) will 
 increase certain nervous symptoms and hence the tendency to 
 
110 IRREGULARITIES OF THE TEETH. 
 
 transmission to the next generation. The widespread influence 
 of nutrition is excellently illustrated in the conditions produced 
 in children and in the insane, by improper food and the reaction 
 of these to hygienic diet. Improper diet in the child may, as 
 Christopher^^ j^^s shown, produce all possible nervous disorders, 
 including those involving the trophic processes. This is pecul- 
 iarly evident in scurvy and rickets and their effects on the general 
 osseous development. Improper maternal diet during preg- 
 nancy may, as Elise Berwig^"* has shown, produce similar effects. 
 
 The influence of the maternal environment upon the foetus 
 has been much underrated because of the belief that the placenta, 
 by its filtering and poison-destroying function, protected the 
 foetus. That this was an error in many respects has been 
 already shown by the arrests of development produced by the 
 toxines of the great contagions. It, however, justified for a 
 time hazardous occupations for pregnant women. Later investi- 
 gation showed that not only did organic poisons, like opium, 
 pass through the placenta, but that mineral poisons, like lead, 
 did also. Calkins,^ ^ nearly four decades ago, pointed out that 
 the children of opium-using mothers died in the first months 
 after birth unless given opium. Bureau later showed that in 
 such cases the umbilical cord contained large quantities of mor- 
 phine. 
 
 Many years ago it was known that the children of the work- 
 ers in tobacco factories exhibited very little vitality and much 
 deformity .i** As tobacco is a government monopoly in France 
 an attempt was made to destroy this opinion by a cooked report 
 from the Imperial authorities. The evidence, however, from 
 other sources contradicted this report and the latest investiga- 
 tions in France (those of Etienne^'^) strongly support previous 
 opinion that maternal work in tobacco factories is, as I have 
 elsewhere shown,^^ the cause of frequent miscarriage, of high 
 infantile mortality, of defective children and of infantile convul- 
 
 ^3 Cited in Degeneracy, Op. Cit. 
 
 1* Medicine, 1898. 
 
 IB The Opium Habit. 
 
 1' Annual of the Universal Medical Sciences, 1892. 
 
 1' British Medical Journal, April 23, 1898. 
 
 18 Degeneracy, Op. Cit. 
 
ENVIRONMENT, CLIMATE, SOU, AND FOOD. Ill 
 
 sions. The influence of mineral poisons has been carefully 
 studied by Porak,i" who has found that lead and phosphorus 
 pass through the placenta and enter the child's circulation. Lead, 
 as I have elsewhere pointed out, has been found to produce 
 in those exposed to its fumes systemic nervous exhaustion, 
 characterized by local paralysis about the wrist as well, as the 
 general symptoms of profound systemic nerve tire. This may 
 result, as Tanquerel des Planches^o pointed out nearly half a 
 century ago, in acute insanity of the confusional type followed 
 very often by forms of mental disorder of a chronic type resem- 
 bling paretic dementia. In some cases the patient recovers 
 from the acute insanity to suffer thereafter from epilepsy. In 
 other cases, as Kiernan has shown,2i an irritable suspicional con- 
 dition results in which the patient may live for years, marry 
 and leave offspring. This last condition and the epileptic are the 
 most dangerous as to the production of degeneracy. As already 
 pointed out,22 the women employed in the pottery factories in 
 Germany sufTer, according to Rennert,-^ from a form of lead 
 poisoning which produces decidedly degenerative effects upon 
 the offspring. These women had frequent abortions, often 
 produced deaf-mutes and very frequently macrocephalic chil- 
 dren. On investigation of the Staffordshire potteries,^'* similar 
 conditions have been observed. Kiernan^^ has reported the case 
 of a macrocephalic idiot born of a mother who had lead poison- 
 ing while a worker in a Staffordshire pottery. Brass workers, 
 as I have pointed out some years ago, suffer from a very similar 
 condition to that produced by lead. Hogden,^^ of Birmingham, 
 over half a decade ago, called attention to the grave forms 
 of nervous exhaustion produced among brass workers. His 
 results have since been confirmed by German and other observ- 
 ers.^^ The period during which the patient is able to pursue 
 
 1^ University Medical Magazine, 1895. 
 
 20 Lead Diseases, American Edition, 1848. 
 
 21 Journal of Nervous and Mental Diseases, 1881. 
 "- Degeneracy, Op. Cit. 
 
 23 American Journal of Obstetrics, 18B2. 
 -* British Medical Journal, August, 1900. 
 25 Obstetrics, Feb., 1900. 
 -^ Birmingham Medical Review, Jan., 1887. 
 27 Medicine, 1901. 
 
112 IRREGULARITIES OF THE TEETH. 
 
 his occupation without breaking down is longer than that of the 
 lead workers. Women, like men, are exposed to this condition. 
 The chief efit'ect produced so far as offspring has been observed 
 are frequent abortions and infantile paralysis. 
 
 The occupations employing mercury (whether mining, mirror 
 making or gilding) produce systemic nervous exhaustion in 
 which the most marked symptoms (but less important from a 
 sanitary standpoint) is a tremor amounting at times to shaking- 
 palsy. Like all other systemic nervous exhaustion, the mercurial 
 one may appear as degeneracy in the offspring. The employ- 
 ment of women in match factories and tenement house sweating 
 shops is growing. The chief toxic effects of phosphorus is 
 not the localized jaw neurosis. This is but an evidence of the 
 progressive system saturation with phosphorus. It bears the 
 same relation to the more dangerous effects of phosphorus that 
 "blue gum" does to the systemic effects of lead.^s 
 
 Workers in carbon bisulphide have been noted to suffer from 
 the initial stages of interstitial gingivitis. Lazarus^^ has recently 
 reported the cases of twenty young women employed in rubber 
 factories who exhibited a necrotic process in the jaws and teeth 
 similar to that resultant on phosphorus. 
 
 28 Degeneracy, Op. Cit. 
 
 29 Allg. Med. Cent. Ztg., Dec. 22, 1900. 
 
CHAPTER XIII. 
 
 RACE AD?^IIXTURE. 
 
 Race admixture has l)een greatly underestiinatcd. Etliuic 
 researches of the past decade have thrown much doubt t)n the 
 standards set up as race tests. 
 
 It is usually assumed a clear distinction can be made on philo- 
 k)gic grounds between different races, and even Aryan races can 
 be easily separated. This, however, ethnology has shown to be an 
 error. The following table, modified from Keane, demonstrates 
 that speech is no test of race : 
 
 Peoples. 
 
 Ethnic Group. 
 
 Linguistic 
 
 Family 
 
 English and Lowland 
 
 Kelto-Teutonic 
 
 Teuton io 
 
 
 Scotch. 
 
 
 
 
 Cornish 
 
 Silure-Kelto-Teutonic 
 
 Teutonic 
 
 
 Welsh 
 
 Silure-Kel to-Teutonic 
 
 PCeltic 
 
 
 Scotch (Highland) 
 
 Silure-Kelto-Teutonic 
 
 Keltic 
 
 
 Irish (West) 
 
 Silure-Kelto-Teutonic 
 
 Keltic 
 
 
 French 
 
 Ibero-Kelto-Teutonic 
 
 Italic 
 
 
 Spaniards 
 
 Teuto-Ibero-Keltic 
 
 Italic 
 
 
 Germans 
 
 Slavo- Kelto-Teutonic 
 
 Teutonic 
 
 
 Bohemians 
 
 Kelto-Teuto-Slavonic 
 
 Slavonic 
 
 
 Russians (many) 
 
 Finno-Slavonic 
 
 Slavonic 
 
 
 Fins (manjO 
 
 Teuto-Slavo-Finnic 
 
 Teutonic 
 
 
 Bulgarians 
 
 Ugro-SIavonic 
 
 Slavonic 
 
 
 Hungarians (Magyars) 
 
 Ugro-Teuto-Slavonic 
 
 Finnic 
 
 
 Prussians (East) 
 
 Letto-Teuto-SIavonic 
 
 Teutonic 
 
 
 Roumanians 
 
 Italo-Slavo-Illyric 
 
 Italic 
 
 
 Italians 
 
 Teuto-Liguro-Kelto- 
 Italic 
 
 Italic 
 
 
 Profoundly mixed as this table indicates European races to be, 
 it is far from representing, as I have elsewhere^ shown, the full 
 extent of race mingling. The primitive worship of the Slavonic 
 Czernebog by the Saxons in England demonstrates a Slavonic 
 strain derivable, as Kiernan suggests, from their contact with 
 the W'ends of the Baltic. Xot merely are the Aryan races of 
 Europe mixed together, but the blood of all has a pre-Aryan 
 
 1 Degeneracy, Op. Git. 
 
 9 113 
 
lit IRREGULARITIES OF THE TEETH. 
 
 and a Turanian dash. As Taylor,- Windle-" and others have 
 shown, the Iberian type is found in Wales and Scotland as well 
 as elsewhere, though in lesser degree. These admixtures date 
 back to palaeolithic times when, although the predominant type 
 of skull was dolichocephalic (or long-headed), the brachycephalic 
 (or round-headed type) had begun to appear in America, then 
 connected by land with both Africa and Europe. In subsequent 
 neolithic times, while the type is at first generally brachycephalic, 
 it soon becomes mesocephalic (mixed long and round-headed), 
 pure brachycephalic and dolichocephalic becoming rare. 
 
 As Starr-* admits, even the race type called the American 
 Indian still so retains traces of the race elements forming it in the 
 pleistocene period that these elements are yet distinguishable 
 by ethnologists. In nose types the American Indian race leans 
 toward its proto-caucasic rather than its proto-mongolic or 
 proto-negroid elements. 
 
 Three types appear in Great Britain and Ireland and traces 
 of their blood are still detectable in living men. Sir Walter 
 Scott draws an excellent picture of one in "Rob Roy," whose 
 hero, according to reliable tradition, presented the Pict type. 
 Gomme^ has shown these races persisted long enough to stamp 
 their savage beliefs on coming races and intermingled with them. 
 The Neolithic race in Great Britain was dark, of feeble build, 
 short stature, with dolichocephalic skulls. This race remained to 
 the historic period as the Silures in Great Britain and the Fir- 
 bolgs in Ireland. It had high cheek bones and oblique eyes, 
 as Kiernan^ points out. Towards the middle of the neolithic 
 period this race "was conquered by a brachycephalic, tall, long- 
 armed, muscular race, with florid complexion and yellowish or 
 red hair. Scott's "Rob Roy" is an example of this type. A 
 third race of fair complexion with prognathous jaws, dolicho- 
 cephalic skulls, of tall stature, great bones, great chest develop- 
 ment and massive jaws, later invaded Great Britain. 
 
 As the intermingling of races began early, the question of 
 
 2 Origin of the Aryans. 
 
 3 Life in Early Britain. 
 
 4 Journal of the American Medical Association, Dec. 15, 1900, p. 1575. 
 ^ Ethnology in Folklore. 
 
 6 Alienist and Neurologist, 1891. 
 
RACE ADMIXTURE. 115 
 
 the existence of pure races to-day, or even during the historic 
 period, is an open one. The Hebrews have been comparatively 
 pure since the return from captivity. Before that, as the history 
 of Solomon's foreign marriages demonstrates, they were, as 
 Laing shows, a raceless chaos, the Semitic element predominat- 
 ing." Researches by Flinders Petrie and others indicate that the 
 Copts or ancient Egyptians were a mixture of Turanians, Ham- 
 ites, Aryan and Semite peoples imposed on a negroid basis. 
 When these elements were finally fused, the race bred relatively 
 true, although the lower classes tended to the negroid type and 
 the higher to the Caticastic. 
 
 The Coreans are a mixture of two primitive races, one white 
 and one yellow. The Japanese, whose ancestors emigrated to 
 Japan from Corea, are, according to Topinard,^ the product 
 of the addition of three distinct types to that forming their 
 Corean ancestors. The Caucasic, to a small extent, The Poly- 
 nesian to a greater, and the Malay to a still greater, are mixed 
 with the original Corean. 
 
 The Chinese are neither a homogenous people nor a pure 
 race, albeit the relatively few Mantchus are dominant. The 
 Aryan of India, on whom Max Muller laid such stress, is known 
 to be, despite a rigid caste system, a non-Aryan race, feebly 
 infused with a modicum of Aryan blood. The so-called "Gypsy" 
 seems of all the races of India to have retained most xA.ryan 
 speech and type as well as original Aryan semi-nomadic 
 wagon-journeying in the midst of settled civilization. Ghetto 
 seclusion long helped to preserve relative purity of race in the 
 Jew, but despite vagabond surroundings the "Gypsy" has 
 remained even purer. 
 
 Great as has been the mixture of even widely separated types 
 like three races described as mingling in Great Britain and Ire- 
 land, even greater admixture occurred in comparatively late his- 
 toric times. The so-called Scotch-Irish (whose blood enters so 
 largely in the dominant race of the United States), despite their 
 speech (much more Teutonic and monosyllabic than English) are, 
 asKiernan has shown, a raceless chaos of Gaelic and Cymric Celts, 
 
 "^ Human Origins. 
 8 Anthropology. 
 
116 IRREGULARITIES OF THE TEETH. 
 
 Lowland Scotch, French Huguenots, Danes (Celto-Teuto-Slaves), 
 Palatinate Germans, Magyars, English Puritans, Hollanders, 
 Swedes, Protestant Italians, Poles and Spaniards. The inter- 
 mixture of the dark, small-boned dolichocephalic, orthognathous 
 (with in-drawn jaws) race with the brachy cephalic, prognathous, 
 big-boned, red-haired, and then with dolichocephalic, progna- 
 thous, deep-chested, big-boned fair race, produced in the British 
 Isles as marked variations in type as now occur from the admix- 
 ture of the Indian and the Negro. While religion played a part 
 in these admixtures in the British Isles, war, commerce and 
 art also exerted an influence. Bunyan, the author of the "Pil- 
 grim's Progress," was the descendant of Bunyano,^ an Italian 
 architect, imported to build Melrose Abbey. The destruction 
 of the Spanish Armada introduced Spanish elements all along 
 the West and East coasts of, England, Ireland and Scotland. 
 The capture of Calais by the French from Mary Tudor added 
 a French colony to London. 
 
 In Scandinavia (Denmark, Norway and Sweden), race admix- 
 tures, although less discussed, are as great as those in the British 
 Isles. The primitive race called the Quens was of Eskimo type. 
 This race was first intermixed with a tall, long-armed, brachy- 
 cephalic, muscular race with florid complexion and yellowish 
 or red hair. The race resultant on this mixture was later fused 
 »with a third having prognathic jaws, large dolichocephalic skulls, 
 tall stature, great bones, great chest development but small 
 hands and high arched feet. After these race admixtures had 
 formed the Scandinavians, who became the sea kings, the inter- 
 mixture with other races still continued. Around Bergen, Nor- 
 way, was, as Mantegazza^^ points out, an Irish colony with well- 
 formed, delicate features, brunette complexion, oblique blue 
 eyes and black hair. The influence of this colony is still so 
 demonstrable as to be frequently used in fiction by writers like 
 Bjornson.ii As there were dilYerent types of skull and face 
 among the races making up the English-speaking and Scandi- 
 navian-speaking peoples, the contest for existence (between the 
 
 ^ Notes and Queries, it 
 1" Physiognomy. 
 11 "In God's Ways." 
 
RACE ADMIXTURE. 117 
 
 organs of man) centered itself with peculiar intensity on struct- 
 ures which, like the jaws and teeth, are so variable with a rise 
 in the scale of evolution. The scion of an orthognathic mother 
 and prognathic father would have marked irregularity of the 
 jaws and teeth destitute of the significance of the depth of degen- 
 eracy implied by the same irregularities in a purely prognathic 
 or orthognathic race. Food which exacted less active functions 
 on the part of the jaws and teeth in such a mixed race would 
 imply an intense struggle for existence between the different 
 teeth and this struggle and would proceed with greater or lesser 
 intensity as the organism was or was not afifected by that con- 
 stitutional nerve strain, which precedes general degeneracy. The 
 different factors afifecting the constitution of the ancestor create, 
 as has been shown already, a general loss of nerve tone, which 
 reheves the local nerve systems of control by the central nerve 
 system. These local nerve systems take on a feverish activity 
 in consequence and become themselves exhausted. In propor- 
 tion, therefore, as the general nervous system has control would 
 the evolution of the teeth and jaws, in their relation to the organ 
 struggle for existence, proceed with regularity. 
 
 The influence of food, while beneficial to the organism as a 
 whole, may, as already pointed out, introduce a struggle for 
 existence between the teeth, which would cause local degenera- 
 tions of these and the jaws. Even in man, employment of the 
 teeth and jaws as a weapon of ofifense and defense would prevent 
 that degeneracy as a jaw otherwise consequent upon decreased 
 use resultant on a change from vegetable and nut diet to the 
 more easily digested and masticated meat or fish diet. The per- 
 sistence of prognathism in races as high as those described even 
 when brachycephalic is an indication that the use of the jaw 
 for a weapon interfered with its degeneracy consequent on im- 
 proved food. It may be admitted that man was a vegetable 
 feeder originally, but, as shown by the atrophic tendency of the 
 vermiform appendix, he early became a user of animal food, 
 albeit not to the extent of the carnivorous mammals in whom 
 the appendix has disappeared. This change, however, early 
 initiated a tendency to variability in the jaws and teeth. 
 
 This variability is excellently shown in the following illus-. 
 
1]8 
 
 IRREGULARITIES OF THE TEETH. 
 
 trations, of four generations of so-called "Anglo-Saxon" Ameri- 
 cans of the Knickerbocker type : 
 
 Fig. 31. Here is seen a probably Neolithic Hollander type 
 with low receding negroid forehead, small sunken eyes, protrud- 
 ing nose and upper jaw, short upper lip, cheek bones prominent, 
 receding lower jaw. 
 
 Fig. 32. This subject was born of the previous type, settled 
 in New York. The change in climate has altered the face con- 
 siderably. The forehead is higher, broader, and more promi- 
 
 
 Fig. .3-^ 
 
 ncnt. The eyes are large and not so deeply set. The cheek 
 bones are not so prominent, nose and upper jaw less prom- 
 inent, upper lip longer, chin the same. 
 
 Fig. 33. Admixture of race types has produced a forehead 
 broad and full, eyes less sunken, recession of cheek bones, nose 
 and upper jaw ; upper lip same; lower jaw broader, anterior posi- 
 tion same. 
 
 Fig. 34. Here the forehead is still broader, more prominent, 
 higher ; large, round eyes. There is more recession of the cheek 
 bones. The nose and upper jaw are the same. The face broader, 
 lower jaw broader and anterior position same. 
 
RACE ADMIXTURE. 
 
 110 
 
 This variability is an expression of the law of economy of 
 growth whereby an organ under the influences of the struggle for 
 existence, degenerates from the ideal type of the organ as an 
 organ for the benefit of the organism as a whole. This variabil- 
 ity along local lines of degeneracy has, as De Moor^- shows, 
 peculiarly taken the line of least resistance in the jaws and 
 teeth. 
 
 
 Fig. 33. 
 
 Fig. 34. 
 
 The tendency in race admixture (when the new blood is of 
 stocks with large jaws and regular teeth) is to stamp out local 
 influences which tend to produce arrest of development and 
 irregular teeth. By constant race admixture the jaws retain 
 their normal regular shape. The tendency of the child to inherit 
 the small jaws of one and the large teeth of the other or vice 
 versa is a fruitful source of facial and jaw deformity. 
 
 ^2 Evolution by Atrophy. 
 
CHAPTER XIV. 
 
 CONSTITUTIONAL DISORDERS. 
 
 The influence of constitutional disorders on the development 
 of the skull and face must be viewed from two standpoints. 
 First, from the standpoint of the mother affected during- preg- 
 nancy, and. second, from the standpoint of the foetus affected 
 during intra-uterine life, or of the child affected precedent to 
 or during the periods of stress. The influence of constitutional 
 disorders, especially the infections upon the mother, may, as I 
 have pointed out elsewhere, result in the bony maldevelopment 
 shown to occur in animals by Charrin and Gley,^ and in man by 
 Coolidge. The facial bones, jaws and teeth are peculiarly liable 
 to this. Though the effect of the disease on the parent be but 
 temporary, foetal development may be checked as to higher ten- 
 dencies. Thus mothers have borne moral imbeciles, epileptics, 
 lunatics or deformed children after a pregnancy during which 
 they were attacked by contagious disease. The children of sub- 
 sequent and previous pregnancies were normal. 
 
 The children of pregnancies previous to the one complicated 
 by the contagious disease may be healthy, while those of subse- 
 quent pregnancies are defective. Any contagious or infectious 
 disease may not only interfere temporarily with the bodily 
 strength, but may produce complete change in the parent's sys- 
 tem, extending even to the highest acquirements of man. In 
 some occur changes thus graphically described by Buhver :^ 
 "There have been men who, after an illness in which life itself 
 seemed suspended, have arisen as out of a sleep with characters 
 wholly changed. Before, gentle, good and truthful, they now 
 become bitter, malignant and false. To those whom they before 
 loved they evince repugnance and loathing. Sometimes this 
 change is so marked and irrational that their kindred ascribe it 
 to madness. Not the madness which affects them in the ordinary 
 business of life, but that which turns into harshness and discord 
 
 ^ Degeneracy, op. Cit. 
 
 120 
 
CONSTITUTIONAL DISORDERS. 121 
 
 the moral harniony which rcsuUs from natures whole and com- 
 plete."2 
 
 The nerve centers controlling nutrition, growth, repair, secre- 
 tion and excretion are often as deeply affected as those checks 
 constituting morality. At the periods of physiologic .stress these 
 effects are especially noticcahle. Moral insanity, intellectual 
 insanity, unequal mental balance, hysteria, precocious sexuality, 
 unconscious mendacity, mental parasitism (the germ of pauper- 
 ism), epilepsy, neuroses and all types of nutritive and constitu- 
 tional defects result. The nutritional defects may appear chiefly 
 in the walls of the blood vessels and lymphatics, as in scurvy 
 mercurial poisoning.-^ etc. While these are most common in 
 , the chronic infections and contagions, they often occur in acute, 
 typhoid fever, scarlatina, diphtheria, whooping-cough, etc. 
 Proper blood supply and utilization of waste is thus prevented. 
 Organs cannot perform their function, and are predisposed to 
 disease from disuse and from w^eakness of the disease-fighting 
 phagocytes and antitoxins. From this results irregularity of 
 organ function, which is hereditarily transmissible. The weak- 
 ened vessel walls yield to strain, and thus produce local stom- 
 ach, bowel, liver, gland, and kidney disorders. This organ weak- 
 ness may alone be transmitted to the offspring. The functions 
 of the great ductless glands (thyroid, thymus, adrenals, pituitary 
 body, bone-marrow, etc.) which secrete principles necessary to the 
 equal balance of nutrition, are perverted. The liver, in the acute 
 but more particularly in the chronic contagions, paralyzed in 
 nerve tone, fails in its functions, nutritive and poison-destroying, 
 as for the same reason the kidneys fail in their power of eject- 
 ing hurtful waste. Through this, interaction of perverted nutri- 
 tion, imperfect' poison-destruction and deficient waste ejection 
 result and continue the states of nervous exhaustion after the 
 contagions and infections. Thus nerve exhaustion, with its 
 suspicion, its capricious hopefulness and gaiety, is practically 
 continuous in tuberculosis, syphilis and leprosy. 
 
 The influence on bony and dental development of all consti- 
 tutional diseases in a general way resembles the influence of 
 
 - "A Strange Story." 
 3 Interstitial Gingivitis, 
 
122 IRREGULARITIES OF THE TEETH. 
 
 syphilis. This influence is exerted in two ways. First, on the 
 individual, which may affect development of the bones or teeth 
 if it occur during the periods of evolutionary stress. Syphilis 
 contracted during- infancy thus affects the development of the 
 teeth. The same is true of all infectious diseases to a greater or 
 lesser extent and is also true of conditions like scurvy and rick- 
 ets. In a general way also the influence is of the contagious 
 diseases as exerted on the descendant of two types. Firstly, 
 the direct transmission of the disorder, which must be regarded 
 as intra-uterine infection, and, secondly, the transmission from 
 the ancestor to the descendant of sundry pathologic characters 
 having, as E. Fournier* remarks, nothing specific per se, but con- 
 sisting perchance in native inferiorities of constitution, of tem- 
 perament, of vital resistance, perchance in retardations, arrests 
 (Fig. 35) or imperfections of development, mental, physical or 
 manifested in organic changes ; either malformations of organs 
 or monstrosities. The first of these heredities in the case of 
 syphilis has received the title of syphilitic heredity, properly 
 so-called. The second has received several synonymous titles ; 
 parasyphilitic heredity, dystrophic heredity, or toxinic heredity. 
 In the last toxins produced by germs or poisons produced by 
 maternal nutritional defects cause the arrests, retardations, 
 imperfections of development seen in the children of otherwise 
 healthy mothers suffering from the infections and contagions or 
 from nutritional disorders or defects just precedent to, or during, 
 the period of pregnancy, or, during the period of lactation. Dur- 
 ing the periods of stress, moreover, if these toxins or allied sub- 
 stances be generated in the individual organs, they cause the 
 bony and dental arrests, retardations and imperfections of devel- 
 opment so frequently noticed after scarlatina, pneumonia, cere- 
 bro-spinal meningitis, etc., as well as rickets and allied condi- 
 tions occurring during infancy and childhood. 
 
 The regenerative process in all tissues is below par in consti- 
 tutional diseases. Hence wounds do not heal as readily in a 
 person the subject of constitutional disease. The development 
 of tissue from an embryonal type to mature tissue is identical 
 with the regenerative process in the healing of wounds. There- 
 
 * Stigmates Dystrophiques de I'Heredo-Syphilis, 
 
CONSTITUTIONAL DISORDERS. 123 
 
 fore, the causes which retard the one process must retard the 
 other. According to Mctschnikoff, the energy of the organism 
 is expended in repelHng the advances and barring the further 
 progress of the micro-organisms or other causes of constitutional 
 diseases. In consequence of this continuous warfare between 
 the ceHs and microbes the tissue cells, that are regenerated, do 
 not increase the size of the organs as in normal development. 
 
 Fig. So. 
 
 Senile Stres.s Period of Intra-Uterine Life: 
 four and a half months. 
 
 These constitutional diseases cause arrests of development, which 
 may become permanent from the time of the disease. More 
 often the growth of the child is stopped for one or more years, 
 and frequently development will not proceed until the child is 
 taken to another climate. The effect upon the jaws and teeth 
 is very marked, especially in the upper jaw. When arrest of 
 development of the teeth takes place, frequently pits and furrows 
 are found upon the enamel. By these pits and furrows, the 
 
124 IRREGULARITIES OF THE TEETH. 
 
 exact year when the arrest of development took place may be 
 determined. Hutchinson's teeth, familiar to physicians, dentists 
 and syphilographers, are striking illustrations of this fact. 
 
 The eruptive fevers in children have a tendency to leave the 
 system in a neurotic condition. Children, who before were 
 apparently healthy, after these diseases are sickly and ailing for 
 years, and sometimes they never wholly recover. Such condi- 
 tions affect the eyes and ears and not infrequently the organs 
 of speech. The eyes remain weak, occasionally the patient 
 becomes nearly or quite blind. The hearing is frequently perma- 
 nently impaired ; occasionally the nerve centers, which preside 
 over the development of the osseous system. There is a general 
 arrest of development of the whole body. Such persons not 
 infrequently remain sickly, neurotic or morally imbecile. While 
 they may regain health, the body ceases to develop normally. 
 
 A young girl, now twenty, born of apparently healthy parents, 
 had a severe attack of scarlet fever at the age of seven years. 
 Arrest of development of the upper jaw, and a V-shaped arch 
 developed ; she has been near-sighted ever since and now has 
 very weak eyes ; stopped growing for three years. She was taken 
 to California and Europe, and has now regained her full growth. 
 
 A boy, now fourteen, had pneumonia at the age of four. 
 Arrest of development of the bones of the face is very marked ; 
 he has stopped growing and is now very small for his age. 
 
 A young lady, now twenty-seven years of age, had scarlet 
 fever at the age of four, with a resultant deaf-mutism. The 
 bones of the face and jaws are undeveloped. She possesses a 
 marked V-shaped arch. The pits and grooves upon her teeth 
 denote the age when she had the disease. She has developed 
 into a very handsome, full-grown woman. 
 
 A lady, now forty-five years of age, had scarlet fever at three 
 years. Her eyes became inflamed and she lost her sight for 
 twenty-four years, when they gradually grew better. The bones 
 of the face were arrested in development. 
 
 Arrest of development or retardation or imperfection may 
 take place at any period up to the time of full growth. Arrest 
 of development of the jaws, however, as a result of constitutional 
 disease must occur prior to the sixth year to produce dental 
 
CONSTITUTIONAL DISORDERS. 125 
 
 deformities. However, this is somewhat modified by the influ- 
 ence of the constitutional disorders on the hypophysis, which 
 may lead to the excessive developments of bony tissue anywhere 
 that occur especially in acromegaly, giantism, etc. 
 
 Some arrests of development charged to direct specificity are 
 in reality conditions due to toxinic or nutritional causes. The 
 "old man" appearance of congenital syphilis is in reality an 
 arrest of development of the foetus at the 4.1-month of intra- 
 uterine life ; the so-called senile period. This arrest of develop- 
 ment is produced by other causes than syphilis, whence the senile 
 state in degenerates described by Souques, myself and others. 
 
 One expression of degeneracy peculiarly apt to occur around 
 the periods of stress is the condition known as haemophilia, which 
 is an hereditary constitutional defect evincing itself from a defi- 
 cient coagulability in a tendency to uncontrollable bleeding, 
 either spontaneous or from slight wounds. This is sometimes 
 associated with sub-oxidization conditions, like arthritis and 
 lipomatosis. This diathesis has long been known. As a rule 
 (to which exceptions exist), the mother of the haemophile, 
 according to Nasse, is not a "bleeder" herself, but is the daughter 
 of one. The daughters of a hasmophile, though healthy, transmit 
 the diathesis to the male offspring. Haemophilia generally 
 appears after slight injury during the periods of the first denti- 
 tion. 
 
 The Appleton Swain family, of Reading, Mass., has had 
 "bleeders" for two centuries. Osier has reported instances in 
 the seventh generation. Kolster, who has investigated haem- 
 ophilia in women, reports a case in the daughter of a female 
 haemophiliac. On his analysis of fifty genealogic trees of haem- 
 ophiliac families, it is evident thatNasse's law of transmission 
 is not absolute. In fourteen cases the transmission was direct 
 from father to child, and in eleven cases it was direct from mother 
 to infant. Haemorrhagic symptoms of bleeders are, as Gould 
 points, divisible into external bleedings, either spontaneous or 
 traumatic interstitial bleedings, petechias, ecchymoses and joint 
 affections. External bleedings are seldom spontaneous, but 
 generally follow cuts, bruises, scratches. A minor operation on 
 a haemophile may prove fatal. So slight an operation as draw- 
 
126 IRREGULARITIES OF THE TEETH. 
 
 ing a tooth has been followed by the most disastrous conse- 
 quences. Gum lancing- is equally dangerous. Healthy blood 
 placed on the wound has often so coagulated as to check bleed- 
 ing. This produce is not destitute of dangers as to infection 
 and embolism. Bleeder families are often multiparous, healthy 
 looking and have fine, soft skins. They are, hence, not often 
 suspected of "bleeding"' tendencies by the practitioner who sees 
 them for the first time. 
 
CHAPTER XV. 
 
 INTELLECTUAL AND MORAL DEFECTS. 
 
 There is, as I have elsewhere indicated/ a complete transi- 
 tion from the durencephalic (in whom the chondrocranium alone 
 occurs) monster through the microcephalus, the idiot, the imbe- 
 cile and the feeble-minded, to the mentally normal person. Be- 
 tween the feeble-minded and the normal individual occurs a 
 group whose general characteristics are, as Alagnan remarks, 
 a disharmony and lack of equilibrium not only between the intel- 
 lectual operation properly so-called on the one hand and the 
 emotions and propensities on the other, but even between the 
 intellectual faculties themselves. A degenerate may be a scientist, 
 an able lawyer, a great artist, a poet, a mathematician, a poli- 
 tician, a skilled administrator, yet present from a moral stand- 
 point, profound defects, strange peculiarities and surprising 
 lapses of conduct. As the ethic element (the emotions and 
 propensities) is the basis of determination, it follows that these 
 brilliant faculties are at the service of a bad cause, of the instincts 
 and appetites which, thanks to will defects, lead to very extrava- 
 gant acts. Sometimes the opposite occurs. Degenerates of irre- 
 proachable character may show defects in their intellect, may 
 have feeble memory in certain directions or may be unable to 
 understand figures, music or drawing. In a word an otherwise 
 normal intelligence is lacking as regards certain faculties. The 
 centers of perception are unequally impressionable; are unequally 
 apt to gather together impressions and hence register some 
 impressions only as to leave durable images. Certain relations, 
 certain associations between different centers are perverted or 
 even entirely destroyed. Nearly normal conditions which belong 
 to this category are those sentimentalists, pessimists and neu- 
 rotics. 
 
 Great as is the apparent gap between idiocy and one-sided 
 genius, on the one hand, and between idiocy and crime on the 
 
 1 Degeneracy, op. Cit. 
 
 127 
 
128 IRREGULARITIES OF THE TEETH. 
 
 other, this gap is, as already stated, filled by numerous closely 
 interlinked forms dependent on the proportionate removal of 
 checks (which the race has acquired during evolution) on the 
 explosive expressions of egotism. The removal of these checks 
 is dependent on the absence or weakening of brain associating 
 tracts. The idiot capable of only purely vegetative functions 
 who would perish were food not placed far back in his mouth, 
 is one step lower than the normal infant who is, as has been 
 remarked by Harriet Alexander," an egotistic parasite. On 
 slightly increased development, the idiot with the powers of a 
 rather low animal, gains food and satisfies its instinct. These 
 instincts at this stage may manifest themselves in the explosive 
 manner characteristic of the undomesticated and non-social ani- 
 mals. With these instincts may appear others which man has 
 long lost. Thus an idiot girl (who was delivered of an infant 
 when alone) gnawed through the umbilical cord in the manner 
 of animals, effecting separation and preventing hemorrhage. At 
 still a higher stage the imbecile may manifest destructive 
 instincts, may steal without the signs of remorse exhibited by a 
 housebred dog or may kill without recognizing the results of 
 killing. The intellect may be comparatively developed in certain 
 imbeciles in comparison with the ethical defect. For lack of 
 proper associating fibers the imbecile may be unable to acquire 
 those higher associations constituting the secondary ego in the 
 most elevated sense. To this class ultimately belong the 
 instinctive homicides, torturers, sexual criminals and thieves so 
 frequently found among the juvenile ofifspring of degenerate 
 stock. In them the primary ego is strong and the restraints of 
 the secondary ego, which perceives the rights of others, weak- 
 '•ned or completely absent. This class forms the germ of the 
 congenital criminal, whom no discipline can tame, and who is 
 therefore incapable of being taught the dangers of his proced- 
 ures under the law of the land. Between this class and the 
 paranoiac (or "crank") there is at once a curious likeness and 
 distinction. The lack of proper associating powers prevents the 
 moral imbecile from recognizing any rights of others. The 
 same lack in the paranoiac prevents him from recognizing the 
 
 - Alienist and Neurologist, 1893-4. 
 
INTELLECTUAL AND MORAL DEFECTS. 120 
 
 force and rights of other people in opinion. The moral imbecile 
 has lost the greatest acquirement of the race in evolution, that 
 acquirement which fully recognizes the secondary ego in accord- 
 ance with the sublime precept : "Do unto others as ye would 
 that they should do unto you." Closely akin to that instability 
 of inter-association resulting in loss of proper checks on explo- 
 sive action in the types just described is the sentimentalism 
 which often covers real hardness, but which charms and allures 
 the mass. This has essentially the psychologic basis of the sus- 
 picional tendencies and pessimism with which it is so often 
 associated. Suspicional tendencies arise from states of anxiety 
 resultant on instability of association dependent on lack of asso- 
 ciating fibers. Pessimism (so frequently present in the other- 
 wise healthy degenerates) is, as Magalhaes has shown, nervous 
 instability w'ith alternations of irritability and prostration. The 
 subject is supersensitive, impressions call forth intense and pro- 
 longed reaction followed by exhaustion. The state is character- 
 ized by a general hypersesthesia, which naturally results in an 
 excess of suffering. From instability and hyperiesthesis results 
 discord between the feelings themselves, between the feelings 
 and the intelligence, between the feelings, the ideas and the will. 
 Discord between the feelings shows itself in a great variety of 
 paradoxes, contradictions and inconsistencies. To the pessimist 
 possession of a desired object does not atone for former priva- 
 tion. Pain or unsatisfied desire is replaced by the pain of ennui. 
 With inability to enjoy what he has are coupled extravagant 
 expectations regarding that which he does not have. He is 
 extremely susceptible both to kindness and contempt. He 
 passes suddenly from violent irritability to languor, from self- 
 confidence and vanity to extreme self abasement. His intense 
 sensitiveness results in the intellectual disorders since this 
 involves a great vivacity of the intuitive imagination which favors 
 the setting up of extravagant ideals lacking in solid representa- 
 tive elements. Hence a gap opens between his ideal and the 
 actual. He can never realize the ideal he pursues and so his 
 feelings are of a somber hue. From this excessive realism results 
 a state of doubt, a certain distrust of all this rational objective 
 knowledge. It assumes another form in extreme subjectivism. 
 
 10 
 
130 IRREGULARITIES OF THE TEETH. 
 
 The pessimist is haunted by images of the tiniest rehgious scru- 
 ples, suspicions, fears and anxieties "resulting in alienation from 
 friends, seclusions, misanthropy. The pessimist is further char- 
 acterized by an incapacity for prolonged attention by refractory 
 attention and by a feeble will. These result in inaction, quietism, 
 reverie, self-abnegation, abolition of the personality and an 
 annihilation of the will amounting sometimes to poetic or relig- 
 ious ecstasy. Pessimism is frequently associated with a morbid 
 fear of death. 
 
 In the tramp, to the restless wandering tendency of the neu- 
 rasthenic and paranioac are added the parasitic tendencies of the 
 pauper and the suspicional egotism of the less intellectual pessi- 
 mist. 
 
 The one-sided genius is a link between the neurotic and epi- 
 leptic, the paranoiac, the hysteric and the imbecile. Cases crop 
 up in which all these elements are so mingled as to create a 
 puzzle where they belong. In some cases in accordance with the 
 general law that physiologic atrophy is accompanied by hyper- 
 trophy in other directions the intellectual powers other than 
 along certain lines may be remarkably deficient. Moreover, the 
 intellectual power due to healthy atavism is increased seem- 
 ingly by the degeneracy in certain directions. Without going 
 into the- question raised by Lombroso'^ as to genius being an 
 epileptoid neurosis, sufficient evidence exists to show that illy 
 balanced genius often co-exists with defects in a large number 
 of directions. The co-existence of genius with imbecility and 
 even idiocy has been well illustrated by Langdon Down, who 
 cites numerous instances thereof. Defect in genius whether 
 of the imbecile stamp, or otherwise accompanied by deficiency, 
 is not expressed in the genius, but in its deficient accompani- 
 ment. Even the mental instability of the highest type of defective 
 genius is close kin to that of the neurotic. 
 
 Hysterics, as has been shown by Des Champs, are neurotic 
 women in whom an aggravated sensibility exists. Neurotic 
 women are divisible into three categories, according to the pre- 
 dominance of one of the three centers ; cerebral, genital and 
 neuropathic. These types occur pure or intermixed. The gen- 
 
 ^ Man of Genius. 
 
INTKLI.KCTUAL AND MORAL DKKKCTS. 181 
 
 eral characteristics arc want of equilibrium in sensiljility and will 
 power. Mobility of humor occurs in direct relation with facile 
 impressionability to external influences or to internal states. 
 The nerves vibrate to mental states from within or without 
 and all are registered without proper relation. One fact chased 
 by another is forgotten ; still another fact produces a momentary 
 re-excitation which takes place of truth whence falsehood 
 becomes instinctive, but the patient protests her good faith if 
 accused of mendacity. This lack of equilibrium leads to decided 
 modification of the mental faculties. Intellectual activity is 
 over-excited, but in diverse degrees and variable ways accord- 
 ing to the peculiar tendencies adopted. Absorbed by a pre- 
 occupation or controlled by an idea they become indifferent 
 to all else. The ideas are abundant and the idea quickly is the 
 act. Their vivid imagination, coupled with a bright intelligence, 
 gives them a seducing aspect, but their judgment is singularly 
 limited, attenuated, and therefore false. They judge from a 
 non-personal standpoint excellently. They are quick at discover- 
 ing faults in their nearest relatives, but faults rightly attributed 
 to themselves are repudiated. Their memory is capricious. 
 They forget their faults and their acts under impulse albeit these 
 may be consciously 'done. The cerebral type, led by the intelli- 
 gence, has little or no coquetry, except what is the result of 
 mtention and temporary. There is an ethical sense, frankness 
 and nobility in her ideas, disinterestedness and tact in her acts. 
 She is capable of friendship. Her taste carries her to male pur- 
 suits in which she succeeds. She becomes often what is called 
 a "superior woman," and too often, what is called an "incom- 
 prehensible woman." She has little guile. To the sensual type, 
 voluptuousness is the aim of life and the center of her acts and 
 thoughts. She is well endowed VN^ith guile and extremely diplo- 
 matic, full of finesse, but not very delicate. Her lack of scruple 
 often spoils her tact. She is ruseful, dissimulating and uncon- 
 sciously mendacious. She despises friendship and needs watch- 
 ing. If circumstances permit she loses her delicacy, reserve 
 and modesty. She is destitute of scruples and her crimes are 
 coolly remorseless. The neuropathic type is one to which the 
 
132 IRREGULARITIES OF THE TEETH, 
 
 grasshopper is a burden. Her nerves are always on edge and 
 she is a "heroic" invalid whom trivialities martyrize. 
 
 The character of the neurotic, as Kiernan remarks, recalls 
 the observation of Milne-Edwards concerning the monkey 
 character. Levity is one of its salient features and its mobility 
 is extreme. One can get it to shift in an instance from one mood 
 or train of ideas to another. It is now plunged into black 
 melancholia and in a moment may be vastly amused at some 
 object presented to its attention.* 
 
 Neuroticism in man dififers from that in woman only in the 
 fact that anaesthesia, paralysis of emotional origin and conscious 
 convulsions are less common. The male neurotics are sub- 
 divisible precisely as the female. Neurotics are often long 
 lived, peculiarly resistant to certain acute and fatal diseases, and 
 frequently retentive of their youthful appearance. This last 
 is to a certain extent evidence of their resistance to the wear 
 and tear of life and advancing old age, and is due to emotional 
 anaesthesia. Recognition of the neurotic tendency often induces 
 the individual to take better care of himself. The youthful 
 appearance is often also largely the result of arrest of facial 
 development at an early age. The face therefore retains the 
 child character throughout life. This class of neurotics 
 (which does not include those afflicted with the more serious 
 nervous disorders, such as epilepsy), may be looked upon as 
 the victims of evolutionary processes, constantly going on in 
 the race and especially under civilized conditions. Neurotics 
 are not met with to any extent among barbarous races, but 
 are numerous in civilized communities where the weak are 
 preserved from early death and then subjected to the struggle 
 for existence. Neurotics are individuals naturally imperfect 
 in some directions, but by the law of economy of growth often 
 superior in others. Their disordered nervous functions and 
 hypersesthesias are not necessarily indicative of inferiority of 
 general organization compared to their ancestry. They may 
 simply imply a more rapid advance in some one direction in 
 the development of the nervous system than has been kept 
 
 * Review of Nervous and Mental Disease, 1891. 
 
INTELLECTUAL AND MORAL DEFECTS. 133 
 
 up with by the remainder. These defects may sometimes be 
 advance g-uards in the progress of the development of the race.^ 
 
 Epilepsy, which is chiefly viewed from the standpoint of its 
 "fit," has far more extended mental, moral and other nervous 
 relationship. It is, as Spitzka shows, a morbid state of the 
 brain without a palpable lesion, manifesting itself in explosive 
 activity of an unduly irritable vaso-motor center, leading to 
 complete or partial loss of consciousness which may be pre- 
 ceded or followed by various phenomena expressing the undue 
 preponderance of some and the suspended inhibitory influence 
 of other cerebral districts. 
 
 True epilepsy presents an enormous number of sub-groups, 
 exhibiting every variety of deviation from the ideal convulsive 
 form, and the existence of these forms tends to demonstrate 
 the views just expressed. In ordinary petit mal the initial 
 arterial spasm has but to be confined to the surface of the hem- 
 ispheres leaving the thalamus ganglia undisturbed, and it can 
 readily be understood how the momentary unconsciousness 
 or abolition of cortical function can occur without the patient 
 falling, his automatic ganglia still carrying on their functions. 
 At the same time with the lesser spasm there would be a less 
 extensive sinking of intracranial pressure and less consecutive 
 collateral hyperaemia of the lower centers and therefore no 
 convulsion.^ 
 
 In certain cases, as Meynert has suggested, arterial spasm 
 may fail to affect the entire cortical surface simultaneously, some 
 one trunk may be more previous and as afflux of blood may 
 occur in its special field where certain impressions and motor 
 innervations are stored ; the result will then be that the func- 
 tion of the relatively well nourished territory will be exalted. 
 If it be a visual perception territory, sights, colors or luminous 
 spectra will be seen, if it be an olfactory territory, odors will be 
 smelt, if a tactile center, crawling, tingling and cold sensation, 
 if a speech center, cries, phrases and songs may be observed. 
 Thus occur the manifold epileptic aura which is simply an iso- 
 lated exaggerated limited cortical function. The recurrence 
 
 ^ Evolution by Atrophy^ DeMoor. 
 
 6 New England Medical Monthly, 1881. 
 
134 IRREGULARITIES OF THE TEETH. 
 
 of the aura is readily explicable on the ground of the well- 
 known physiologic law that any nervous process, morbid 
 or normal, having run through certain paths, those paths will be 
 the paths of least resistance for that process to follow in the 
 future. To an extension of the same conditions are due the 
 peculiar convulsive equivalent and post-epileptic mental states. 
 
 Behind the moral disorders of idiots, imbeciles, some crim- 
 inals, some paupers and some prostitutes is the epileptic state. 
 There is no mental or moral disorder which may not occur as 
 a substitute for the "fit." 
 
 The moral defects of epilepsy have not unnaturally led to the 
 opinion that crime was an expression of disease or mal-devel- 
 opment. Crime being, however, a matter of law rather than 
 ethics, must be dealt with from the standpoint of individual 
 criminals. Tyndall' was convinced that the classification given 
 him by a governor of a great British prison, was of truly prac- 
 tical value. Criminals according to this classification were 
 divisible into three types : First, those whom external accident 
 and internal taint had brought within the grasp by the law. 
 They were essentially of sound moral stamina, though wearing 
 the prison garb. Then came those with no strong bias, moral 
 or immoral, plastic to the touch of circumstances which would 
 mold them into either good or evil members of society. Thirdly, 
 came a class, happily not a large one, whom no kindness could 
 conciliate and no discipline tame. They were sent into the 
 world labeled incorrigible. Havelock Ellis,'^ following a similar 
 principle, divides criminals into political criminals who are not 
 necessarily guilty of any anti-social ofifence. From the Eight- 
 eenth Century British statutory standpoint, Washington, 
 Jefferson, Franklin and the Signers of the Declaration of Inde- 
 pendence were all criminals of this type. The political criminal 
 of one age or land may therefore be the martyr, saint, or hero, 
 of another. The criminal from passion like the man who resents 
 the dishonor of his daughter, sister or wife, is a modification 
 of the first type described by Tyndall. The instinctive crim- 
 inal, otherwise the moral imbecile, is the third type of Tyndall. 
 
 ' Lectures cited by C. K. Mills, Pa. Med. Society Trans., 1882. 
 ® The Criminal. 
 
INTELI.ECTUAT, AND MORAL DEFECTS. '135 
 
 The periodic criminal who suddenly breaks out into anti-social 
 acts at more or less regular intervals is closely allied to the epi- 
 leptic and the periodic lunatic whether cyclothymiac (circular in- 
 sanity), maniac, melancholiac, dipsomaniac, nymphomaniac, or 
 other types. Then there is a large class of law made or society 
 made criminals, whose crimes are violations of law, but the 
 reverse of anti-social in nature. Thus during the reign of the 
 normally imbecile paranoiac George III. of England, the hus- 
 band of a hard-working, honest woman was seized by a press 
 gang and forced to serve in a fleet which sailed with troops for 
 America. He left her destitute with six children, one just born. 
 To avoid starvation for them she stole a bolt of cloth, but 
 troubled by conscience she returned it, was caught, tried and 
 hanged for example. The babe was nursing at her breast just 
 ere the black cap was put on. 
 
 Criminals on occasion like this one may be made into habitual 
 criminals by despair and from the evil associations into which 
 the law flings them. The criminals of the political and occa- 
 sional type are often further removed from degeneracy than the 
 criminal within the law type : the dominant type of the century 
 just closed. 
 
 From this fact comes the negative results of so many 
 researches in prisons. These negative results also are due to 
 the observation being made by tyros in medico-anthropometric 
 examination and classification. 
 
 Nine decades ago, Grohman,^ who made positive observa- 
 tions of this kind and was "impressed in criminals, especially 
 in those of defective development by the prominent ears, the 
 shape of the cranium, the projecting cheek bones, the large, 
 lower jaws, the deeply placed eyes, the shifty animal-like gaze." 
 Despine's researches revealed the absence of human checks on 
 the instinctive tendencies in criminals. These started from the 
 doctrine of moral imbecility as elaborated by Rush, Prichard, 
 Brigham, Ray, Gait, C. H. Hughes, and others. Bruce Thom- 
 son, testing Despine's results by primitive races and Scotch 
 criminals, found that defective abnormal and anomalous states 
 of the instinctive faculties exist in entire races and in the 
 
 9 Havelock Ellis, Op. Cit. 
 
136 IRREGULARITIES OF THE TEETH. 
 
 "moral idiots" that occur in the best races. Criminals are a 
 variety of the human family quite distinct from the law abiding 
 men. A low type of physique indicating a deteriorated char- 
 acter gives a family likeness, due to the fact that they form a 
 community which retrogrades from generation to generation. 
 The low physical condition of juvenile criminals in reforma- 
 tories, etc., becomes at once obvious if they be compared with 
 healthy, active school children. They are puny, sickly, scrofu- 
 lous, often deformed with peculiar unnaturally developed heads, 
 sluggish, stupid, liable to fits, mean in figure and defective in 
 vital energy, while at the same time they are irritable, violent 
 and too often quite incorrigible. The adults usually have a 
 singularly stupid and insensate look. The complexion is bad. 
 The outlines of the head are harsh and angular. The boys are 
 ugly in feature and have as a rule repulsive appearances. These 
 diseases of criminals are a proof of their low type and deterio- 
 rated conditions. Their deaths are mainly due to tubercular 
 disease and affections of the nervous system. In the greater 
 number crime is hereditary which is, in most cases, associated 
 with bodily defect such as spinal deformities, stammering or 
 other imperfect speech, club-foot, cleft palate, hare-lip, deformed 
 jaws and teeth, deaf-mutism, congenital blindness, paralysis, 
 epilepsy and scrofula. 
 
 Elisha Harris, of New York, among 233 convicts found 54 
 to belong to families in which insanity, epilepsy and other 
 neurosis existed. Eighty-three per cent belong to a criminal 
 pauper or inebriate stock and were therefore hereditarily or 
 congenitally afifected. Nearly 76 per cent of their number hence 
 proved habitual criminals. According to Harris pauperism and 
 insanity so revert into each other that insanity in the parent 
 produces crime or pauperism in the offspring or vice versa ; 
 crime or pauperism in the parent produces disease or insanity in 
 the offspring. Campagne, Broca, G. Wilson and others about 
 the same time made similar researches. 
 
 The American sociologist Samuel Royce, after a careful 
 study of American and European defective classes found that 
 observation of the hereditary nature of pauperism which con- 
 genitally reverts into insanity, disease or crime, leaves no doubt 
 
INTELLECTUAL AND MORAL DEFECTS, 137 
 
 but that pauperism is one of the worst forms of race deterio- 
 ration and that the paralysis of the human will and its energies 
 is but the result of a fearful dissolution in progress. 
 
 The pauper, inebriate, opium user, and cocaine habitue may 
 be all divided as the criminals have already been. In the occa- 
 sional type whatever defects may be produced on the offspring 
 as regards degeneracy, the stigmata need not necessarily be 
 expected in the irxlividual victim of circumstances. In the 
 periodic and instinctive types such as stigmata will occur with 
 as great frequency as in other cases of these types. The fact 
 is often forgotten that the criminal manifestation of the periodic 
 type as well as the pauper manifestation may be a mere tinge 
 of the underlying degeneracy which would be present and 
 evince itself in some other morbid way did not the pauper, .crim- 
 inal or other tinge make its appearance. There is, however, 
 a pseudo-periodicity produced by pauperism, crime, alcohol and 
 other conditions w^iich turns on the nerve law of periodicity 
 already referred to. In the pseudo-periodic type degenerative 
 conditions while occurring far more frecjuently than in the occa- 
 sional types are much less frequent than in the true innate 
 periodic types. The pauper type contains more of the occa- 
 sional type than the criminal or prostitute, but less than the 
 inebriate. 
 
 The tramp contains, however, like the prostitute, more of 
 the degenerative types. In him are found the restless wander- 
 ing tendencies of the neurasthenic and paranoiac added to the 
 parasitic tendencies of the pauper and the suspicional egotism 
 of the "reasoning maniac." In a general way it may be said that 
 degenerative conditions of skull, jaws and teeth of all the cases of 
 intellectual and moral defect are excellently illustrated by those 
 found in the prostitute. This will be obvious on comparison of 
 those hereinafter given of the prostitutes with the tables regard- 
 ing other classes to be found in the appendix. 
 
 As has been remarked by Airs. Ballington Booth, of the 
 Salvation Army, a by no means small proportion of the prosti- 
 tute class are illustrations of the Bibhcal axiom that "the 
 fathers have eaten sour grapes and the children's teeth are set 
 on edge." Her conclusions are borne out by the results of the 
 
138 IRREGULARITIES OF THE TEETH. 
 
 studies of Chaplain Merrick, of the Milbank prison, and by 
 those of PauHne Tarnowsky, Lombroso, Grimaldi, Andronico 
 and myself. Tarnowsky^*^ finds that prostitution is crime in 
 women taking the line of least resistance. Prostitutes, like other 
 criminals, are divisible into criminals on occasion (vice, mone- 
 tary reasons, etc.), accidental criminals, law-made criminals, weak- 
 willed criminals, periodic criminals, born criminals and insane 
 criminals. The proportion of law-made and accidental crim- 
 inals in the prostitute class is much less than among other 
 criminals. Seduction stands very low in the list of causes. The 
 proportion of the weak willed criminal type is very large. In 
 addition to arriving at similar general conclusions to those of 
 Chaplain Merrick and Mrs. Booth, Tarnowsky^i points out that 
 the professional prostitute is usually a degenerate being, the 
 subject of an arrest of development, tainted with a morbid hered- 
 ity and presenting physical and mental stigmata fully in con- 
 sonance with her imperfect evolution. The physical stigmata 
 due to an imperfect organization are manifested in prostitutes 
 princi])ally by the frequency of skull deformities (44% per cent), 
 face deformities (42% per cent), ear anomalies (42 per cent), 
 and teeth anomalies (54 per cent). The mental stigmata are 
 more or less marked intellectual feebleness with a notable 
 deficiency of moral sense. 
 
 Of 150 prostitutes taken at random from those meeting the 
 necessary requirements (uniformity of race, ability to give their 
 family history, and for years resident of houses of prostitution), 
 Dr. Tarnowsky found signs of physical degeneracy in eighty- 
 seven per cent. The following abnormalities were noted. 
 Deformities of the bony cranium, sugar-loaf heads (oxycephaly), 
 heads flattened at the vertex (platycephaly), narrow heads, com- 
 pressed at the temples (stenocephaly), oblique crania (plagio- 
 cephaly), heads with marked depressions or cavities whether in 
 the region of the bregma or that of the lambda. All these 
 cranial malformations may depend upon different causes. Arrest 
 of development of the bones ; premature synostosis of the 
 sutures ; pathologic processes during intrauterine life or early 
 
 ^'' Lcs Voleu.scs et Prostituees. 
 11 Degeneracy, Op. Cit. 
 
INTELLECTUAL AND MORAL DEFECTS. 
 
 139 
 
 infancy (syphilis, rickets, scrofulous affections, hydrocephalus) 
 meningitis, etc. 
 
 Recklinghausen, of .Strassburg, claims that in infant crania, 
 premature synostosis of the sutures may produce (according as 
 one or all of the sutures are involved) either dolichocephaly 
 (sagittal suture), trocho- and oxycephaly (generalized synostosis) 
 or plagiocephaly (coronary suture of one side). The girth of the 
 brain, and skull, he states, influence each other reciprocally and 
 form of the cranium, especially the pathologic forms, is ordinar- 
 ily the result of any concurrent conditions. It mav depend as 
 much upon disturbances of the development of the sutural syn- 
 
 
 Fig. A. 
 
 Fig. B. 
 
 Fig. C. 
 
 ostosis or of the bone as upon primordial anomalies in brain 
 development. 
 
 Deformed heads in prostitutes present marked development 
 of the external occipital protuberance in one-third of the cases. 
 In an equal numxber of virtuous women it was found but five 
 times. Among the abnormal skull types presented were three 
 herewith illustrated. In the first the head was flattened at the 
 vertex, the forehead was hydrocephalic, the nose flat and the 
 lobe of the ear as much developed, (Fig. A). In the second, 
 the head was elevated at the vertex and the nose flat, (Fig. B). 
 In the third type the parietal region was asymmetrical, (Fig. 
 C). The anomalies of the face were marked asymmetry, sub- 
 nasal prognathism and disproportion of different parts. There 
 
140 IRREGULARITIES OF THE TEETH. 
 
 was deviation of the nose and deep excavation of its root. 
 The nose, being often strongly flattened, the Gothic palatine 
 vault occurred very frequently. There was frequently com- 
 plete division of the palate. There were teeth defective, irregu- 
 lar in growth, riding over each other or widely separated. The 
 teeth were often notched and grooved (Hutchinson's and Par- 
 rot's teeth). The teeth often encroached outside of the dental 
 arch, the parabola of which was thus rendered irregular. There 
 was atrophy or complete absence of the superior lateral incisor. 
 The anomalies were thus distributed among the 150 examined. 
 Malformation of the head (oxycephaly, plagiocephaly, etc.) 
 noted in sixty-two women. 
 
 Development of the occipital protuberance 62 Women 
 
 Very receding foreheads 18 " 
 
 Hydrocephaly 15 " 
 
 Face anomalies (sub-nasal prognathism, asymmetry, 
 
 etc. ) 64 " 
 
 Gothic palatine vault 38 " 
 
 Cleft palate 14 " 
 
 Vicious implantation of teeth 62 " 
 
 Hutchinson's and Parrot's teeth 19 " 
 
 Absence of lateral incisors 10 " 
 
 Badly margined ears (Morel) 16 " 
 
 Defective ears (detached from head, deformed, 
 
 etc.) 47 
 
 Anomalies of the extremities 8 " 
 
 These anomalies were found in the following numbers in 
 the same individual. 
 
 In 15 prostitutes, a single anomaly, or one in 10 per cent. 
 In 34 prostitutes, 2 anomalies at once, or 22.66 per cent. 
 In 35 prostitutes, 3 anomalies at once, or 23.33 per cent. 
 In thirty prostitutes, 4 anomalies at once, or 20 per cent. 
 In 14 prostitutes 5 anomalies at once, or 9.33 per cent. 
 In 66 prostitutes, 6 anomalies at once, or 6 per cent. 
 In 4 prostitutes, 7 anomalies at once, or 2.66 per cent. 
 In I prostitute, 8 anomalies at once, or 0.66 per cent. 
 
 Eliminating the first fifteen women presenting only one 
 anomaly (who must not therefore be classed as badly organ- 
 ized) and with them one prostitute who showed no physical 
 deviation, the other 134 prostitutes show (82.6 per cent of the 
 
INTELLECTUAL ANT) MORAL DEFECTS. 141 
 
 whole) more than one anomaly at the same time. Respectable 
 women (both illiterate and cultured) show an enormous differ- 
 ence. Amongst educated women were found but two per cent 
 of anomalies and among illiterates 14 per cent. 
 
 Lombroso, in an examination of 50 prostitutes, found 
 exaggerated lower jaw twenty-six times ; plagiocephaly, twenty- 
 three times ; asymmetrical noses, eight times ; prominent zygo- 
 ma, forty times. Grimaldi had from the study of twenty-six 
 prostitutes similar results to those of Tarnowsky. 
 
 C. Andronico (vv^ho was among the first to describe stigmata 
 of degeneracy in prostitutes) found among 230 the following 
 anomalies. Flat nose, twenty times; handle-shaped ears, 
 thirty-five times ; vicious implantation of teeth, ten times ; con- 
 vergent strabismus, two times; facial asymmetry, four times; 
 prognathism, seven times ; receding foreheads, thirty-five times. 
 Some eight' years ago I made, in company with Harriet C. 
 B. Alexander and J. G. Kiernan, researches in the Chicago 
 "bridewell." The prostitutes here confined are the least intelli- 
 gent of the class. The researches are necessarily far from com- 
 plete, owing to the difficulties under which such researches must 
 be made in case of persons with short-term sentences. They 
 were, however, habitual offenders, some being in the institution 
 from time to time for twenty years. 
 
 The number examined was thirty, with the following results : 
 Race. 
 
 Celtic-Irish I3 American 2 
 
 Irish-American 5 English-American i 
 
 Scandinavian 3 Latin-Swiss i 
 
 German i Negro •■• 2 
 
 German-American I 
 
 These results tell relatively little since the system of "fining" 
 in Heu of imprisonment, of Chicago places only the "obtuse" 
 class under imprisonment. One was seventeen years old, two 
 eighteen years, one nineteen years, five between twenty and 
 twenty-five years, three between twenty-five and thirty, six 
 between thirty and thirty-five, five between thirty-five and forty- 
 five, one was forty-six years old, two were fifty-five, three sixty, 
 and one sixty-five. Neither race nor age data are of special 
 value. There were eighteen blondes, ten brunettes and two 
 
142 
 
 IRREGULARITIES OF THE TEETH. 
 
 negroes. Four were demonstrably insane, and one was an epi- 
 leptic. 
 
 In sixteen cases the zygomatic process were unequal and 
 very prominent. There were fourteen other asymmetries of 
 the face. Three heads were Mongoloid ; one Irish-Celt, one 
 Swiss and one Scandinavian. There were Mongoloid race types 
 in the regions where the first two come. Sixteen were epignathic 
 and eleven sub-nasally prognathic. In one there was arrest of 
 development of the lower jaw and in four arrest development 
 of the bones of the face. The nose was abnormal in six. 
 
 There were seventeen brachycephalic and thirteen mesat- 
 icephalic skulls. There were no dolichocephalic skulls. There 
 
 Fig. A. 
 
 Fig. B. 
 
 Fig. c. 
 
 were three oxycephalic skulls of v.-hom one was a Celt, one a 
 German and one a Scandinavian. There were eighteen dome- 
 type skulls of whom seven w^ere Irish-Celts, five Celtic-Amer- 
 icans, one English Anglo-Saxon, one American Anglo-Saxon, 
 and one German-American. There were four tectocephalic 
 skulls of whom one was an Irish-Celt, one an Anglo-Saxon 
 American and one a Scandinavian. There were three platy- 
 cephalic skulls of whom two were Celts and one a Scandinavian. 
 There was one plagiocephalic German and a stenocephalic Celt. 
 One skull had a protuberance at the bregma. Twelve occiputs 
 were flattened in four of which there was no tubercle ; eighteen 
 had an enormously developed occipital protuberance. 
 
 Twenty-nine had defective ears ; eleven were of the type 
 shown in Fig. A; nine of the type shown in Fig. B., and nine 
 
INTEI.I.KCTUAL AND MORAI. DKKRCTS. 143 
 
 of the type C. Normal cars were present in a member of a 
 family which had furnished one mother and two sisters to the 
 institution. Five Celtic-Irish had type A, and three Celtic- 
 Americans, seven Celtic-Irish and one Celtic-American had 
 type B. One Irish-Celt and one American-Celt had type C. 
 One Celt had type A. One German and one German-Amer- 
 ican had type C. The negroes had type C. One Anglo-Saxon 
 American had type C, and one English Anglo-Saxon had 
 type A. The Scandinavians (all more or less mentally defective) 
 presented all three types. Frigerio (corroborating a fact long 
 ago pointed out by Morel) has said that the ear should be 
 placed in the first rank among the organs affected by degen- 
 eracy. 
 
 The table XI in the appendix shows the measurements and 
 percentage of jaw deformity. 
 
 An allied class belonging to a still blacker phase of biology 
 are the sexual perverts.^- The congenital form which is asso- 
 ciated with the stigmata of degeneracy is an expression of the 
 defective line whence the victim is sprung. Like the prostitute, 
 the sexual pervert may be divided into precisely the same crim- 
 inals as other criminals. 
 
 Between the criminal and the insane is a debatable line 
 occupied by moral imbeciles, reasoning maniacs, etc. In many 
 insane the most demonstrable deviation from the normal con- 
 sists in disorder of the moral faculties. This is the striking 
 factor of the case since superficially the mind otherwise appears 
 clear and rational by contrast. In these cases, as Krafft-Ebing 
 has shown the most striking features are moral insensibility, 
 lack of moral judgment and ethical ideas. The place of these 
 is usurped by a narrow sense of loss or profit logically appre- 
 hended only. Such persons may mechanically know the law 
 of morality. If such law^s enter their consciousness they do not, 
 however, experience real appreciation, still less regard for them. 
 The laws to them are cold lifeless statements. The morally 
 defective know not how to draw from them motive for omission 
 or commission. To this "moral color-bHndness" the whole 
 moral and governmental order appears as a mere hindrance 
 1- Kiernan, Detroit Lancet, 1884. 
 
144 IRREGULARITIES OF THE TEETH. 
 
 to egotistic ambition and feeling which necessarily leads to 
 negation of the rights of others and to violation of the same. 
 
 These defective individuals are without interest for aught 
 good or beautiful, albeit capable of a sentimentality which is 
 shallow cant. Such persons are repellent by their lack of love for 
 children or relatives and of all social inclinations and by cold- 
 hearted indifference to the weal or woe of those nearest to 
 them. They are without other than egotistic care for ques- 
 tions of social life, sensibility to either the respect or the scorn 
 of others, without control of conscience and without sense of 
 or remorse for evil. Morality they do not understand. Law 
 is nothing more than police regulation. The greatest crimes 
 are regarded as mere transgressions of some arbitrary order. 
 If such persons come to conflict with individuals, ^then hatred, 
 envy and revenge take the place of coldness and negation and 
 their brutality and indifference to others know no bounds. 
 
 These ethically defective persons (where incapable of hold- 
 ing a place in society) are often converted into candidates for 
 the workhouse, jail, or the insane hospital. One or the other 
 of these places they reach after they have been, as children, 
 the terror of parents and teachers through their untruthful- 
 ness, laziness and general meanness and in youth the shame 
 of the family and the torment of the community and the ofificers 
 of the law, by thefts, vagabondage, profligacy and excesses. 
 Finally they are the despair of the insane hospital, the "incor- 
 rigibles of the prisons," the veritable burdens of the poor- 
 house. If intellectual insanity or crime do not claim them, 
 pauperism or criminality is likely to be their destiny. The 
 moral imbecile may, however, keep within the law and achieve 
 business success. His descendants often evince degeneracy 
 in an aggravated form. ]\Iany of the "reformers" of various 
 alleged social evils are often of this class. Their morbid 
 egotism takes the direction of cant and sentimentality so com- 
 mon at certain states of evolution as points of least resistance. 
 Like Guiteau, the assassin of President Garfield, they aim at 
 doing a "big thing for humanity and myself," the humanity being 
 concentrated in "my" ideas. 
 
 The moral lunatic needs but a slight twist intellectually to 
 
INTELLECTUAL ANU MORAL DEIKCTS. 145 
 
 become the paranoiac to whom there is, as Spitzka'^ has pointed 
 out, a permanent undercurrent of perverted mental action, 
 pecuHar to the individual running Hke an unljroken thread 
 through liis whole mental life, obscured it may be, for these 
 patients are often able to correct and conceal their insane symp- 
 toms, but it nevertheless exists and only requires fricti(jn to 
 bring it to the surface. The general intellectual status of these 
 patients, though rarely of a high order, is sufficient to keep 
 the delusion under check for practical purposes of life. While 
 many are what is termed crochety, irritable and depressed, yet 
 the symptom of the typical cases of this disorder is of the fixed 
 delusions. These patients consider themselves either the victim 
 of a plot or as unjustly deprived of certain rights and position, 
 or as narrowly observed by other delusions of persecution are 
 added to the fixed ideas and the patient becomes sad, thoughtful 
 or depressed in consequence or the reverse may occur. Because 
 he is watched and made the subject of audible comments (hal- 
 lucinatory or delusional), he concludes that he must be a 
 person of some importance. Some great political movement 
 takes place ; he throws himself into it, either in a fixed character 
 that he has already constructed for himself, or with the vague 
 idea that he is an influential personage. He seeks interview's 
 with the big men of the day. accepts the common courtesy 
 shown him by those in office as a tribute to his value, is rejected 
 however, and then judges himself to be the victim of jealousy 
 or of rival cabals, makes intemperate and querulous com- 
 plaints to higher officials, perhaps makes violent attacks upon 
 them and being incarcerated in jail or asylum looks upon this 
 as the end of a long series of persecutions which have broken 
 the power of a skilled diplomatist, a capable military com- 
 mander, a prince of the blood, an agent of a camarilla, a para- 
 mour of some exalted personage or perchance the ^Messiah 
 Himself. All through this train of ideas there runs a chain 
 of logic and inference in which there is no gap. If the inference 
 of the patient were based on correctly observed facts and prop- 
 erly correlated with his actual surroundings his conclusions 
 would be perfectly correct. For years and years many such 
 
 '"' Spitzka, St. Louis Clinical Record, 1879-80. 
 11 
 
146 IRREGULARITIES OF THE TEETH. 
 
 patients exhibit a single delusive idea as the only prominent 
 symptom. There is hereditary taint in most of these subjects 
 who are strange in disposition from infancy. As children they 
 frequently shun society and indulge in day-dreams. Their bodily 
 growth is normal, but even trifling disease takes on a cerebral 
 tinge. They may show talent in special directions, but their 
 intelligence rarely passes out of the puerile stage. They often 
 brood over a feminine ideal, a girl who has never encouraged 
 them, and whom they persecute with absurd plans of marriage. 
 
 Connecting the paranoiac with the moral imbecile are the 
 co-called "reasoning maniacs" in whom the intellectual power 
 is less than either that of the moral imbecile or of the paranoiac, 
 twisted though the intellect of the latter be. Loquacious or 
 unusually taciturn, heedless or morbidly cautious, dreamers, 
 wearisome to all brought in contact with them, capricious and 
 unmitigated liars, their qualities are often in a certain manner 
 brilliant, but are entirely without solidity or depth. Sharpness 
 and cunning are not often wanting, especially for little things 
 and insignificant and, quick comprehension, they readily appro- 
 priate the ideas of others, developing or transforming them 
 and giving them the stamp of their own individuality. But the 
 creative force is not there and they rarely possess enough 
 mental vigor to get their own living. Passing without the 
 slightest transition from one extreme to another they felicitate 
 themselves to-day on an event which they sneered at the night 
 before. In the course of a single second they change their 
 opinion of persons and things; novelty captivates and wearies 
 them almost at the same time. They sell for insignificant sums 
 things they have just bought, in order to buy others which, in 
 their turn, will be subject to like treatment, and, strange to say, 
 before possessing these objects they covet them with a degree 
 of ardor only equaled by the eagerness they exhibit to get 
 rid of them as soon as they become their own. To see, to 
 desire and to become indififerent to these stages which follow 
 each other with astonishing rapidity. 
 
 The intense egotism of these persons makes them, as W. 
 A. Hammond has shown, utterly regardless of the feelings and 
 rights of others. Everybody and everything must give way to 
 
INTELLECTUAL AND MORAL DEFECTS. 147 
 
 them. Their comfort and convenience are to be secured, though 
 everyone else is made uncomfortable and unhappy; and some- 
 times they display positive cruelty in their treatment of persons 
 who come in contact with them. This tendency is especially 
 seen in their relations with the lower animals. 
 
 Another manifestation of their intense egotism is their entire 
 lack of appreciation of kindness done them or benefits of which 
 they have been the recipients. They look upon these as so many 
 rights to which they are justly entitled and which in the bestowal 
 are more serviceable to the giver than the receiver. They are 
 hence ungrateful and abusive to those who have served them, 
 insolent, arrogant and shamelessly hardened in their conduct 
 toward them. At the same time, if advantages are yet to be 
 gained, they are sycophantic to nauseousness in their deport- 
 ment toward those from whom the favors are to come. The 
 egotism of these people is unmarred by the trace of modesty 
 in obtruding themselves and their alleged good qualities upon 
 the public at every opportunity. They boast of their genius, 
 their righteousness, their goodness of heart, their high sense of 
 honor, their learning, and other qualities and acquirements, 
 and this when they are perfectly aware they are common-place, 
 irreligious, cruel and vindictive, utterly devoid of every chival- 
 rous feeling and saturated with ignorance. They know that in 
 their railings they are attempting to impose upon those whom 
 they address and subsequently will even brag of their success. 
 
 It is no uncommon thing for the reasoning maniac still 
 influenced by his supreme egotism and desire for notoriety to 
 attempt the part of reformer. Generally he selects a practice 
 or custom in which there is really no abuse. His energy and 
 the logical manner in which he presents his views, based as they 
 often are on cases and statistics, impose on many people who 
 eagerly adopt him as a genuine overthrower of a vicious or 
 degrading measure. Even when his hypocrisy and falsehood are 
 exposed he continues his attempts at imposition and when the 
 strong arm of the law is laid upon him he prates of the ingrati- 
 tude of those he has been endeavoring to assist and of the 
 unselfishness and purity of his own motives. 
 
CHAPTER XVI. 
 
 INTER-OPERATIONS OF CAUSES AND PREDISPO- 
 SITIONS. 
 
 From the previous chapters, it will be seen that forces tend- 
 ing to change in an existing organism, act in various ways as part 
 of the environment of the individual, and through its influence 
 on him produce changes in the complex union of checks, bal- 
 ances, forces and material bases which constitute the human 
 organism as inherited. Of necessity any change in this complex 
 unity being unusual must be abnormal so far as the organism 
 existing prior to the change is concerned. The question whether 
 such abnormality be of benefit or injury is another matter. 
 
 As Virchow^ remarked seven years ago: Transformation, a 
 metaplasia, a change from one species into another, whether in 
 individual animals or plants or individuals or their tissues, cannot 
 take place without anomaly; for if no anomaly appear this new 
 departure is impossible. The physiologic norm hitherto sub- 
 sisting is changed, and this change cannot well be called anything 
 but an anomaly. In former days an anomaly was called pathos 
 and in this sense every departure from the norm is a pathologic 
 event. If such pathologic event be ascertained, this forces inves- 
 tigation as to what pathos was the special cause of it. This 
 cause may be, for example, an external force or a chemical 
 substance or a physical agent producing in the normal condition 
 of the body a change, an anomaly (pathos). This can become 
 hereditary under some circumstances and then may become a 
 foundation for certain light hereditary characteristics propo- 
 gated in a family. In themselves these belong to pathology, even 
 though they produce no injury. Pathologic does not mean 
 harmful, nor does it indicate disease. Disease in Greek is 
 nosos and it is nosology that is concerned with disease. The 
 pathologic tmder some circumstances may be of advantage to 
 its inheritor. 
 
 1 Correspondenz-blatt v. Deutsch. Gesellschaft f. Anth., 1894. 
 
 148 
 
INTER-OPERATIONS OF CAUSES AND PREDISPOSITIONS. 149 
 
 From this standpoint it is obvious that the fact whether a 
 given change in the organism shall prove a defect or not is 
 determined by the conditions of periods of stress during intra 
 and extra-uterine life. According to general observations made 
 by Weismann and others any condition affecting the indi- 
 vidual must in some way affect the organism as a whole in order 
 to survive these periods of stress. 
 
 In dealing with the origin of any defect or gain in the animal 
 organism, several factors must be taken into account, indepen- 
 dently of the simple element of heredity. Heredity, moreover, 
 is not the uncomplicated agent which is usually regarded as pro- 
 ducing certain effects. In dealing with heredity the influence 
 of the inter-uterine stress on the foetus must be determined. 
 Unusual strain of any kind upon the mother during gestation 
 may unfavorably effect the foetus. The healthier the ancestry 
 the less liable the mother would be to ill effect from such strain. 
 On the other hand unusually favorable conditions during gesta- 
 tion may correct defects observable at previous pregnancies. 
 Periods of stress are constituted by the different periods of 
 embryonic development as well as by those extra-uterine. Even 
 sex is determined by conditions of stress after a certain period. 
 Poor maternal nutrition will determine an excess of males, while 
 good will determine an excess of females. Arrests at certain 
 periods of intra-uterine life will procfuce prematurely senile 
 states ; since, as already stated, there is a period in intra-uterine 
 life during which the foetus wavers between the senile appear- 
 ance of adult anthropoid apes and that of mankind in youth. 
 This intra-uterine stress may be an expression of the general 
 nervous exhaustion of the mother Avhich first affecting checking 
 influences of the central nervous system finally leads to 
 unchecked excessive nervous action of the part of the local 
 nervous systems of the organs leading secondarily to exhaustion 
 of these. In consequence the mother is unable either to manu- 
 facture proper elements of nutrition or to excrete waste material. 
 The foetus thereby, starved and poisoned, fails to pass through 
 the periods of stress in a complete well-balanced manner. The 
 stress in these periods is strongest on those structures which 
 are transitory and variable in type. This influence may further- 
 
150 IRREGULARITIES OF THE TEETH. 
 
 more be exerted on the foetus through stress, mental or other- 
 wise, of the mother. The human foetus exhibits, as elsewhere 
 shown, very decided reaction to sensory impressions on the 
 mother. 
 
 At every one of these periods, the forces which determine 
 the variations of the individual from the race and those which 
 tend to preserve the race type are in constant conflict. Con- 
 ditions affecting nutrition of the ovum prior to fecundation (as 
 derived from the mother) and conditions affecting the fecun- 
 dation of the ovum (as derived from the father), as well as 
 those derived from both father and mother after fecundation, 
 will determine whether or not the foetus shall pass through the 
 complete embryologic evolution determined by the race type 
 and, whether or not individual variation present in the parents 
 shall be transmitted successfully through these periods of stress. 
 
 While all of the factors enumerated, enter into the cause of 
 jaw degeneration, one of the great factors is the extraction 
 of the temporary and permanent teeth. In no country is this 
 pernicious habit so marked as abroad. Constant extraction of 
 the teeth produce variations (arrest of development) which are 
 transmitted from one generation to another. In the evolution 
 of the jaws, nothing could be easier accomplished than this. 
 One period of stress is marked by eruption of the temporary 
 and the next period of stress by the eruption of the second 
 set. The first permanent molar is the first tooth to erupt in 
 the permanent set. It is situated in the center of the jaw. 
 Permanent teeth erupt anterior and posterior to this tooth. 
 This tooth, because it is larger, requires more room. The first 
 molar is the first tooth to decay. As soon as it aches it is 
 removed. When the other permanent teeth erupt they move 
 forward and fill the space made vacant by the lost first molar. 
 Since, therefore, the jaw expands and grows only for the pur- 
 pose of containing the teeth, if they be not present the jaw- 
 ceases to develop. What is true of the first molar is also true 
 of the other teeth. In many countries one tooth after another 
 is sacrificed as soon as it begins to ache. Not infrequently 
 whole sets of teeth are removed in young Hfe before the jaws 
 have fully developed. The habit of early extraction of the 
 
INTKR-Ol'ERATIONS OF CAUSES AND PREDISPOSITIONS. 151 
 
 temporary and permanent teeth from one generation to another 
 causes arrest of development in two ways. First, through the 
 inheritance of acquired defects ; second, by natural selection. 
 Since the jaws and teeth are so unstable in their development 
 they are easily affected. 
 
 The influence of the complex sociologic state civilization, 
 while not having the malign influence ascribed to it, has, by its 
 economy as regards food production and preparation, lessened 
 markedly the functions of the jaws and teeth. Food no longer 
 needs the grinding and tearing required from primitive man 
 or even types as high as the "pile dwellers," whose food is 
 still to be found even to coarse breads and cakes. Under the 
 law of economy of growth, lessened muscular action leads to 
 lessened blood supply. Lessened blood supply produces con- 
 ditions in the offspring tending to under nutrition of certain 
 parts for the benefit of the body as a whole and to diminish in 
 size of unused parts. As the jaws, alveolar process and teeth 
 are comparatively unstable in all mammals, these of necessity 
 would be peculiarly affected by disuse. A very similar evolu- 
 tion is occurring in the dog in whom domestication plays the 
 part of civilization and who from a carnivore has become an 
 omnivore. In the mongrel dog, race admixture and other fac- 
 tors producing change in man are to be found. In him, 
 peculiarly, domestication would play the part of civilization. 
 In him jaw and tooth irregularities ascribed to other causes 
 occur. Facility for producing food under domestication has 
 played a part. Disuse of the jaw as a weapon by man has done 
 its share in the changes comparatively early in development. 
 To a certain extent this last change is still going on in the 
 dog. In cases predisposed to advance in evolution, irregular- 
 ities of beneficial type would occur with great facility. In 
 cases predisposed in the opposite direction changes would result 
 of opposite effect. 
 
 As (Table XXXIII) shows the irregularities of the jaws and 
 teeth increase proportionately westward from Greece to the 
 British Isles, the rate in the British Isles being greatest. Greece, 
 however, no longer contains the race which so long dominated 
 the world intellectually. The people are a mixed Slavo-Mon- 
 
152 IKREGULARITIF.S OF THE TEETH. 
 
 goloid race who speak Greek. Furthermore as the correctional 
 charitable and hospital arrangements are primitive the defective 
 classes are not accumulated. Under such conditions a certain 
 seeming decrease in stigmata of degeneracy must result. This, 
 however, would extend more to deeper stigmata than to those 
 of the jaws and teeth. As tables show degenerate jaws and 
 teeth are commonest next to the English speaking people among 
 the Scandinavian speaking. As both have passed through very 
 similar phases of race evolution and both contain at bottom 
 the same race elements, this was to have been expected. The 
 general result of this table shows, as I have pointed out some 
 years ago, that the struggle for existence between the organs, 
 dependent on race evolution and race admixture, has resulted 
 in the higher races in the triumph of the brain and skull at 
 the expense of the face, hence, the higher the intellectuality the 
 greater the tendency to local degeneracy of the face, jaws and 
 teeth. 
 
ciiAr'ri':R xvii. 
 
 DEX'KLOPMENTAL NEUROSES C)E THE FACE. 
 
 To tlie great anatomist, Camper, belongs llic credit of study- 
 ing the human face from the scientific standpoint. This great 
 anatomist gave his name to the facial angle which, even up to 
 the present day, serves as a standard by which to judge the 
 rank of the human face in comparison with the lower forms of 
 animals. In one of his works he gives (Fig. 36) "physical 
 observation on the difference of the feature of the face considered 
 in profile, as the heads of apes, orang-outangs, of negroes and 
 other peoples, tracing up to antique heads." "You will be 
 astonished," he says, "to find among my first plates two heads 
 of apes, then of a negro and then one of a camel." 
 
 Fig. 36. 
 
 Showing the gradual retreat of the jaws in passing from the lower to higher types of 
 face. (Rimmer. Art Anatomy, London, 1884.) 
 
 The facial angle of Camper, Cuvier, Cloquets, Jacquarts, 
 the Munich-Frankfort Angle and that of Topinard involve 
 merely the bones of the face, not the inferior maxilla. Most 
 authors dealing with prognathism and orthognathism refer 
 merely to the skull including the superior maxilla. Medical 
 specialists must, however, include the inferior maxilla in the 
 outline in order to show what may or may not be required in 
 improving the jaws and teeth. In studies of the etiology of 
 irregularities of the jaws and teeth, I have simply extended 
 the facial line downwards below the lower jaw. Fig. 37. An 
 imaginary perpendicular line dropped from the superciliary ridge 
 below the lower jaw will decide whether the jaws be prog- 
 nathous or orthognathous. 
 
 153 
 
154 IREEGULARITIES OF THE TEETH. 
 
 During a trip to Europe in 1897, observations were made in 
 both the British Isles and the Continent as to the facial angle. 
 In most countries casual examination was made, but where 
 marked deformities presented themselves more careful obser- 
 vations were conducted. The soldiers, police and cabmen, as 
 a rule, as well as citizens were observed. In Stockholm, on 
 examination of 5,000 people, the following results were obtained, 
 two per cent outside the perpendicular, 14.70 per cent on the 
 line, and 83.30 inside the line. In London, examination of the 
 faces of 10,000 passers-by revealed 4.13 outside the line, 12.87 
 on the line, and 83.00 inside of the line. In an examination of 
 3,000 English school children (about ten years of age), 93 
 per cent possessed jaws inside of the perpendicular line. Prog- 
 
 Fig-. 37. 
 
 nathism elsewhere in Europe furnishes an offset sufficient to 
 interfere with the production of marked irregularities. 
 
 In comparison with these results are those obtained in 
 Baltimore under the supervision of B. Holly Smith, by William 
 C. Palmer ; in Chicago Robert Keith, under my own super- 
 vision. Those made in Baltimore showed 8 per cent outside 
 the line; 36.5 on the line, and 55.5 inside the line. Those in 
 Chicago were 4.6 outside the line; 14.6 on the line, and 80.7 
 inside of the line. 
 
 The rapidity of evolution of the facial angle is shown in the 
 faces of American negroes. On examination of 357 by William 
 Ernest Walker in New Orleans, protrusion was found in 97.5 ; 
 on the line 2.5 per cent. On examination by Arthur R. Dray, 
 of 686 in Philadelphia, 83.57 per cent were found to present pro- 
 trusion, and 15.95 on the line; 1.13 recession. On examination 
 
DEVELOPMENTAL NEUROSES OF THE FACE. 155 
 
 of 1,085 in Chicago, 51.06 presented protrusion; 31.08 per cent 
 on the line and 16.6 recession. Examination by Eugene F. 
 O'Neill, of negroes in Boston showed that of 1,000, 454 or 45.4 
 per cent were protrusion, 395 or 39.5 per cent on the line and 
 151 or 15. 1 per cent receding. O'Neill says, "many of the faces 
 classed as protruding have a marked protrusion of both jaws, 
 but have the symphysis well back of the vertical plane. In 
 fully one-half of the cases enumerated as protruding, the pro- 
 trusion is comparatively slight and a smaller number has the 
 typically protruding angle which is shown in the diagram. 
 
 Evolution of the jaws in their recession is hence more rapid 
 than the teeth and alveolar process. The teeth do not grow 
 small in proportion to the jaws, wherefore they retain their 
 contour. Northern and older negro families from race admix- 
 ture have less protrusion and more recession than the Southern 
 negro. Ward has shown that absolute size of the lower jaw 
 is greater in savages: "Of nine aborigines, including seven North 
 American Indians, one African and one American negro, six 
 Malays and five Australians, all with beautifully perfect teeth, 
 the mean weight of the jaw was 102.4 grams. Of eighteen 
 white males the mean weight of the jaw was only 83.4 grams. 
 Yet the weight of the skull was nearly alike in both classes, 
 being 690.9 grams for the aborigines as against 680.5 ^^r the 
 whites. The weight of the lower jaw compared with that of 
 the cranium, or the Cranio-Mandibular Index, as I have termed 
 it, is 15.6 for aboriginal men as against 12.16 for white men. 
 It is 46.2 for anthropoid apes, our nearest living relatives 
 among mammals. 
 
 Does not this prove a progressive degeneracy in the mas- 
 ticatory apparatus of civilized man?"^ 
 
 Examination of the heads of eighteen negroes, taken at ran- 
 dom, revealed that five had a cephalic index below seventy, six 
 between seventy and eighty, and seven above eighty. These 
 results tend to show that mesocephalic skull types are increasing 
 in numbers among American negroes and that the jaws are 
 gradually shortening. Dolichocephaly is decreasing. Upon 
 
 lA Cranio-Mandibular Index. Proceedings of the Association of 
 Americaji Anatomists, 1897. 
 
156 IRREGULARITIES OF THE TEETH. 
 
 examination of about two thousand Chicago negroes, I was 
 able to find but six cases of doUchocephaly. Even allowing 
 for slight admixture of brachycephaly from the negro races 
 themselves, it is obvious that changes in climate and admixture 
 with the Indian and Caucasic races in America have completely 
 changed the shape of the head as well as the physicjue of the 
 negro. 
 
 The persistent prognathism of the negro is due in a great 
 measure to excessive development of the inferior maxilla. The 
 rami and body of the lower jaw, also the muscles of mastication, 
 are verv large and massive compared with those of the white ; 
 upon the other hand the superior maxilla is smaller and more 
 delicate. The constant force of the larger lower jaw upon the 
 
 Fig. 38. 
 
 upper, causes the alveolar process to be carried forward and 
 upward, thus producing prognathism. American negroes 
 to-day (especially those living in the Northern States) possess 
 jaws not unlike those of the Caucasic races. The zygomatic 
 arches are smaller, the muscles less dense and rigid, the lower 
 jaw massive and orthognathism in lieu of prognathism occurs 
 to a certain extent. This is brought about by the arrest of 
 development of the muscles and body of the lower jaw, due to 
 change of climate and of soil and race admixture. 
 
 Since Camper's time scientists have been studying the pecu- 
 liar forms and shapes of the face more extended. 
 
 As I have pointed out elsewhere, the degeneracies imply 
 deficiencies in constitution not only in mental, moral, but also 
 
DEVELOPMENTAL NEUROSES OF THE FACE, 157 
 
 in neurosal and other directions. These deficiencies, as has 
 been shown in the discussion of neuroticism, are often expres- 
 sions of imperfect advance evincing itself in the unequal balance 
 between hypertrophy, excessive development, statu quo and 
 atrophy. This is especially illustrated in the following cases 
 showing protrusion and arrest of development of the face and 
 jaws. In the first case the figure given is a correct outline of 
 the patient described albeit the figure is taken from Tarnowsky. 
 Casei. Fig. 38. The patient is a school teacher, thirty-seven 
 vears of age. of nervous temperament, bright, and well edu- 
 
 Fig. 39. 
 
 cated. Father is a periodical drunkard. The paternal grand- 
 mother died of consumption. One of the paternal cousins 
 committed suicide, and another became insane. A sister of this 
 cousin hanged herself. The grandmother on the mother's side 
 became insane and a grandaunt committed suicide. The patient 
 was born in the East, but came West on account of a tendency 
 to consumption. The forehead is very prominent, with a marked 
 depression at the bridge of the nose. The nose is undeveloped 
 and has the appearance of falling into the face. Hypertrophy 
 of the mucous membrane and bones of the nose require her to 
 breathe through the mouth. The chest is undeveloped. She 
 
158 
 
 IRREGULARITIES OF THE TEETH. 
 
 is round-shouldered. The jaws and chin are fairly well devel- 
 oped. The alveolar process, although small for the body, has 
 normal dental arches. Width outside first permanent molar, 
 2; outside second bicuspid, 1.90; width of vault, 1.60; height 
 of vault, .62. Third molar not present and teeth small. Ordinary 
 causes of deformity are hence absent. 
 
 Case 2, Fig. 39, is a twenty-three year old man, whose 
 mother was epileptic and died in the status epilepticus. The 
 father died of locomotor ataxia. The lower jaw seems prog- 
 nathous. The face from the upper border of the lower teeth 
 
 Fig. 40. 
 
 to the superciliary ridge is markedly concave. The superior 
 maxillary bones as well as the zygomse are arrested in their 
 development. The eyes are quite deeply set in the head. Fore- 
 head narrow and quite prominent. There is total collapse of 
 the walls of the nose, difficuhy in breathing, hypertrophy of the 
 turbinated bones and mucous membrane, adenoid growth and 
 mouth-breathing. In this case the lower jaw is not excessively 
 developed since the teeth, which are not large, just fill the 
 space, while the incisors do not protrude and the third molars 
 are in place. The upper jaw, however, is greatly arrested in 
 
DEVELOPMENTAL NEUROSES OF THE FACE. 
 
 159 
 
 development. The third molars are not present. They could 
 not erupt if they were there for want of space. The left first 
 bicuspid has been extracted allowing spaces to occur between 
 the incisors. In order that the teeth may all come into position, 
 the anterior alveolar process has been pushed forward .60 of 
 an incli. If the bones of the face had developed, the lower jaw 
 would have appeared to a better advantage. There is arrest 
 of development of the superior maxillse, zygomae and nasal 
 bones with a normal lower jaw. A marked ridge extends the 
 entire length of the vault at the suture. The distance outside 
 
 Fig. 41. 
 
 of first molar is 2; outsifle of second bicuspid, 1.75; width of 
 vault betwen second bicuspid, i ; height of vault, .62. The chest 
 walls are very contracted, the shoulders considerably stooped 
 and the chest expansion very slight. 
 
 Case 3. Fig. 40. A young man twenty years of age is mark- 
 edly neurotic. Bookkeeper, but is above the average in intellect. 
 The appearance of the face and jaws are about the same as Fig. 
 39, with this exception, that the zygomae are a little more devel- 
 oped. Width outside first permanent molars, 2; outside second 
 bicuspids, 1.72; between second bicuspid, 1.02; height of vault, 
 .59. There is total collapse of the nasal openings, causing him 
 
160 
 
 IRREGULARITIES OF THE TEETH. 
 
 to breathe through the mouth since he was four years of age ; 
 the two sides of the left nostril approximate, while the turbin- 
 ated bones upon the right side owing to hypertrophy fill the 
 space. A thickening of the mucous membrane throughout the 
 anterior and posterior nares is also observed. This picture was 
 taken two years after the contour of the teeth had been restored ; 
 therefore, the upper lip is more pronounced than in Fig. 39. 
 There is, how^ever, a marked concavity of the face between the 
 zygomae and the upper jaw ; the upper lip was depressed as in 
 Fig. 39 before the operation. The chest is very contracted, with 
 
 Fig. 42. 
 
 very little or no expansion on inhalation. The father has well 
 formed jaws. The mother has marked arrest of development of 
 the upper jaw. 
 
 ■ Case 4, Fig. 41, is a married stenographer of excellent habits 
 and good principle, steady and a hard worker. When a small 
 child he was. a chubby, fat boy. His father and uncle possess 
 this arrest of development. This gentleman has two sisters and 
 a brother ; one of the sisters has the deformity and a brother 
 slightly. The cheek bones are prominent, there is arrest of devel- 
 opment of the superior maxillary bones, a well formed and reg- 
 ular alveolar process and dental arch, fine teeth and full normal 
 
DEVELOPMENTAL NEUROSES OF THE FACE. 
 
 161 
 
 lower jaw. Width outside first permanent molar, 2.25 ; outside 
 second bicuspid, i.yo; width of vault, 1.26; height of vault, .52. 
 With such a history no one could dispute that this deformity was 
 a clear case of direct heredity. The chest is a little broader than 
 the other two, but there is the same weakness of voice. 
 
 Case 5, Fig. 42. This patient was above the average in intel- 
 lect. Father, mother, brother and sisters all living; no untoward 
 family history. He was a marked neurotic ; a fair dentist, but 
 liked medicine better and would have made a good practitioner. 
 He was a good musician ; could [jlay several instruments but pre- 
 
 ^ 
 
 
 1^ ■ Jt'^'' 
 
 ^^y 
 
 ^Fk 
 
 _ ,^ 
 
 Bk»:i 
 
 
 Fig. 43. 
 
 ferred the cornet. Arrest of development of the upper jaw 
 occurred at or about the sixth year. As the teeth were crowded, 
 with considerable protrusion of the anterior teeth and. alveolar 
 process, there was a pronounced semi-saddle-shaped jaw. Was 
 strictly temperate. Died at the age of twenty-six of paretic de- 
 mentia (of the acquired type). Width outside first molar, 
 2.03; outside second bicuspid, 1.90; inside, 1.60; height of 
 vault, .75. 
 
 Case 6, Fig. 43. Aged forty-one years; married. Born in 
 England of English parents. Father, sailor, died of peritonitis ; 
 12 
 
162 IRREGULARITIES OF THE TEETH. 
 
 mother, heart rheumatism. He came to America fifteen years 
 ago. He is in the harness business and of excellent habits. The 
 patient is a neurotic. The bones of the face are arrested in their 
 development. The line drawn from the bridge of the nose to 
 a point opposite second molar produces a marked depression. 
 There is a marked arrest of the lower jaw. The anterior surface 
 of the lower centrals occlude at the first bicuspid ; this gives the 
 appearance of no chin. All the teeth are present in the upper 
 jaw, the width of which is 1.75 outside first permanent molar; it 
 is also a saddle-shaped arch. In order that the jaws may accom- 
 modate all the teeth, they have pushed the alveolar process and 
 jaw bones forward. This man has always been a mouth breather. 
 
 FiK. 44. 
 
 The mouth, therefore, has always been open; as a result the 
 teeth and alveolar process have grown downward. Although 
 the lips are long enough, he cannot close them, owing to the 
 excessive development of the alveolar process. The alveolar 
 process and teeth of the lower jaw are normal in development. 
 The height of vault is .82 (this is an unusually high vault). The 
 alveolar process is large and thin. The excessive development 
 of the alveolar process nicely illustrates how high vaults are 
 produced. The cheek bones are also arrested, but not to the 
 extent of some. The eyes are deeply set; the superciliary ridges 
 very prominent. The nose is very long and thin; the sides of 
 the nose approximate and there is a marked thickening of the 
 mucous membrane ; nose breathing is impossible ; the chest is 
 
DEVELOPMKNTAL NKUROSKS OF THE KACE. 
 
 103 
 
 contracted and the nioiitli is continually open. The iiead is sub- 
 microcephalic ; the forehead low ; the posterior part of the head 
 is very prominent ; the ears are large. 
 
 Case 7, Fig. 44. Twenty-nine years of age. Her father is 
 now suffering from paralysis. The patient is a neurotic. She 
 is a fine musician and artist and a brilHant conversationalist. Jaw- 
 bones proper are well developed. The rami are excessively 
 developed, but the teeth and alveolar process are undeveloped. 
 There is very Httle enamel upon the teeth, and what remains 
 can be scraped oflf like horn. The crowns of the teeth are worn 
 
 Fig. 4.5. 
 
 away one-half their length. Width of the jaw outside first molar, 
 2.25; outside second bicuspid, 2; width of vault, 1.50; height 
 of vault, .50. She is unable to bring the teeth together and there- 
 fore cannot masticate her food. To compensate for this she does 
 her chewing with her tongue and the roof of her mouth, on 
 account of wbicn ler tongue has become hypertrophied to such 
 an extent th it the jaw has been widened by the lateral pressure 
 upon the teeth. With an effort she can bring her jaws together, 
 whif^h makes her pout and the chin protrude, making her 
 resemble an old woman. In order to meet this deficiency crowns 
 
164 
 
 IRREGUI.ARITIES OF THE TEETH. 
 
 were placed upon all her teeth, which had the effect of bringing 
 her jaws at rest in the proper positon. 
 
 Case 8, Fig. 45. This patient is eight years of age. His 
 father and mother are Scotch and are cousins. He has arrested 
 hydrocephalus with resultant macrocephalic head. He is about 
 the average in intellect. The first permanent molars have erupted 
 and the central incisors are just coming through. It is early yet 
 to decide just what deformity will be produced, because the 
 permanent teeth are not far enough advanced. A saddle or 
 V-shaped is sure to follow, because there is not room for the 
 
 Fig. 46. 
 
 cuspids and bicuspids to erupt. Arrest of development of the 
 lower jaw is quite noticeable at this early age. There is consid- 
 erable hypertrophy of the superior alveolar process now. Width 
 outside first molar, 2 ; height of vault, .50. 
 
 Case 9, Fig. 46. This girl is a fourteen-year-old neurotic. 
 Father and mother are living. The upper jaw and face are very 
 much undeveloped. The dental arch was V-shaped and the 
 teeth very irregular. This picture was taken after the teeth 
 were regulated. The upper dental arch was spread .62. The 
 face, therefore, is fuller in every direction and appears at a better 
 
DEVELOPMENTAL NEUROSES OF THE FACE. 
 
 165 
 
 advantage than it would otherwise. She is very bright and a 
 fine reader. The jaw became arrested at the sixth year. Width 
 outside first permanent molar, 1.75; outside second bicuspid, 
 1.50; width of vault, .84; height of vault, .50. Before treatment 
 the face was very thin and contracted at the ate of the nose, not 
 unlike Figs. 55, 56, 57. She is a mouth-breather. There is 
 marked thickening of the mucous membrane and hypertrophy 
 of the turbinated bones. While the chest is very much con- 
 tracted, it is now filling out. She has a husky voice and a very 
 old face. This case shows how much a face can be improved by 
 treatment. 
 
 Fig. 47. 
 
 Case 10, Fig. 47. Seven years of age. Father and mother 
 living. No history obtainable; both have well-developed jaws. 
 This boy has always been a mouth-breather. He has been sick 
 most of his life. He has so little vitality that it was with diffi- 
 culty he has been raised to this period of his life and is still deli- 
 cate. There is septum deflection, mucous membrane and tur- 
 binated bone hypertrophy. The mouth has been kept open 
 to such an extent that occlusion has not taken place. The rami 
 are short; the result of this is, nature has caused an excessive 
 
166 
 
 IRREGULARITIES OF THE TEETH. 
 
 development of the anterior alveolar process. Width outside 
 first molar, 2; outside second temporary molar, 1.75; width of 
 vault, I ; height of vault, 36. 
 
 Case II, Fig. 48. Age thirteen years. Father and mother 
 living; father a paranoiac. He has an excessively developed 
 forehead and well developed jaw. The boy borders on imbecility. 
 The face looks like tliat of a man thirty-five or forty years of 
 age. This is a result of arrest of development at the "senile" 
 (four and one-half month) period of intra-uterine Hfe. The whole 
 
 Fig. 48. 
 
 body is arrested in its development. His legs are short and he 
 walks like a man of seventy. His joints are large, while the bones 
 are very small, showing impoverished blood. There is a marked 
 arrest of development between the supercilary ridges and the 
 zygomai and also the lower jaw. This gives an apparent pro- 
 trusion to the nose and upper jaw. The eyes and their sockets 
 are also arrested. He is obliged to wear glasses on account of 
 astigmatism. The bones of the nose are well developed and 
 there is plenty of breathing space. He has a growth of fine, 
 white hair all over his face. The ears are undeveloped. The 
 hearing is affected. Width outside first permanent molar, 1.84; 
 
DKVELOPMKNTAL NEUROSES OF THE FACE. 
 
 1()' 
 
 outside second bicuspid, 1.75; width of vault between second 
 bicuspids, .84; height of vault, .50. 
 
 Case 12, Fig. 49. This patient, now sixteen years of age, came 
 to have a deformity of the mouth corrected, four years ago. Her 
 mother is a neurotic. Her father, although a large, fleshy man, 
 has small jaws. Marked arrest of development of the bones of 
 the face has taken place. She possesses a very thin nose, deflec- 
 tion to the left of the septum; enlarged right inferior turbinated 
 bones and hypertrophied mucous membrane. She is a mouth- 
 breather like Fig. 48, the mouth being kept open. The anterior 
 
 Fig. 49. 
 
 alveolar process has developed downward, causing the teeth to 
 protrude. Width outside of first molar, 1.95; outside second 
 bicuspid, 1 .65 ; width of vault, i ; height of vault, .47. 
 
 Case 13, Fig. 50. There is here excessive development of the 
 bones of the face. This lady, thirty-two years of age, married, 
 has one child. Father and mother living and in perfect health. 
 She is healthy in every respect and above the average in intellect. 
 Bones of the face are normal, except zygomse, which are exces- 
 sively developed. 
 
 Case 14, Fig. 51. This patient has a weak physical make-up; 
 
168 
 
 IRREGULARITIES OF THE TEETH. 
 
 has very contracted chest and stoops. Marked arrest of bones 
 of the face, long- slender nose, the outer walls coming in contact 
 with the inner, and therefore a mouth-breather. There is slightly 
 excessive development of the lower jaw. He was supposed to 
 be in consumption and was ordered West. The change of cli- 
 mate and out-door exercise have completely restored him to 
 health. 
 
 Case 15, Fig. 52. This gentleman is a medical student, pos- 
 sesses about the same history as Case 14. He, however, has 
 more marked deformity. There is a great arrest of development 
 
 Fig. .50. 
 
 of the bones of the face and a more marked protrusion of the 
 chin ; this, however, does not show owing to the beard. 
 
 On comparison of these cases there is very little difference in 
 the width of the upper jaw in the first five cases. Three are 2, 
 one 2.03 and one 2.25. Fig. 38 shows arrest of development at 
 the bridge of the nose. Fig. 39 shows arrest of development 
 of the bones of the face extending from the supra-orbital ridge, 
 including the eyes, zygonicC and superior maxillae, presenting 
 a concavity of the face as far down as the superior border of the 
 inferior teeth. Fig. 40 is precisely like Fig. 39 with the excep- 
 
DEVELOPMENTAL NEUROSES OF THE FACE. 
 
 169 
 
 tion that the zyg^omae are still more developed. Fig. 41 is 
 exactly like the last two, with the exception that the zygoinse 
 are still further developed. In V\g. 42 the features are still more 
 normal, but arrest of development is not noticed at the alse of 
 the nose. Fig. 43 not only shows arrest of development of the 
 bones of the face, but also marked arrest of the inferior maxilla. 
 The apparent prognathism is the same in all except Fig. 44. 
 This is not excessive development of the lower jaw, but a normal 
 development. The lower jaw develops independently of the bones 
 
 Fig. 5L 
 
 of the head. and. owing to its mobility, usually develops normally. 
 The apparent prognathism is due to arrest of the upper jaw. 
 
 In a large number of cases, however, the face is normal, but 
 the undeveloped lower jaw is present. Again, the bones of the 
 face are normally developed upon one side and arrested upon 
 the other. In these cases all the conditions presented in the 
 chapter on the development of the bones of the face are readily 
 seen. 
 
 Comparing these faces and their deformities with those of 
 the degenerate classes the deformities of one do not differ from 
 the other. The make-up of the contour of the head, face, jaws 
 
170 
 
 IRREGULARITIES OF THE TEETH. 
 
 and ears of degenerates differ from the others only under dental 
 observation. 
 
 The question naturally arises, at this point, as to how fre- 
 quently stigmata occur with people in the ordinary walks of life. 
 Repeated examinations in street and steam cars, medical and 
 dental colleges, halls and practice in and about Chicago have 
 given the following results : In practice, 68 per cent ; in halls, 
 cars, etc., from 45 to 65 per cent; in a billiard hall, out of 128 
 persons, either playing or looking on, 72 to 87 per cent of 
 deformities of the face and jaws. In medical and dental colleges. 
 
 Fig. 52. 
 
 where students come from the country and different parts of 
 the United States, the percentage will fall as low as 45 per cent, 
 while the congregation of city people, who necessarily include 
 large numbers of degenerates from rural regions, the per cent 
 of deformities will range from 55 to 65. It would not be fair to 
 take the percentage of my patients into consideration, because 
 my practice is made up largely of the treatment of irregularities 
 of the teeth. In analyzing the large percentage found in dental 
 examinations, the fact should' be remembered that irregularities 
 of the jaws and teeth come under observation in large numbers 
 
DEVELOPMENTAL NEUROSES OF THE FACE. 171 
 
 for special treatment. It would, however, be safe to say that 
 from 55 to 60 per cent possessed these deformities. Taking the 
 defective classes, which include numbers of acquired cases not 
 necessarily of defective birth or heredity, as a whole, as found 
 in asylums, the difference in percentage of deformities between 
 them and society at large is not striking. If, however, congenital 
 cases, habitual criminals, drunkards, prostitutes, paupers, etc., 
 be considered the percentage is from 85 to 95 per cent. 
 
 In cases just cited are to be noticed arrested development of 
 the orbit. As in other parts of the face, the checking of the 
 development of dermal bones plays a part here. The poten- 
 tialities of the infant are not on this account fulfilled. As I have 
 elsewhere shown when the typical infant begins to develop, the 
 cerebral part of the skull predominates over the facial more than 
 in the adult, the superciliary ridges are not developed, the alveo- 
 lar borders are not prominent, nor are the cheek-bones, the nose 
 is without a bridge and the cartilages are flat and generally short, 
 the eyes are larger. In this last particular the human infant 
 resembles the lemurs and therein retains an embryonic tendency. 
 In some degenerates this tendency remains unchecked. The 
 result is unusually large orbits. In other instances the orbit of 
 the human foetus passes through this lemurian stage to reach 
 and at times even to exceed the anthropoid type in smallness 
 and close approximation. 
 
CHAPTER XVIII. 
 
 DEVELOPMENTAL NEUROSES OF THE NOSE AND 
 INTERIOR FACIAL BONES. 
 
 The bones of the nose follow the same laws in embryonic 
 development and its arrest as do the other structures of the head 
 and face. As, however, completion of the ossification occurs 
 very nearly at that great period of stress, puberty, greater varia- 
 tions occur at that period even, in seemingly otherwise normal 
 individuals than with other bones of the head and face. This 
 stress underlies the so-called "catarrh" of puberty. 
 
 Deformities of the nasal septum, deflection, hypertrophy and 
 atrophy of the turbinated bones and deformities of the maxillary 
 simuses, are generally associated with arrest and excessive devel- 
 opment of the facial and maxillary bones. As it is possible to 
 occasionally find deformities of the maxillary bones without 
 deformities of the nose, so it is possible to find deformities of 
 the nose without maxillary deformities. 
 
 Theile examined 117 skulls and found the septum normally 
 placed in 29. Semeleder examined 49 and found the deflection 
 to the left in 20, to the right in 15 and sigmoid deformity in 4. 
 Harrison Allen, in 58 skulls, found narrowing to the left side 
 in 19, to the right in 21 ; in six of the latter the septum and 
 superior and middle turbinated bones met. 
 
 According to Zuckerkandl dry skulls do not give an accurate 
 illustration of the true condition. His researches were made upon 
 the cadaver; out of 370 cases he found 123 symmetrical and 140 
 asymmetrical ; in the deformed specimens, the septum was 
 inclined to the right in 57 cases, to the left in 51 and was sigmoid 
 in 32. Mackenzie, on examination of 2,152 skulls in the Museum 
 of the Royal College of Surgeons, found 1,657 cases where the 
 septum was more or less deformed. In 834 the deviation was 
 to the left and in 609 to the right. In 205 the deflection was 
 sigmoid, while in 5 the irregularity was zigzag, showing 70 per 
 cent of deformities in the dry skulls and only 40 in the cadaver. 
 
 172 
 
ADOLESCENT NEUROSES OF NASAL AND KACIAL BONES. 173 
 
 Heyman's examination showed 99 per cent of deformities in 
 living subjects. With the status already, there seems to be quite 
 a difference in the percentages as regards races. Thus Zucker- 
 kandl found in 103 cases of barbarous and semi-barbarous people 
 twenty-four were asynmietrical. Mackenzie found in 430 skulls 
 of superior races 22.0 per cent of deformities and also confirms 
 the observation of Zuckerkandl. 
 
 Harrison Allen found in 93 skulls of negroes deformity of 
 the septum in 21.5 per cent. I have examined over 11,000 in 
 this country and Europe, including the large collection in the 
 Museum of the Royal College of Surgeons, and 347 living indi- 
 viduals with the following results : Owing to the fragility of the 
 septum the whole or anterior part was lost in many of the skulls, 
 the results of which only 7,600 had sufficient bone remaining to 
 give any idea of its shape. My examination of skulls in the 
 Royal College of Surgeons, London, practically tallies with 
 Mackenzie. In the 7,600 skulls, 5,762 showed marked deform- 
 ities. Out of 687 ancient Peruvian skulls, 147 possessed deflec- 
 tion of the septum. In 69 stone-grave Indians, 35 were normal 
 and 34 deformed. In 18 mound-builders, 8 were normal, 10 
 deformed ; 6 California Indians, 4 were normal. 
 
 In a collection by J. M. Whitney, of Honolulu, of 28 skulls 
 of ancient Hawaiians, taken from lava caves, the jaws were 
 unusually well developed as well as the bones of the face. The 
 external bones of the nose were also well formed. While there 
 was a lack of that marked asymmetry due to excessive arrest of 
 development of the turbinated bones, as noticed in Peruvian 
 skulls, yet the bones were far from being uniformly located in 
 the cavities of the nose. There were, however, two in which the 
 inferior turbinated bones were undeveloped, only rudimentary 
 ridges being present. Deflection of the septum was noticed 
 in 23 cases — some in the anterior part of the bone, others in the 
 middle, and still others in the posterior part. In the two cases 
 where the inferior turbinated bone was undeveloped the septum 
 deflected to that side. There were projections which seemed 
 to take the place of the missing turbinated bones. One case 
 was observed in which the deflection commenced midway, from 
 before backwards, the greatest deformity being three-fourths of 
 
174 IRREGULARITIES OF THE TEETH. 
 
 its distance into the left cavity, midway between the turbinated 
 bones. Upon that side of the vomer there was a large ridge, its 
 greatest projection being about .25 of an inch in length. Upon 
 the opposite side there was another smaller ridge, evidently for 
 the purpose of supporting the deflected point, and also for the 
 purpose of affording greater surface for mucous membrane and 
 blood supply. Of the 347 living persons, 107 showed deflection 
 of the septum. 
 
 Unlike Zuckerkandl, I do not find that dryness of the skull 
 makes any difference ; whether it be from a living subject, on the 
 dissecting table, or skull that has been grinning from the shelf 
 of a museum for twenty years. The two points of attachment 
 are fixed (if the patient has reached puberty), and the septum, 
 green or dry, cannot very well change its position, except there 
 may not be quite so noticeable a deflection in the dry subject. 
 
 If the deformity were of a sigmoid (S-shaped) nature upon 
 one side, the part of the bone or cartilage being dry would pre- 
 vent its changing to the opposite side in the one case, or a 
 reversal of the S-shape in the other. Diagnosis of deflection of 
 the septum is more difficult in the living subject or cadaver than 
 in the dry skull, because of the soft tissues located in the anterior 
 part of the nose. This accounts for the small percentage of 
 deformities reported by Zuckerkandl and myself. I found great 
 difficulty in making my examinations upon living individuals; 
 indeed, it seems almost impossible to discover the contour of the 
 vomer in its middle and posterior parts, where they are as fre- 
 quently observed as in the anterior part. This deformity was 
 of all manner of shapes, sometimes like the letter S, again the 
 letter C, and often like the small italic letter f. Sometimes it 
 would be carried over so far as to approximate the right or left 
 wall of the nose. From the fact that it is attached throughout 
 at its upper and lower border to a solid, bony framework, its 
 middle portion is liable to bend in any direction like a loose 
 sail in the wind. Deflection of the vomer, due to fracture of the 
 cartilage, or the deflection of the anterior part of the nose, is 
 easily differentiated from a fractured vomer. 
 
 Several theories have been advanced as to the cause of these 
 deformities. Quelmalz and Schultz believed they were due to 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL HONES. 175 
 
 the action of astringents drying up the mcnil^rane, causing it 
 to contract, thus drawing the bone and cartilage down upon 
 itself. Morgagni bcheved they were due to excessive develop- 
 ment of the vomer. Trendelenburg held they were due to a 
 crowding up of a high-arched palate, as he had observed the 
 two conditions frequently connected. Jarvis has reported four 
 cases, all in the same family, and suggests they are due to direct 
 hereditary defect, while neurotic or degenerate conditions which 
 underlie the building up of the system may produce the deflec- 
 tion, direct hereditary here as elsewhere is rare. Schaus' and 
 Welcker's investigations show there is a faulty development of 
 the facial skeleton. Bosworth^ and others believe that septal 
 deformities are due to traumatism. According to Bosworth, 
 "The clinical history of many of these cases affords direct evi- 
 dence of this, and even in those cases in which the direct injury 
 is not testified to, I think it safe to say that an injury has 
 occurred, which may have been of so slight a character as not 
 to have excited especial attention at the time of the occurrence. 
 An injury to the nose need not necessarily give rise to the imme- 
 diate development of a notable deformity, as in fractures, but it 
 may set up a low grade of morbid action, which, going on 
 through a number of years, will finally develop a condition by 
 which the normal function of the nose is seriously hampered. 
 The point on which I would lay especial emphasis is that the 
 deformity is primarily the result of traumatism and secondarily 
 of a slow inflammatory process which results therefrom." That 
 deformity and fracture of the septum may, however, be traced 
 to traumatism, I am personally well aware. In one case, when 
 a boy of sixteen. I asserted my rights and received a blow upon 
 the nose from my opponent which fractured the cartilage which 
 made a lasting impression upon me. The theory from 50 to 80 
 per cent, or even 5 per cent of deformities of the septum are due 
 to such injuries, is demonstrably illogical. In the large number 
 I examined, 2,684 possessed what appeared to be fracture. The 
 vomer in many of these specimens commenced to deflect at its 
 outer surface and gradually deepened until at about its middle 
 or posterior two-thirds, it reached its deepest part and then grad- 
 ^ Diseases of the Nose and Throat. 
 
176 IRREGULARITIES OF THE TEETH. 
 
 ually decreased in depth until the posterior attachment was 
 reached. Its appearance was not unUke the sail of a ship. On 
 the convex surface, in many cases, nature had thrown out pro- 
 visional bone to support this curvature, which might be con- 
 sidered a break, but in most cases simply a bend. That a blow, 
 whether slight or as powerful, could produce a fracture of the 
 vomer, the greatest deformity of which is located from .75 to 
 two inches inside the nose from the point of the nasal spine 
 seems hardly probable. Anterior and posterior to this deflec- 
 tion, the vomer appeared in most cases to be nearly or quite 
 normal. In nearly every case of fracture would involve only 
 one-half of the vomer, the other simply bending ; that such a 
 condition could be brought about by a blow is absurd. It 
 seemed the greatest deformity was the thinnest part of the bone. 
 
 It would appear to be a very easy matter in the skull to 
 decide whether a fracture had taken place before or after com- 
 plete ossification by the character of the wound, thus approx- 
 imating the date of the injury. That it was caused by a low form 
 of inflammation set up as a result of a slight injury in utero or 
 after birth does not seem rational since the inflammatory con- 
 dition must necessarily extend upon both sides of and through 
 the septum extending its entire length. If due to an inflamma- 
 tory condition the bend or break W'ould be found at any part of 
 the septum and the position and shape would be different in 
 every case. As the location upon the septum, from above down- 
 ward, is nearly always the same, and as the shape is always 
 from before backward, inflammation could not produce it. In 
 order to produce a fracture, there must be excess of septum. 
 Therefore, unless the fracture is the result of a direct blow it 
 would require years for sufficient growth and curvature to pro- 
 duce a condition in which fractures or even an abrupt bending 
 could take place. 
 
 The theory the deformity is "primarily" the result of trau- 
 matism due to injury in utero or at the time of delivery or even 
 subsequently, except by direct force and secondarily to a slow 
 inflammatory process, will, therefore, not account for these 
 deformities. Indeed, fracture of soft tissue, such as the vomer 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL BONES. 177 
 
 before ossification, is not possible. The theory advanced by 
 Trendelenburg cannot be maintained. 
 
 Wherever a high, contracted vault exists, a deflected septum 
 is found. Often, however, a deflected septum is found without 
 a high contracted vault. While the high vault and deflected 
 septum go hand in hand, the one does not produce the other. 
 It has been shown in the chapter upon the development of the 
 vault, that it is developed downward and not up. The develop- 
 ment of the suture, which unites at the median line, is precisely 
 like laying the keel of a ship, only upside down; it is laid first 
 and is the foundation upon which the superstructure rests. The 
 narrow, contracted vault is, except in monstrosities, never seen 
 before the sixth year. Many septa are deformed before that 
 
 Fig. 33. 
 
 date. There is nothing to cause upward movement of the vault. 
 The ridge does not result from pushing down of the suture by 
 the vomer. The vomer must be taut to accomplish this, but 
 it is always bent in such cases. Again, if the ridge was produced 
 by the action of the vomer it would be nearly or quite uniform 
 in thickness its entire length, but this is never the case. If it 
 were possible to crowd down the middle and posterior palate, 
 it would be impossible to crowd down the anterior part of the 
 palate, which is covered by the anterior alveolar process. I have 
 frequently observed a ridge extending along and including the 
 alveolar process as far as the incisor teeth. In 1,367 skulls, 
 containing vaults so depressed, I have never found a correspond- 
 ing depression in the floor of the nose. 
 
 13 
 
178 
 
 IRREGULARITIES OF THE TEETH. 
 
 It would be as impossible to force down the vault at the 
 median line as it would be to force a keystone through a brick 
 or stone wall by the weight resting upon it. The author, and 
 others, have shown that deformed septa are common among 
 early and pure races, who do not possess contracted arches ; so 
 that it will be seen that one is not dependent upon the other. 
 As regards length of septum, I agree with Morgagni, that it 
 has developed beyond normal, and in order to accommodate 
 itself to its surroundings, it must deflect either to the right or 
 left. 
 
 In some cases the right side has the preference, in others 
 
 Fig. 54. 
 
 the left side is more favored, while again, there is an even divi- 
 sion as regards deformities. 
 
 The first seven cases which I shall choose for illustration 
 of this point are Peruvian skulls from Harvard college. 
 The cases seen in Figs. 53 to 56, inclusive, are well devel- 
 oped, while those in Figs. 57, 58 and 59 are arrested in their 
 development. These photos were arranged so as to get as 
 much light into the cavities as possible. Some, however, are 
 quite unsatisfactory, for, while they show the septum, the tur- 
 binated bones and surrounding parts are not well illustrated. 
 Fig- 53 shows the. septum deflected to the left — resting upon 
 the inferior turbinated bone of that side. The right turbinated 
 hones (which are poorly shown) are excessively developed, to 
 huch an extent that while they do not quite touch, they take the 
 contour of the nasal septum. Fig. 54 shows a similar condition, 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL BONES. 
 
 179 
 
 while the nasal septum is not deflected quite as far. The right 
 superior turbinated bone is excessively developed, but not to 
 the extent of the inferior one. Fig. 55 shows a septum almost 
 straight. The left inferior turbinated bone is well shown. The 
 other turbinated bones are also excessively developed, but do 
 not extend so far forward. The septum is divided into two 
 parts. It will be observed that in the other two, unlike this one, 
 the turbinated bones are arrested in their development upon 
 one side, and excessively developed upon the other. Both 
 cavities are entirely, but vmiformly, filled with complete 
 masses of soft, spongy portions of the turbinated bones. Stig- 
 mata are marked in the skulls, while the cavities of the nose are 
 smaller, or arrested in their development. The two sides of the 
 
 Fig. 55. 
 
 face are quite unlike, and the orbits are very much undeveloped. 
 There is a marked arrest of development of the left maxillary 
 Done, which contains an antrum only about one-half the size of 
 the right side. The arrest of development has caused the teeth 
 to be forced out on a large circle, in order that they may come 
 in contact with the lower teeth. This action has caused the 
 roots of the teeth, in many cases, to protrude through the outer 
 plate of alveolar process. The mastoid processes are also 
 excessively developed. A profile view was taken of this skull 
 (Fig. 56), in order to obtain as good a view as possible of the 
 large right inferior turbinated bone. This bone is so large that 
 it extends nearly to the floor of the cavity. The most remark- 
 able point in regard to this deformity, outside of the excessively 
 
180 IRREGULARITIES OF THE TEETH. 
 
 developed turbinated bones, is, that not only is the septum 
 deflected to the left until it rests upon the wall of the cavity, but 
 that the nasal spine is also deflected. In Fig. 57 are seen nasal 
 cavities arrested in their development. The septum is but 
 slightly curved to the left. The nasal cavities are filled with 
 excessively developed turbinated bones, and the spaces between 
 the turbinated bones and the vomer are about evenly divided. 
 In Fig. 58 is seen a very small nose, the vomer is deflected to the 
 left below, and at about one-third of the way up it takes a 
 decided turn to the right. In the examination of the turbinated 
 bones the right inferior bone is very large, the left very small, 
 while the reverse is the case in the two upper bones. In Fig. 59 
 are seen stigmata of degeneracy in the nasal cavities. Here the 
 
 Fig. 56. 
 
 vomer is about straight, while the turbinated bones upon both 
 sides are so large that they fill the cavities ; the spaces between, 
 however, are uniform upon both sides. Deflection of the septum 
 and excessive development of the turbinated bones are hence 
 associated with large, well-formed nasal cavities, as well as with 
 small, contracted cavities in ancient as well as modern people. 
 The same relation exists between the vomer and turbinated 
 bones in all the skulls as well as in living persons. The extent 
 and location of the deformity depend upon the extent of develop- 
 ment and location of the turbinated bones. They may not 
 necessarily be excessively developed or arrested in their develop- 
 ment, but if the outer walls be small, reducing the size of the 
 nasal passages, and the turbinated bone unevenly situated or 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL BONES. 181 
 
 nearly filling the cavity, the septum will deflect to the right or 
 left and conform to their shape, leaving uniform spaces through- 
 out the entire length of the bone. Inhalation and exhalation 
 cause the vomer before or during ossification to deflect to the 
 right or left, according to the size and location of the turbinated 
 bones. The air striking the septum, just as the wind strikes 
 the sail of a boat, produces uniform spaces between the septum 
 and turJMnatcd bones. The bend or breakage is almost invari- 
 ably at a point of the concavity just midway between the two 
 turbinated bones on that side, and at the thinnest part of the 
 vomer. When the turbinated bones are undeveloped upon 
 one side and excessively developed upon the other, the force 
 of air causes the vomer to bend toward the smaller turbinated 
 
 Fig. 57. 
 
 bone, thus lengthening it, so that the air will enter and leave 
 uniformly upon both sides, as illustrated in Figs. 53 and 54. If 
 the turbinated bone is large upon one side, the force of air will 
 cause the unossified vomer to develop, and if the cavity of the 
 nose is large, the whole volume of air will eventually strike 
 the vomer upon one side, causing it to bend right or left until the 
 air is uniformly distributed or it comes in contact with the 
 turbinated bones upon the opposite side. In Figs. 57 and 59, 
 the turbinated bones, developing nearly uniformly upon both 
 sides and filling the nasal cavity, give no opportunity for the 
 septum to deflect to the right or left. The spaces, therefore, 
 are uniform upon both sides. It is also safe to say that when 
 these bones are covered with mucous membrane that the nose 
 
182 IRREGULARITIES OF THE TEETH. 
 
 was completely filled, and that these persons were mouth- 
 breathers. 
 
 Associated with unstable development of the superior maxilla 
 and bones of the nose, must necessarily occur unstable develop- 
 ment of the mucous membrane, resulting in a thickening of the 
 membrane and adenoid grow^ths. These conditions are almost 
 always to be found in connection with stigmata of degeneracy. 
 Idiots, imbeciles, etc., patients possessing (apparently) high 
 vaults, are hence mouth-breathers. There is an arrest of devel- 
 opment of the bones of the face, jaw and nose. The patient 
 cannot breathe through the nose ; the mouth being open the 
 teeth and alveolar process develop down for want of antagonism ; 
 
 Fig. 58. 
 
 and the contracted vault, which looks high l)ecause of the arrest 
 of development, results. 
 
 It is quite common to find entire arrest of the inferior tur- 
 binated bones upon one side or upon both sides. Again, one 
 or both inferior turbinated bones will be partially developed. 
 
 The following skulls, in the Army Medical Museum at Wash- 
 ington, possess such deformities : 
 Alaska Indians — 
 
 Skull No. 1,090, case 177; low^er right turbinated bone 
 
 undeveloped. 
 Skull No. 1,092, left inferior turbinated bone undeveloped, 
 
 vomer gone. 
 Skull No. T.094 both inferior turbinated bones unde- 
 veloped. 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL liONES. 183 
 
 Skull No. 2,431, no inferior turbinated bone. 
 
 Skull No. 2,453, "O inferior turbinated bone. 
 
 Skull No. 2,798, no inferior turbinated bone. 
 
 Skull No. 2,451, no left inferior turbinated bone. 
 
 Skull No. 1,216, case i8o; both inferior turbinated bones 
 
 undeveloped. 
 Many Peruvian skulls show undeveloped inferior turbinated 
 bones. Thus : 
 
 Skull No. 630, case 166; no ri^ht inferior. 
 
 Skull No. 631, case 166; no right or left inferior. 
 
 Skull No. 115, case 167; no left inferior turbinated bone. 
 
 Individual over twenty-two years of age at time of 
 
 death. 
 
 Fig. 59. 
 
 Excessive development of the turbinated bones is also very 
 common. Thus, No. 2. 131, case 175, \"ancouver Island Indians: 
 The right middle turbinated bone is excessively developed, so 
 that it falls the anterior middle of the nasal cavity with a large 
 cavity in the center. The left mi Idle and right and left inferior 
 bones were well developed, filling both nasal cavities. In this 
 case the vomer, which stands uniformly between the turbinated 
 bones, takes the shape of the letter S. No. 2,129, Vancouver 
 Island Indiaiis, shows left superior turbinated bones ; exces- 
 sively developed to a level with middle turbinated bone. The 
 vomer is deflected to the right, then to the left, in order that 
 it may stand in a central position. Skull 1,309. case 173, illus- 
 trates the theory of the author very nicely. The right middle 
 turbinated bone undeveloped, inferior right excessively devel- 
 
184 
 
 IRKEGULARIIIES OF THE TEETH. 
 
 oped ; the vomer at its middle takes a V-shape, in order that 
 it may stand in the middle between the turbinated bones. 
 
 That inhalation and exhalation govern the development and 
 shape of the bones of the nose is shown in many ways. When 
 the nasal cavities are small and the bones become enlarged upon 
 one side, the outer wall will become concave, encroaching upon 
 the antrum. Again, when the nasal cavities are small, the tur- 
 binated bones will develop and curl upon themselves so that 
 uniform space is obtained for the passage of air. In a long, nar- 
 row nasal passage the bones will develop long and narrow ; the 
 superior turbinated bone will develop down, sometimes below 
 the lower edge of the superior turbinated bone. In other cases 
 the nasal cavities will be short and broad. In these cases the 
 
 Fig. GO. 
 
 bones will become large and short. They may develop straight 
 out from the outer wall, and then turn upon themselves back 
 to the point of origin. Sometimes they are very thin and dense, 
 like the vomer. Again, they are thick and cancellated, like the 
 spongy alveolar process. Occasionally one nasal cavity will be 
 lower than the other. In such cases a corresponding deformity 
 is almost sure to result in the vault. When the nasal cavities 
 are not uniform in development — that is, narower in front than 
 behind — the turbinated bones will develop posteriorly, and either 
 become undeveloped anteriorly or will curve more, so that air 
 may be evenly distributed throughout the cavity. When the 
 turbinated bone develops larger or smaller behind than in front, 
 the bone will bend upon itself to conform to this deformity. 
 
ADOLKSCKNT NKUUOSKS Ob' NASAL AND FACIAL IJONKS. 185 
 
 Skull No. 736. case 179, has also a very marked deformity 
 of the vomer; it is bent in both directions. The anterior half 
 is midway between the turbinated bones, while the posterior 
 half is bent to the right, the greatest point being between the 
 right upper and lower turbinated bones. Both concavities have 
 projections — one to the right, the other to the left. The anterior 
 curvature of the vomer is the largest; and for this reason the left 
 turl)inatcd bone is undeveloped. This, however, does not allow 
 sufficient room for the air to become evenly distributed through 
 the nostril upon one side. The most remarkable thing is that 
 to procure room the air had forced the vault of the mouth on 
 
 Fig. 61. 
 
 that side downward, making a very marked and noticeable 
 deformity. The dental arch is well developed. 
 
 Occasionally the turbinated bones are so situated that the 
 air will deflect the vomer to one side or the other in such a man- 
 ner that there will be a deformity at right angles, just below 
 the inferior turbinated bone. This, however, cannot be located 
 very near its place of attachment, for the reason that the vomer 
 commences to enlarge or thickens as it reaches the nasal spine, 
 thus preventing the bend. 
 
 The drawings of Zuckerkandl are here given because they 
 illustrate the points made, and are true to life. 
 
 Figure 60 shows the bone very unevenly developed. This 
 is partly due to an excessively developed antrum upon the left 
 
186 
 
 IRREGULARITIES OF THE TEETH. 
 
 side and a correspondingly small one upon the right side. It 
 will be noticed that the turbinated bones and vomer are so dis- 
 tributed that there is a uniformity of space throughout the cavity. 
 The vomer even has deflected to the right in order to produce 
 this harmony. It will be observed, however, that the bone is 
 not broken, but simply bent, and that this bend is almost oppo- 
 site the enlarged left inferior turbinated bone. Although the face 
 is very asymmetrical, the bones, which are intended for the pur- 
 pose of warming the air, are nicely arranged. The right cavity is 
 considerably lower than the left ; the inferior turbinated has 
 lengthened to correspond. Aspiration has separated the lateral 
 halves of the vomer, and the space has filled in with bone. 
 
 Fig. 62. 
 
 Figure 6i presents quite another state of things. Here the 
 facial bone is uniformly developed ; the antra are comparatively 
 uniform ; the turbinated bones, however, are very unevenly 
 developed. The bend and break in the vomer are about at a 
 point betwen the two turbinated bones, and exactly opposite 
 the excessively developed right inferior turbinated bone. It 
 will be observed that the bend is no greater in the one than in 
 Fig. 60, and yet in Fig. 61 the left plate is fractured, while the 
 right one is slightly bent. This is usually the case. There is not 
 a complete fracture, but a semi-fracture. 
 
 Figure 62 shows still a different condition. The left antrum 
 is nearly closed; to compensate for this a number of sinuses are 
 formed. In order that the air may be warmed uniformly the 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL BONES. 187 
 
 septum has developed to the left. The lower part has enlarged, 
 and the middle has deflected to the right, thus giving a more 
 uniformity of spaces. The right inferior turbinated bone has also 
 enlarged for the same purpose. 
 
 Fig. 63 is an excellent illustration of arrest of development 
 of the bones of the face, nose and jaws. The bones are very 
 unevenly developed, with excessive development of the left 
 superior turbinated bone, which has a cavity in it no doubt for 
 the purpose of producing more surface for the blood supply. 
 An individual wath such a development must necessarily possess 
 a degenerate condition, with weak lungs, small chest, and low 
 vitality. In order that the air may be uniformly w-armed the 
 
 Fi'S- 6.S. 
 
 septum has deflected toward the right. The vomer has deflected 
 toward the right in order that the turbinated bone may have 
 room, and also to furnish uniform space. The septum in this 
 case is bent and not broken. 
 
 Fig. 64 is another form of deformity which I have occasion- 
 ally observed. In this case the nasal cavities extend laterally 
 nearly outside of the alveolar process. Were one to undertake 
 to open the antrum through the cavities of the teeth he would 
 drill into the floor of the nose. I have observed such cases. 
 Having such a large space the turbinated bones have adjusted 
 themselves to the best advantage. The septum also has adapted 
 itself as best it can by deflecting toward the left side, having bent 
 itself at its w^eakest part and opposite the enlarged turbinated 
 bone. There is, however, a large space upon the right side 
 
188 
 
 IRREGULARITIES OF THE TEETH. 
 
 between the two turbinated bones. The thickness of the bone 
 prevents its being bent by the pressure of air, and excessive 
 development of the vomer has taken place upon that side as 
 a substitute. 
 
 Fig. 65 shows the turbinated bones upon both sides exces- 
 sively and uniformly developed, the result of which is that the 
 vomer is straight upon the left side, while the right half has been 
 torn away, and by aspiration the air has drawn it slightly into 
 the space between the two bones. 
 
 Figs. 66 and 67 are drawings taken from frozen specimens 
 in the Army Medical Museum at Washington, showing that 
 the parts of fracture and deflection are situated between the 
 turbinated bones. 
 
 A skull in my possession is that of a girl fourteen years of 
 age, who died of consumption. There is hardly a bone whicfi 
 goes to make up the skull, including the lower jaw, that does 
 not show stigmata of degeneracy. The left inferior turbinated 
 bone did not develop. A simple ridge is present where the bone 
 should be attached to the outer wall. The right inferior tur- 
 binated bone is excessively developed. The vomer has curved 
 to the side where there is space and from the enlarged right tur- 
 binated bone. Although there is quite a bend, still, owing to the 
 fact that the girl died at the age of fourteen, this is not as 
 marked as it would have been had she lived. 
 
 Another case is that of a bone projecting .36 of an inch, 
 (situated upon the right side of the vomer just midway between 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL HONES. 189 
 
 the superior and inferior turbinated bones), .75 of an inch in 
 length, 1.50 inch in from the nasal spine, and .50 of an inch 
 from the posterior border, which is comparatively straight. The 
 anterior part is slightly curved, but perfectly straight .50 of an 
 inch anterior to the commencement of the deformity. There is 
 a slight groove upon the opposite side of the vomer to cor- 
 respond to the line of projection. It stands just midway between 
 the two turbinated bones. This is not a fracture, nor can it be 
 claimed that the projection is for the purpose of repairing a 
 fracture. The length of this projection would alone preclude 
 such an idea. These projections vary from a mere ridge up to a 
 
 Fig. 65. 
 
 projection .36 of an inch in w'idth. It would seem that nature, 
 being unable to develop the bone sufficiently to carry it far 
 enough, built out a projection in order to complete its design. 
 
 These projections were first mentioned by Langenbeck, who 
 gave to them the name of exostoses. They were afterward 
 described by Theile, Harrison Allen and John Mackenzie. 
 ''These projections," according to Bosworth, "are always found 
 along the sutural lines of the septum, and consists in a more or 
 less well-developed angular prominence or ridge, which pro- 
 jecting into the nasal passage, acts to obstruct normal respira- 
 tion." 
 
 This has not been my experience. I have always found them 
 situated upon the convex surface, and the greatest projection 
 
190 
 
 IRREGULARITIES OF THE TEETH. 
 
 being at the weakest point of the septum. As the greatest 
 deformity may be located at any point between the anterior and 
 posterior edges of the bone, the greatest point -of projection 
 may occur on any part of the septum, but always situated mid- 
 way between the turbinated bones. This projection is due to 
 irritation, from inhalation and exlialation. 
 
 In deviation of the vomer to the right or left, with a decided 
 depression always at a point where there is the greatest space; 
 sometimes in the anterior part of the bone, and often in its pos- 
 terior part ; sometimes high up, and again low down, depending 
 upon the location of the turbinated bone, with a rib of bone 
 developed upon its convex surface. It seems to be a super- 
 
 numerary turbinated bone. The deflection and the supernumer- 
 ary turbinated bone compensate for the space on either side of 
 the nose. Just as the intelligence of the individual depends 
 upon the amount of gray matter in the brain, and the gray matter 
 depends upon the number of lobes or convolutions, so the warmth 
 of air which is taken into the lungs depends upon the amount of 
 blood, the blood upon the amount of mucous membrane, and 
 the mucous membrane upon the contortion of the bones of the 
 nose to produce surface. If they are arrested upon one side, 
 those upon the other enlarge or elongate, and thus make up for 
 the deformity. When the inferior turbinated bone is entirely 
 arrested the bend in the septum and projection seems to compen- 
 sate for the loss. In neurotics and degenerates, in many cases, the 
 lungs and the chest walls are undeveloped and very delicate. 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL HONES. 
 
 191 
 
 The deforniities take place before puberty, and in a majority 
 of cases before the sixth year. The arrest of development of 
 the jaw takes i)lace at the time the second teeth erupt, and the 
 arrest of the nose and face shows that the individual possesses 
 a face of that age. 
 
 The width of the external nasal cavity varies considerably. 
 In 2,000 cases, the greatest width was 1.25 of an inch; the 
 smallest width w^as .75. The length from the nasal spine to the 
 edge of the nasal bones was (greatest length) 1.54 and the small- 
 est 1.20 of an inch. These skulls, however, are made up of 
 Peruvians, stone-grave Indians, mound-builders, clifT-dwellers, 
 Hawaiians, etc.. etc. In neurotics and degenerates, when arrest 
 
 Fig. 67. 
 
 of development of the face and nose had taken place, I found 
 that the wndth measured .50 to .60 of an inch, and the length 
 .80 to .90 of an inch. In these cases, if the turbinated bone 
 developed uniformly, the vomer will be straight. If asymmetry 
 exist, the vomer will be deflected to one side or the other, in 
 which case the bone, when covered with mucous membrane, 
 wall fill the cavity of the nose and mouth-breathing will result. 
 
 On general view of the nose, a want of harmony in its general 
 outline in many cases is seen. The nasal bones become arrested 
 in their development, and the tip of the nose is turned up, owing 
 to a normal or excessively developed cartilage. Another and 
 very marked deformity is one in which the nasal bone and car- 
 tilage are excessively developed. The bone takes one angle and 
 
192 IRRKGUI-ARITIES OF THK TEpyiH, 
 
 the cartilage another, producing a donljle nose. This condition 
 is very common among Hebrews. There are, however, Ameri- 
 cans who have nasal organs containing material enough for two 
 fair-sized noses. In a majority of these cases there is a total 
 collapse of the walls of the nose, and frequently mouth-breathing 
 results. 
 
 Fig. 70 illustrates such a case, although the nose is not 
 nearly as large as these two I have just described. This illus- 
 tration, however, gives a fair idea of such cases. In over 2,000 
 measurements of the nasal bones, the shortest was found to be 
 .40, the longest 1.65 of an inch in length. It will be seen that 
 even the bones without the cartilage would make a fair-sized 
 nose. These bones take different angles. It would seem that 
 those which are the largest take the greatest angle. A form of 
 deformity, which is more common than is generally supposed, 
 is that in which the nose is deflected to the right or left. This 
 deformity, however, is often so great that it produces a marked 
 asymmetry of the face, and often so slight as to be unnoticed 
 by the average observer. There is no doubt that it is carried 
 to the right or left by the cartilaginous septum, when only the 
 soft tissues are involved ; but when the bones of the nose are 
 deformed, quite another condition exists. Marked deflection, 
 as well as other deformities of the nose, are not observed in 
 early life, but as the face develops the deformity becomes more 
 prominent, and at puberty is well defined, although it does not 
 reach its full development until twenty-five or thirty years. In 
 most every instance the two lateral halves of the face are asym- 
 metrical, as well as the nasal bones. The bones of the nose 
 develop upon one side and deflect the lower border to the oppo- 
 site side, where the bones are undeveloped. This has a tendency 
 to deflect the cartilaginous septum in the same direction, which, 
 in turn, exaggerates the deformity. Noses in neurotics and 
 degenerates may be deflected nearly 45° from a normal position. 
 The claim has been made that these marked deflections are due 
 to injury in utero or at birth. As the bones of the nose are 
 undeveloped at birth, and as marked deflection is not observed 
 until later in life, such a theory does not fit the case. 
 
 At birth the nasal cavities are not evenly developed. If one 
 
ADOLKSCENT NKUROSKS OF NASAL AND FACIAL IJONES. 11);] 
 
 side is larger than the other, more air will pass through one side 
 than the other. If the two sides are nearly even, the amount of, 
 air will be about uniformly distributed. 
 
 Ziem has shown that if one nostril of a rabbit be permanently 
 closed and the animal killed after it has attained its full growth, 
 the nasal cavity of the afifected side. will be found to be unde- 
 veloped, and asymmetry of the face will have taken place. This 
 is also the case when one side is undeveloped; the air passes 
 through the opposite side and the passage becomes enlarged. 
 A greater quantity of air passing through, a greater surface of 
 mucous membrane is required to warm it. The turbinated bones 
 become physiologically enlarged, owing to the stimulation of 
 the air, and the vomer is carried to the weak side. The unde- 
 veloped condition of the nose and asymmetry of the face of 
 animals, as demonstrated by Ziem, can be accounted for in no 
 other way than a want of stimulation of air inhaled and exhaled. 
 
 The septum ossifies much slower than the surrounding bone, 
 and therefore it is more easily moved out of its normal position. 
 At, or about the sixth year, the deformity is well established. 
 The air stimulates a physiological development of the septum, 
 and it bends toward the undeveloped side. It grows faster than 
 the points of attachment, and as a result the septum, according 
 to the law of mechanics, bends toward the smaller part. When 
 inhalation takes place, the air passing through the undeveloped 
 passage, produces suction, thus drawing the bone toward that 
 side ; while upon the other hand, the large volume of air passing 
 through the large nostril, forces it in the same direction. Thus, 
 by aspiration and pressure, the thinner part of the bone is bent 
 to the weaker side, which gives a uniform space for the pressure 
 of air throughout the nose. The location of the deformity 
 depends upon the asymmetry of the two sides and the thinness 
 of the vomer. Close examination of section of the vomer shows 
 projection upon one side or the other, and sometimes vipon both 
 sides, due to fracture or excessive development of bones that 
 they are always located between — the turbinated bones. They 
 are not just in the center, but not far from it. These are also 
 the result from stimulation by exhalation or aspiration of air, 
 producing healthy physiologic action at that point. 
 
 14 
 
194 IRREGULARITIES OF THE TEETH. 
 
 When a slight irritation of the mucous membrane takes 
 place, as a result of cold, it thickens. The child experiences 
 difficulty in breathing. In the spasmodic effort to draw air into 
 the lungs through the nose a vacuum is formed and the septum 
 is developed and drawn to the point of least resistance, which 
 would naturally be at a point between the turbinated bones. In 
 this manner the septum takes the outline midway between the 
 bones. The fracture very rarely extends through the two halves 
 of bone ; only one side breaking, while the other is simply bent. 
 The fractured half being always upon the convex side leads to 
 the opinion that it is due tofijthe thickeningof the mucous mem- 
 brane, (2) accumulation of moisture or purulent mucus, and (3) 
 an excessive effort on the part of the patient to draw air through 
 the nose. This being impossible the vomer is drawn into the 
 space after partial ossification has taken place, and, as a result, 
 fracture of that half and simple bending of the other half. The 
 edges of the broken half are torn apart from the other half, pro- 
 ducing a space between, which is eventually filled up with bone 
 cells. This condition is not unlike the fracture of a green stick. 
 Sometimes it will be drawn to the right side in one place and 
 to the left in another. Again, in the same manner, the two 
 lateral halves are separated their entire length, as illustrated in 
 Fig. 55. There is a projection of the right half at a point midway 
 between the right turbinated bones. This seems to be only 
 natural, since, in many cases, the deflection and fracture only 
 extends a short distance in the anterior middle, or posterior 
 part of the vomer, while the bone will be perfectly straight 
 anterior and posterior to the deformity. The shape of the deflec- 
 tion and fracture can be accounted for in no other way. In 
 order that fracture may take place, the vomer must have ossified 
 partially or completely, which occurs at middle life; therefore 
 injuries in utero or subsequently, before ossification, are out of 
 the question. If the turbinated bones be uniformly developed 
 the vomer will, in most cases, remain quite or nearly straight. 
 The force produced by drawing air will frequently separate the 
 two halves and, occasionally, produce one fracture upon one side, 
 the other upon the other side. Not only are the cartilages of the 
 nose brought in close relation to each other, but, occasionally, 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL BONES. 195 
 
 the force is so great that there is a total collapse of the outer 
 bony walls and they are drawn toward the septum, making a 
 groove upon either side, the nasal bones remaining perfectly flat 
 at the upper edge. 
 
 Deviation of the nasal septum to one side or the other is the 
 result of an unequal development of adjacent bony parts, more 
 especially and directly of that of the turbinated bones. It 
 depends largely, if not exclusively, u])<)n'the development and 
 position of these latter. They, in turn, are dependent in great 
 measure upon the development of the facial bones, which are 
 
 Fig. 68. 
 
 modified as the facial angle increases and prognathism is lost. 
 The turbinated bones being, as it were, exostosed, not molded 
 in many directions by adjacent parts, encroaching more irregu- 
 larly upon the nasal cavity, as their origins are disturbed or dis- 
 located. Freedom of these nasal passages for transit of respired 
 air is essential. In normal respiration the tendency is for both 
 nostrils to share equally. The natural consequence is, that the 
 vomer, the ossification of which is incomplete until puberty, is 
 deflected and occupies, as a rule, nearly a midway position 
 between the bony prominences on either side. Deflection of 
 
196 
 
 IRREGULARITIES OF THE TEETH. 
 
 the septum hence is compensatory arrangement for the evolu- 
 tionary variations of facial development. It is therefore most 
 frequent in the higher races, while in the lower its occurrence 
 is markedly less. 
 
 Instability of tissue-building is to be expected in neurotics 
 and degenerates. It is easy to see how, with such an unstable 
 bone tissue to build upon, the mucous membrane of the nose 
 can take on atrophy, hypertrophy and adenoid growths, result- 
 ing in mouth-breathing. 
 
 Total collapse of the outer walls of the nose is frequently 
 
 FiR. 69. 
 
 observed among neurotics and degenerates. This is associated 
 with arrest of development of the bones of the face, jaws, deform- 
 ities of the dental arch, weak, contracted chest, round shoulders, 
 husky voice, etc. In most cases of this description the nose is 
 very long and thin. The nasal bones are excessively developed 
 or arrested, with marked deflection of the septum. Frequently 
 nasal catarrh is present. When the patient attempts to inhale 
 air the outer walls are brought together and nose-breathing is 
 impossible. The result is mouth-breathing, not only taking 
 cold air into the lungs, but also diseased germs. The preceding 
 illustrations (Figs. 68, 69 and 70) are those of persons who 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL BONES. 197 
 
 possess all of the signs herein enumerated. These pictures 
 are front views of those used in the chapter upon deformities 
 of the face, and are intended to illustrate the long, slender nose. 
 By comparing these with those representing the side view, a 
 very good idea of the thinness may be obtained. Three of these 
 persons are now infected with tuberculous deposits, and the 
 fourth will require the best of care to prevent infection. It is 
 possible for persons to contract tuberculosis who do not present 
 stigmata, but parents who have children possessing the somatic 
 conditions here noted should pay particular attention to early 
 hygienic welfare. 
 
 Fig. 70. 
 
 The type of the antrum (which depends on the variations in 
 evolution of the face and the further variations dependent on the 
 nature of the transitory structures with which it is connected 
 as well as on the periods of evolutionary stress) must be 
 extremely variable. It is, hence, not surprising that as I have 
 pointed out nearly a decade ago the variability of the antrum 
 cannot well be overestimated. In a general way it may be said 
 the length, height, location and width is governed by the shape 
 of the face and by the type of the nose and of the superior max- 
 
198 
 
 IRREGULARITIES OF THE TEETH. 
 
 ilia. The shape and position of the antrum hence vary widely. 
 Thus in one case the cavity may be very small and resembles a 
 crescent with its concavity toward the nasal wall, its convexity 
 toward the molar process. It may not be large enough to admit 
 the end of the little finger and may not extend as far laterally 
 as the inferior orbital opening. The oppoiste side may be similar 
 in shape and extend just beyond this opening. Sometimes the 
 antrum upon one side will be very long while that upon the 
 other is very small. Usually the nasal cavity will be carried over 
 nearly one-half of its size to the side of the smallest antrum. 
 There is sometimes soft, cancellated bone extending from the 
 alveolar process into and filling the antrum, leaving a number 
 
 of small openings or sinuses which resemble the ethmoidal cells. 
 In these cases the contour of the face is also very much dis- 
 figured, a drill passed through the alveoli of the first and second 
 bicuspids would not reach an opening. 
 
 Although the antrum is usually regarded as a triangle it 
 assumes even in normal subjects a great variation from this 
 shape. The variations which may occur are best illustrated in 
 the contrasts between the following cases. The first three have 
 nothing degenerate recorded in their history. 
 
 In Fig. yi is seen a jaw and nasal bone of a person certainly 
 in later life. After all the teeth had been removed absorp- 
 tion of the external surface of the alveolar process had been 
 proceeding for many years. The roundness of the alveolar pro- 
 
ADOLESCeNT NEUROSES OF NASAL AND FACIAL RONFS. 
 
 I'M) 
 
 cess, the ridge of bone in the vault and the vault itself indicate 
 this to be the case. An alveolar process the size and shape 
 illustrated here could only develop with the second set of teeth. 
 It will be observed the left antrum is unusually large; that it 
 extends up to and encroaches upon the left orbital cavity and 
 quite a distance along the inner border. It also encroaches upon 
 the left nasal cavity and downward into the alveolar process. 
 The right antrum is very small as a result of which the alveolar 
 process is very large and extends quite a distance into the floor 
 of the nose. To compensate for this want of harmony in the 
 development of the antrum, the turbinated bones have become 
 enlarged, and, although the nasal cavities have developed con- 
 
 Fig. 72. 
 
 siderably to the right of the face, all the bones of the nose have 
 so arranged themselves there are uniform spaces between them. 
 If the teeth in this individual remain the usual number of years 
 (this illustration represents a person from forty-five to sixty- 
 five years of age), the only absorption that could possibly take 
 place would be at the outer border of the alveoli. 
 
 Fig. 72 not only shows the antra extending toward the 
 median line upon both sides encroaching upon the nasal cavity, 
 but there are also ridges of bone and septa extending through 
 the cavity. This is likewise the case in Fig. 71. 
 
 Case I is that of a prostitute. Width of dental arch, 2.25. 
 The antrum upon the right side extends back as far as the third 
 
200 IRREGULARITIES OF THE TEETH. 
 
 molar, forward to the canine eminence from the lower border 
 of the alveolar process to the floor of the orbit, the cavity was 
 triangular in shape, the apex being downward at the alveolar 
 process ; the base being the floor of the orbit. Its length of the 
 ■ lower part was 1.50, at the upper 1.75, height at the posterior 
 part 1.75, anterior 1.50, width below .25, at the upper .62 of an 
 inch. The cavity was divided into two parts by a septum of 
 bone .50 of an inch in height ; another septum of bone extended 
 horizontally along the inner side opposite the inferior orbital 
 ridge. The left side of the superior maxilla was very much 
 arrested in its development with a marked protrusion of the 
 alveolar process and teeth to make a respectable dental arch to 
 correspond to that of the other side. The antrum extended from 
 the third molar forward to the second bicuspid. The length 
 of the antrum at its lower part measured i; upper part, 1.50; 
 height at the anterior part, 1.24; at the posterior part, 1.60; 
 width at lower border, .36, at upper border, .50. The apex in 
 this case was located at the malar process, its base being the 
 outer wall of the nose. A drill passed into the cavity of the 
 first bicuspid upon the right side would penetrate only one-half 
 of the antnun, while it would require an opening of the second 
 molar to drain the posterior cavity. In either case the drill 
 would have to travel only about .25 an inch from its outer 
 border. If a drill were carried into the antrum at the anterior 
 root of the first permanent molar upon the left side, it would 
 have to pass .75 of an inch to reach it. 
 
 Case II is that of an Irish epileptic degenerate. Width of 
 dental arch 2.75; vault is .84 in height; jaws are very large and 
 massive. The antrum upon the right side extends from the 
 posterior surface of the third molar forward at the lower border 
 to the anterior root of the first permanent molar, at the upper 
 border on a line with canine eminence. Over the root of the 
 second bicuspid there is a very marked depression, showing the 
 walls of the antrum unite at that point. The cavity is almiost 
 square, as will be seen by the figure ; length of lower border, 1.12 
 of an inch; upper border, 1.52 of an inch; height of anterior 
 part, 1.25; posterior, 1.20; width below, .75; above, .80. To 
 reach the antrum at the second bicuspid the drill would have to 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL BONES. 201 
 
 travel 1.25 from the lower border of the alveolar process; at the 
 anterior root of the first molar .75 from lower border. The 
 antrum upon the left side extended .50 of an inch back of tlie 
 second molar (the third molar not being present), forward to a 
 point over the root of the second bicuspid ; the upper part 
 extended as far as the canine eminence. Length of lower border, 
 1.25; upper, 1.75; height anterior, 7; posterior, 1.25; width, .75; 
 lower border, .78 ; upper border, .80. To reach the antrum at 
 second bicuspid the drill would have to pass i, with dif^culty 
 in reaching it ; at anterior root of first molar, .84. Both cavities 
 are free from septa. 
 
 Case III is that of a criminal. The third molar was never 
 present upon the right side. The antrum therefore extended 
 .50 beyond the second molar forward as far as the anterior root 
 of the first permanent molar on the upper border to a point 
 above the canine eminence. This cavity possesses a very pecu- 
 liar shape, as will be noticed in the figure. Length of the lower 
 border, i; upper, .84; triangular in different directions. First 
 apex at outer surface of malar bone base outer plate of the 
 nose ; second apex anterior near the nose and base toward pos- 
 terior surface. The roots of the first and second molars pene- 
 trate the antrum as in illustration. The antrum could only be 
 reached by going through the outer plate of the alveloar process 
 of the first permanent molar. The antrum upon the left side 
 extended from the posterior surface of the second molar forward 
 to the first permanent molar. Length of lower border, 1.25; 
 upper, 1.75; height anterior, .75; posterior, 1.25; width lower, 
 .50; upper, .60. This was a very remarkable cavity. The roots 
 of the second and third molars penetrated the floor of the cavity 
 abscess had appeared upon the buccal roots of the first molar 
 without injury to the floor of the antrum. The outer wall of 
 the nose had bulged into the antrum in its entire length and 
 width from the lower turbinated bone to the floor of the nose. 
 The inner and outer walls of the antrum had become united at 
 about its middle by a septum making two distinct cavities. 
 
 Case IV is that of a pauper. The antrum upon the right side 
 extended .50 of an inch beyond the third molar forward at the 
 lower border as far as the second bicuspid ; at the upper border 
 
202 IRREGULARITIES OF THE TEETH. 
 
 to a point over the canine eminence. The apex of the triangle 
 in this case is located at the junction of the wall of the nose 
 and floor of the orbits. The base was formed by the outer 
 surface and malar process, a ridge dividing the anterior part of 
 the antrum into two cavities extends from the floor of the orbit 
 down about half the depth of the antrum at a point of exit of 
 the naterior orbital nerve and artery. The outer wall of the 
 nose curves into the antrum filling it about one-third full. It 
 will be seen, therefore, the cavity is very irregular in shape. 
 Its length at the lower border is 1.12; upper border, 1.38; 
 height anterior, .75 ; posterior, 1.25. with lower border 36, upper 
 I inch. The molar teeth extend into the floor of the cavity. 
 Arrest of development of the maxillary bone upon the left side 
 necessarily causes the antrum to be much smaller than upon the 
 right side. Like the right antrum it extends .60 of an inch 
 beyond the molar, its lower border extends forward to the 
 anterior root of the first permanent molar, its upper border to a 
 point over the cuspid teeth. Length of lower border, i ; upper, 
 1.25; height anterior, .75; posterior, 1.25; width lower edge, 
 .25 ; upper, .92. The palatine roots of the first and second molars 
 penetrate the floor of the antrum. 
 
 Case V is that of a prostitute. The right antrum is very small 
 and extends back to the posterior surface of the second molar, 
 the third molar not being present From the lower border of 
 the antrum to the lower border of the alveolar process is .75 
 of an inch, the roots of the teeth therefore do not reach within 
 .25 of the floor of the cavity. The length of the lower border 
 is .75; upper, 1.12; height of the antrum, .60; posterior, i; 
 width of lower, .25; upper, i. A septum extends the entire 
 length of the outer and inner walls except a space about the 
 size of a lead-pencil dividing the antrum into almost two dis- 
 tinct cavities. The left antrum extends to the posterior border 
 of the third molar ; the cavity is slightly larger than the other 
 although the alveolar process is just as large and therefore the 
 anterior border so far as the teeth are concerned has no relation 
 to this. The length of the lower border, .86 ; anterior, i ; width, 
 .28; upper, 1.20. This cavity contains a number of septa run- 
 ning in every direction. The nasal bone bends inward and in 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL BONES. 203 
 
 every way shows stigtnata of degeneracy. If a drill were to be 
 carried into the antrum through the roots of the bicuspid it 
 would have to travel .60 of an inch and then would not reach the 
 lowest point. We are not warranted in making openings into the 
 antrum through the root canals of the molars because they 
 rarely incline in the direction. The drill would pass either into 
 the floor of the nose or out at the cheek. 
 
 The following figures here illustrate stigmata of the antra and 
 the difficulty of always reaching the floor of the antrum by 
 passing a drill up through the alveolus for the purpose of drain- 
 age. In Fig. 60 the left antrum is seen to be excessively devel- 
 oped. The base of the cavity, located at the floor of the orbit, 
 the apex near the borders of the alveolar process, extends quite 
 a distance toward the median line and under the nasal cavity. 
 It even encroaches upon the left nasal cavity at its upper border. 
 A drill would pass without trouble into this cavity through the 
 palatine or even buccal roots of any of the molar teeth. Quite 
 a different state of things is noticed upon the right side. The 
 nasal cavity is carried over and occupies the space where the 
 antrum should be located. The antrum is very small upon the 
 inner surface of the malar process under the eye. A drill passed 
 through the alveolus would certainly enter the floor of the orbit. 
 In Fig. 61 both antra are seen so located that the drill passing 
 through the alveoli would not penetrate, but in both cases the 
 floors of the nasal cavities would be punctured. The left antrum 
 (Fig. 62) is almost entirely obliterated. Stigmata are not only 
 seen in the antra, but also throughout the nasal bones and 
 ethmoidal cells. 
 
 To reach both antra by drilling through the alveoli, could 
 only be accomplished with difficulty. The cross section (Fig. 63) 
 was taken so far forward that description of the antra is out of 
 the question. 
 
 In Fig. 64 the antra are seen to be so small as to be almost 
 obliterated. The nasal cavities, however, are so large that the. 
 floors of these cavities would be punctured if a drill was passed 
 through the alveoli. 
 
 Some years" ago I recorded a case in which a patient, had 
 an opening drilled through the cavity of the second bicuspid 
 
204 IRREGULARITIES OF THE TEETH. 
 
 to relieve the antrum, and the drill passed into the floor of the 
 nose. At that time it occurred that there was gross ignorance 
 on the part of the operator as to the location of the antrum. 
 An opinion I have since changed. 
 
 On examination of skulls, I have discovered some eight cases 
 where the floor of the nose was so wide and the facial bones 
 so deformed that the long axis of the roots were directed into 
 the floor of the nose. In each case the floor of the nose would be 
 perforated were the operator to drill through the palatine buccal 
 roots of the first or second molars. I have frequently observed 
 arrest of development of the maxillary bone on a line with the 
 alffi of the nose, when the alveolar process (in order that the 
 teeth might antagonize with the lower teeth) extended outward 
 to such an extent that the apices of the roots of the bicuspids 
 would point entirely outside of the line of the antrum. Hence 
 the alveoli are not a reliable route by which to reach the lowest 
 point in the floor of the antrum, nor is the operator sure of 
 reaching it at all. It is easy to see how in a very few cases the 
 development of the antrum and nasal cavities might be such, 
 together with the thinness of the alveolar process, that the roots 
 of the teeth may penetrate the floor of the antrum (Fig. 73). 
 These cases, however, are very rare. In most cases, owing to 
 the thickness of the alveolar walls and the position of the 
 antrum, the roots of the teeth will not reach it. The roots of 
 first and second bicuspids almost never enter the floor of the 
 antrum. The roots of the first permanent molar in its relation 
 to the antrum are such that it is almost impossible to penetrate 
 them. 
 
 Of the 11,000 skulls examined for deformities, only 3,000 
 were in a broken condition, so that the antra could be exam- 
 ined, making 6,000 antra in all. Of this number 1,274, or about 
 21 per cent, had abscessed molar teeth. Of this number 76, or 
 about 6 per cent, extended into and apparently discharged into 
 the antrum. As specialists were unknown among the people 
 whose skulls were examined, a larger percentage of abscessed 
 cavities would be found than at present. Septa were found in 
 963 cases. These ranged all the way from a simple ridge run- 
 ning along the floor to a partition extending two-thirds the 
 
ADOLESCENT NEUROSES OF NASAL ANd'fACIAL BONES. 205 
 
 height of the cavity. Again, several septa occurred in all direc- 
 tions, which gave the appearance of ethmoidal cells extending 
 throughout the entire cavity. 
 
 In the treatment of 367 cases of pulpless teeth, in connection 
 with the superior molars, in the past twenty-two years, only 
 three cases of diseased antrum were noticed, making less than 
 three per cent of diseased antrum. 
 
 M. H. Fletcher found in 224 cases of pulpless molar teeth, 
 only one case of pus. in the antrum. Antral difficulties are hence 
 very rarely connected with the teeth. Most cases of diseased 
 antrum seek the rhinoloeist because most are connected with 
 
 Fig. 73. 
 
 the nasal lesion, hence, the dental surgeon sees but a small per- 
 centage of actual cases. Disease of the antrum is very rarely 
 due to diseases of the teeth. Like diseases of the mucous mem- 
 brane of the nose, disease of the mucous membrane of the antra 
 is to a great extent the result of — first, a very abnormal develop- 
 ment of the osseous system, and, second, of improper tonicity 
 of the nervous system acting upon a badly developed mucous 
 membrane. 
 
 Disease of the antrum, in my experience, is most often 
 observed in persons who have been exposed to cold weather, 
 and that' both sides are more or less affected. This was a com- 
 
206 IRREGULARITIES OF THE TEETH. 
 
 mon occurrence with epidemic la grippe. If only one side is 
 involved, the other frequently is or has been at a previous time. 
 In the large number of skulls examined, the floor of the antrum 
 was found to be nearly on a level with the line of the alveolar 
 process as far as the anterior roots of the first molar. It then 
 curves upward and forward, terminating at a point above the 
 apex of the root of the cuspid tooth. That being the case, a 
 drill passed through the alveoli of the first and second bicuspid 
 would reach a point quite a distance above the floor of the 
 antrum. From what has been said in regard to the shape and 
 location of the antrum, it will be seen that the lowest and safest 
 locality to puncture the antrum, is just between the roots of the 
 first permanent molar and the root of the second bicuspid. The 
 opening should be made with a drill directed backward and 
 inward. This part is nearly always on a level with the floor of 
 the antrum, and the outer wall is very thin at that point. The 
 patient should be requested to lie first upon the back and then 
 upon the face. Should there be any septa the fluid will in this 
 jvay be easily drained. 
 
 M. H. Fletcher,^ of Cincinnati, has said with equal truth and 
 clearness, in a paper read before the Section on Oral and Dental 
 Surgery of the American Medical Association, June i, 1893: 
 
 "The summing up or rationale, then, of the evidence here- 
 with seems to be. first, that the anaJ:omical relations between the 
 teeth and the antrum are not generally understood, since the 
 sections here shown give evidence of much more cancellous 
 bone than is usually considered to exist. 
 
 "Second. Small septa are present in a large per cent of cases, 
 and these septa or ridges have no direct relation to the position 
 of the teeth. 
 
 "Third. Statistics seem to show that a very small per cent 
 of abscessed teeth have any connection whatever with the 
 antrum; this per cent probably not being over seven to ten. 
 
 "Fourth. The evidence seems to indicate that the protru- 
 sion of the teeth into the cavity is very largely the exception 
 instead of the rule, and that if they do protrude, it is not evi- 
 
 ' Journal of the American Medical Association, 1893. 
 
ADOLESCENT NEUROSES OF NASAL AND FACIAL BONES. 207 
 
 dence that an alveolar abscess would break there, since these 
 tubercles are usually formed of dense, hard bone. 
 
 "Fifth. A number of cases have been found where there is 
 a perforation of the bone by the apices of the teeth and no 
 protrusion ; but that these apices are simply covered with 
 mucous membrane, thereby the teeth may be afifected by inflam- 
 mation of the antrum, causing their death and loss or a continu- 
 ance of the trouble in the antrum by their presence in conse- 
 quence of this special feature of the anatomy, and that pulpless 
 and inflamed teeth are thought to be the usual cause of antral 
 trouble, where the reverse is often probably the case. 
 
 "Sixth. . That seemingly the best place to perforate the 
 antrum of Highmore for pus, is between the apices of the second 
 bicuspid and first molar." 
 
 "Since writing this paper, Dr. Fletcher examined an addi- 
 tional 400 skulls, and finds the figures changed in regard to the 
 per cent of abscessed molars which are connected with the 
 antrum. In 500 skulls (making 1,000 antra) he found 252 upper 
 molars abscessed, making twenty-five per cent of antra which 
 have abscesses in this locality, or every fourth antrum. This 
 per cent is probably smaller than it should be, since many teeth 
 were lost and the alveolar process absorbed away, and undoubt- 
 edly some of these lost teeth have been abscessed. Out of these 
 252 possible cases, perforation into the antrum was found only 
 twelve times ; thus showing over four and one-half per cent, or 
 about one in every twenty-one of the abscessed teeth in this 
 locality, which are connected with the antrum." 
 
CHAPTER XIX. 
 
 DEVELOPMENTAL NEUROSES OF THE EYE. 
 
 In the typical human infant the eyes are larger than in the 
 adult. In this last particular the human infant resembles the 
 lemurs and thus retains an embryonic tendency which, as else- 
 where shown, may remain unchecked and result in unusually 
 large orbits, or the orbits may pass through this lemurian stage 
 to reach and even exceed the anthropoid in smallness and close- 
 ness together. 
 
 The eye, according to Lee Wallace Dean,i during its develop- 
 ment, passes, just as the brain does, through stages which resem- 
 ble and correspond to the eyes of lower animals. If, owing to 
 an affection of its governing center, its development is interfered 
 with or stopped, the eyes correspond more or less to those of the 
 lower animals, as in persistent hyaloid, colobomata, microph- 
 thalmia, etc. Neither the degenerate human brain nor the unde- 
 veloped eye resemble exactly the brain or eye of the lower 
 animal. While, as I have elsewhere- shown, there is a conflict 
 as to the primitive type of the vertebrate between morphologists 
 represented by Howard Ayres (who claims the eyes were derived 
 from the median eye of the ascidian lancelet) and Semper (who is 
 of the opinion that the existing vertebrates' eyes represent the 
 paired eyes of a hypothetical annelid precursor), still both opin- 
 ions are reconcilable through study of the ascidian and lancelet 
 eye collated with cyclopian and triophthalmic (three-eyed) 
 degeneracies in man, the human eye and the third eye of rep- 
 tiles, like the hatteria of New Zealand. The eye of the ascidian 
 tadpole agrees fundamentally with the type of eye peculiar to the 
 vertebrates in that the retina is derived from the wall of the 
 brain. On this account it is called a myolonic eye. In the 
 typical invertebrate eye, on the contrary, the retinal cells are 
 differentiated from the external ectoderm. 
 
 1 Ophthalmic Record, Sept., igoo. 
 
 2 Degeneracy, Op. Cit. 
 
 208 
 
l)K\i:i.()l'MKNTAI. NEUKOSKS OF TlIK KVE. ;j( )!) 
 
 llic ascidian eye differs essentially from llic paired eyes of 
 (!io oraniati' (skulled) vertebrates in that the lens as well as the 
 lelina is (KriM'd frou! \\\v wall of the brain. The lens of the 
 lateral eye ot the vertebrates is deri\e(l bv an invagination of 
 the extoderni, which meets and tits in the retinal cup at the end 
 of the ojitic Ni'sii-jc. The ascidian eye, however, as^rees as to lens 
 origin with the ])arietal or i)in(.'al eye of the lizard, in which the 
 lens is likew ise derived from cells which form part of the wall of 
 the cerebral outgrt)vvth that gives rise to the pineal body. 
 
 The pineal Ijody is a remarkable rudimentary structure whose 
 constant presence in all groups of vertebrates forms such an 
 eminently characteristic median outgrowth from the dorsal wall 
 of the brain (thalamencephalonj, the distal extremity of which 
 dilates into a vesicle and becomes separated from the proximal 
 jiortion. The distal vesicle becomes entirely constricted off from 
 the primary epiphysial (pineal) outgrowth of the brain and the 
 parietal nerve does not represent the primitive connection of the 
 ]iineal eye with the roof of the brain but arises quite inde- 
 pendently of the proximal portion of the epiphysis. 
 
 The remote ancestors of the vertebrates possessed a median 
 unpaired myolonic eye which was subsecpiently replaced in func- 
 tion by the evolution of the paired eyes. The cyclopic condi- 
 tions occur very frequently among human monstrosities, much 
 more frequently than among animals. Hannover claims this is 
 due to the fact that human monstrosities are much more fre- 
 qviently recorded. Of the 120 cases of human cyclopia, 56 pre- 
 sented other evidences of degeneracy than cyclopic conditions 
 and 60 had neuropathies or other taint in the ancestry. Accord- 
 ing to Dareste the production of a single eye, the changes in 
 the structure of the mouth, the atrophy and abnormal situation 
 of the olfactory apparatus and of the vesicle of the hemispheres 
 all result from an arrest of development. The determining 
 influences must be exerted very early in the life history of the 
 embryo. 
 
 According to Hannover, coincidently occurs hydrocephalus 
 and harelip, imperfect genital development and allied arrests, of 
 development. J. R. Folsom, of Cecil, Georgia, has reported a 
 female born alive to a negro multipara, which died two hours 
 
 15 
 
210 
 
 IRREGULARITIES OF THE TEETH. 
 
 after birth. The eye was centrally located in the forehead on 
 a line with the nose. The brow was a complete arch, as was the 
 upper eyelid. The lower lid had a mark midway indicating an 
 attempt at division. The nasal bones were wanting. The soft 
 part of the nose destitute of the orifice hung over the mouth, 
 which was completely covered. The chin was recedent. In a 
 case reported by C. Phisalix, the nose was wanting. Its place 
 in the median line was occupied by a single eye ; on the hori- 
 zontal diameter were two pupils separated by a narrow space. 
 Landolt, discussing a case reported by Valude,. claims that while 
 in cyclopic eyes all the parts may be doubled or unite in every 
 degree, there is never a single lens or double vitreous. Bock 
 
 Fig. 74 
 
 and others, however, describe cases in which the eye had not 
 been formed by the conglomeration of two separately devel- 
 oped eyes, but is a single developed eye ; the other being want- 
 ing entirely. Bruce reports a cyclops in which there was a single 
 socket for the eye, of a lozenge-shape, situated in the lower 
 middle of the forehead. The socket was furnished with two pairs 
 of eyelids, upper and lower. The eye was found to consist of two 
 rudimentary retinae apparently springing from a single optic 
 vesicle. The nose was represented by a short process attached 
 to the forehead, above the median eye. The cyclops illustrated 
 (Fig. 74), was born to a seventeen-year-old neuropathic primi- 
 
DEVELOPMKNTAL NEUROSES OF THE EYE. 211 
 
 para after a protracted labor. The child was living, but killed 
 by pressure on the funis. The mouth contained an ivory tusk- 
 like tooth at each corner. There was mane-like hair around 
 the neck. Cyclopia is very frequently associated with the absence 
 of both the internal and external ear and with synotia (joined 
 ears). Tn tlu- lri(»])hlhalniic cases the three eyes are usually 
 separate; two occup}ing- the usual position while the third is 
 situated as illustrated in the case cited. Ninety families of degen- 
 erates, averaging eleven children each, had five cases of cyclopia. 
 Degeneracy which affects so deeply the development of the 
 eye natural!}- tends to evince itself in other anomalous state in 
 the organ. As excessive asymmetry of the body is one of the 
 most noticeable of the stigmata of degeneracy it is not aston- 
 ishing to find that this asymmetry expresses itself both in the 
 position as well as in the size and structure of the eye. As 
 Kiernan pointed out twenty-three years^ ago, asymmetrical 
 irides are exceedingly frequent in the types of insanity due to 
 hereditary defect. This observation has since been confirmed 
 by Fere,"* not only as to the insane but as to other classes 
 of degenerates. The conditions of the eye known as microph- 
 thalmia (small eye), macrophthalmia (big eyes) and anophthal- 
 mia (absence of eyes) are found quite frequently in degenerate 
 families. Corectopia (displacement of the pupil so that it is 
 not in the center of the iris) often exists. Coloboma (eye fissure) 
 is also not infrequent among degenerates. These vary greatly 
 in situation and general results. The iris is sometimes com- 
 pletely absent" on one or both sides (aniridia). Beside these 
 anomalies, diseased conditions like retinitis pigmentosa, con- 
 genital cataract and the macular degeneracy (reported by C. 
 P. Pinckard^) are far from infrequent expressions of degenerate 
 taint of the eye. The organ in this particular obeys the general 
 law that degeneracy may show itself in the minute change result- 
 ing in disturbances of functions or in that producing disease or 
 finally atavism. The defects of the eye requiring glasses are 
 
 3 Journal of Nervous and Mental Disease, 1878. 
 * La Famille Nervopathique. 
 5 Medicine, 1898. 
 
212 
 
 IRREGULARITIES OF THE TEETH. 
 
 exceedingly frequent in degenerates and aggravate their mor- 
 bidity. 
 
 The following cases reported b\' T.. W. Dean/' are of interest 
 here since they demonstrate two marked deformities of arrest 
 of development of the upper and lower jaws : 
 
 Case XIV. Lillie L. (Fig. 75). Female, age 14. Patient's 
 people are exceedingly poor and so ignorant as to make it 
 impossible to get any reliable family history. There are four 
 sisters and three brothers, all poor and ignorant. The patient 
 is idiotic. She has a retreating forehead, and exceedingly crooked 
 
 Fig. 75. 
 
 nose, a very long neck and an exceedingly small, retrusive jaw, 
 the lower incisors striking at least one-half inch behind the 
 upper. The teeth are exceedingly irregular. The two left upper 
 incisors are large, the two others very small. Of the lower 
 incisors, the two central ones are like mice teeth, pointed and 
 sharp. They are separated at their bases, but come together at 
 their tops at an acute angle. The other two are conical and 
 lie each parallel to its neighbor. Examination of eyes reveals 
 V — fingers in ^ M. Eyes small. Nystagmus. Fundi apparently 
 normal. Diagnosis, microphthalmus. 
 
 "Op. Cit. 
 
DEVELOPMENTAl, NEUROSES OF THE EYE. 
 
 213 
 
 Case XV. Ida C. (Fig. 76). Female, age 17. Father is 
 deaf. Could obtain no history of degenerate stigmata in mother. 
 Has four sisters living, nine dead. Has four brothers living 
 and one dead. Had to depend on patient for family history. The 
 patient is exceedingly dull. It is impossible for her to learn. 
 She has jaws that, at the junction of the premaxillary and max- 
 
 Fig. 7G. 
 
 illary bones, present a well marked angle. Her teeth are conical. 
 The incisors are sharp and pointed ; are like mice teeth. The 
 ears are small and placed high up on the head ; she is almost a 
 typical degenerate, both physically and mentally. Examination of 
 the eyes reveals Y — cannot count fingers, but sees large objects. 
 
CHAPTER XX. 
 
 DEVELOPMENTAL NEUROSES OF THE BONES OF 
 
 THE EAR. 
 
 Aural affections are frequently a result of degeneracy, exhib- 
 iting itself under the various forms of deformity impUcating 
 the auditory apparatus. Thus total absence of the external ear, 
 as well as embryonic internal ear, occurs. The mere fact of the 
 exceedingly primitive structure of the internal auditory mechan- 
 ism necessitates abnormal or defective hearing power. To this 
 many cases of congenital deaf-mutism owe their origin,- inas- 
 much as the auditory mechanism is not in a condition to appre- 
 ciate sound. Even though the individual may not have been 
 born deaf, deaf-mutism from inability to appreciate sound occurs 
 and the whole auditory apparatus subsequently degenerates. 
 Sometimes a mental taint superadded aggravates the case. The 
 absence of the external ears and even closure of the Eustachian 
 tube may occur without deafness.^ 
 
 Stigmata of the bones of the ear occasionally take place. 
 Taking into consideration the complicated structure of which the 
 bone and sundry parts of the ear are composed, lesions of the 
 ear must be attributed to such deformities. In an examination 
 of 1,935 persons, taken as they come, deformities of the jaws, 
 were observed (Table XVHI). 
 
 Of 143 cases of congenital deaf mutes. 93 per cent exhibited 
 deformities of the head, face, jaws and teeth. 
 
 1 Gould Anomalies, page 261. ' 
 
 214 
 
CHAPTER XXI. 
 
 DEVELOPMENTAL NEUROSES OF JAWS OF THE 
 SEEMINGLY NORMAL. 
 
 The mouths of i,ooo school children over twelve years of 
 age and i,ooo adults, patients and friends, were examined with 
 the following results: (Table XIX). There were fifteen per 
 cent more deformities in adults than in children. This is 
 accounted for in two ways: (i) That as people grow older 
 slight irregularities of the teeth 'may become sometimes more 
 prominent, owing to movement and permanent arrangement of 
 the teeth later in life. (2) Some of those examined are patients 
 who presented deformities that alarmed them. The percentage 
 of deformities, however, compares favorably with the percentage 
 of deformities of the face. Taken as a w'hole they give an 
 approximate idea of the percentage of deformities in this com- 
 munity at least. The facial bones may become excessively 
 developed or arrested while the jaws remain normal. The jaws 
 may be deformed and the face remain apparently normal. The 
 percentage is from twenty-five to tliirty-three per cent less than 
 found in institutions for defectives. 
 
 215 
 
CHAPTER XXII. 
 
 DEVELOPMEXTAL XEUROSES OF THE .MAXILLARY 
 
 BONES. 
 
 Excessive gro^vth of bone-tissue is frequently seen in connec- 
 tion with the superior and inferior maxillae. It may be a natural 
 growth or the result of disease. If the jaw be naturally large, 
 it will develop gradually and will not attain full size before the 
 age of from twenty-six to thirty-six years. The size of the jaw 
 corresponds quite closely to the size of the head, other things 
 being equal, the large head containing the large jaw. Occa- 
 sionally, however, there is a very small jaw in a very large head 
 and vice versa. The upper jaw is more subject to morbid influ- 
 ences than the lower jaw, because of its connection with the 
 bones ©f the head. The lower jaw rarely exceeds the average size. 
 Constant use may increase the size of the jaws, as in acrobats, 
 especially those who use the jaws in various feats, like "the 
 man with the iron jaw." Jaws of tobacco-chewers, singers, 
 public speakers and of the early races who lived upon corn, shell, 
 roots, etc., show that the jaws may l)e favored in size develop- 
 ment by use. 
 
 Enlargement of the jaw-bones occasionally causes dental 
 irregularities. This may occur in either jaw, but generally in the 
 upper. It may be due to hypertrophy on the one hand, or hyper- 
 plasia upon the other, to- osteitis, periostitis, continued irritation 
 drawing blood to the part, in some cases to disease of the antrum 
 and nasal fossae, producing the same result. Disease of the 
 antrum may cause either periosteal or osteal enlargements. 
 Hereditary syphilis has an especial predilection for the bones, 
 particularly at the junction of epiphysis and diapliysis. Growth 
 of the teeth does not proportionately increase, hence consequent 
 disproportion between the teeth and jaws necessarily produces 
 deformity. The forms of irregularities of the teeth that co-exist 
 with crowded arches are not seen in enlarged jaws. Rachitis 
 in children, whether due to syphilis or not, causes hypertrophy 
 
 216 
 
DKVEI.OI'IMF.NTAI, N'KUROSES OF THE MAXILLARY RONES. 217 
 
 and hyperplasia of tlie jaws. The hypertrophy and hyperplasia 
 may be localized in some portion of the jaw, causing it to be 
 imevenly developed. ;\s illustrative of the interesting character 
 of some of these conditions described, I take the liberty to 
 present a few cases which have come under my notice. 
 
 Case i^. Arrest of development. Girl aged ten years. 
 Father and mother have well developed jaws. Consumption on 
 father's side ; cancer on mother's side. Child scrofulous, witli 
 small bones, especial!}- the maxillae, which are unusually small. 
 When first seen the teeth of both jaws (permanent first molars 
 and incisors, tem])orary cuspids and molars) are in a very 
 crowded condition. The teeth are normal in size. With such 
 unusually small jaws and the teeth at this age being very 
 crowded, marked \' or saddle-sha])ed arches were prophesied. 
 Four years later the jaws were arrested in their development 
 and a marked V-shaped arch was produced. 
 
 Case 2. Arrest of development. Girl aged sixteen years. 
 \\'hen quite young had a severe attack of scarlet fever and the 
 arrest of the development of the bony frame-work resulted. The 
 jaws were unusually small and the teeth are crowded to such an 
 extent that the cuspids remain outside the arch. 
 
 Case 3. Enlargement of the superior maxilla. A fourteen- 
 year-old boy was sent to me for an opinion in regard to teeth 
 which were found of the normal size. Spaces existed between 
 all the teeth as far back as the first permanent molars. The 
 bicuspids were not fully developed, but were through the gum 
 sufficiently to notice their position in connection with the other 
 teeth. The spaces were not uniform, those between the incisors 
 being the largest. The widest space was between the central 
 incisors ; the incisors of the lower jaw coming in contact with the 
 mucous membrane of the mouth posterior to the superior 
 incisors. 
 
 Case 4. Hypertrophy of the jaw. A nineteen-year-old 
 patient came under treatment in June, 1887. When fourteen 
 years he received a blow upon the side of the jaw. He is 
 scrofulous. The blow produced a low form of inflammation 
 and hypertrophv of the bone supervened. The teeth of that 
 
 1 This case was noticed in the second edition, 1890. 
 
218 IRKEGULARITIES OF THE TEETH. 
 
 side of the jaw were carried laterally and spaces existed between 
 the bicuspids and molars. 
 
 Case 5. Antrum disease. German-American boy aged 
 seven years. Scrofulous. Quite a deformity was noticed upon 
 the left side of the face, produced by the bulging of the antral 
 wall. Hypertrophy of the alveolar process existed. The tem- 
 porary teeth on the left side of the upper jaw extended beyond 
 those of the lower jaw. Upon opening into the antrum a thick, 
 ropy fluid exuded. After three months' treatment there was no 
 improvement. 
 
 The superior maxilla is influenced to a greater degree by 
 the various causes of jaw deformities than the inferior. The 
 bones of the upper jaw are in direct contact with the other bones 
 of the body, while tlie lower jaw develops independently and 
 is only attached at its remote extremities by articulation. The 
 body of the bone is free to develop or to remain dwarfed, depend- 
 ing v/holly upon its nerve and blood-supply for its nourishment. 
 There are indications that the superior is gradually diminishing 
 in size. The inferior maxilla, although under the same influ- 
 ences, has a powerful factor to aid preservation, viz.. motion and 
 exercise. The question naturally presents itself as to what 
 extent certain properties of the jaws, influenced by habit (use), 
 may be transmitted. The tissues of the body, especially those 
 of the osseous and muscular systems, possess a certain degree 
 of plasticity, by which they are enabled to change their weight 
 or shape. This quality depends upon the use of muscles and 
 bones. Among vertebrates a close relation exists between the 
 muscles and the bones upon which they are inserted. The 
 union is made up of tendons, which are prolongations of the 
 muscles to the periosteum and the periosteum is attached to 
 the bones. Powerful muscles and large bones are always asso- 
 ciated, exercise developing them both simultaneously. As out- 
 ward changes occur in the life of human beings or animals, 
 adjustment to environment tends to alter the physical charac- 
 teristics. These changes often occur through such gradual mod- 
 ifications that from one generation to another but little marked 
 difTerence is noticed, but the structure, in the course of a number 
 of generations, will §0 change that a new species will be devel- 
 
DEVELOPMENTAL NEUROSES OF THE MAXILLARY BONES. 219 
 
 oped. Any animal domesticated from a wild life shows this 
 change. The negro imported from Africa will, after several 
 generations, have a less prominent jawbone, more prominent 
 frontal bone. The changes, however, are more gradual in the 
 white races, after intermarriage, than with negro cross-breeds. 
 No part of the body demonstrates these changes so forcibly 
 as the superior or inferior maxilla. The extremities must be 
 measured and weighed to compare the two halves of the body. 
 The changes in the shape of head and jaws are not confined to 
 one race nor to past generations and are continually progress- 
 ing. 
 
 Asymmetry of the lateral halves of the maxillary bones exists 
 in the present era of the human race and prevails to a greater 
 extent among neurotics and degenerates and among the off- 
 spring of mixed races. Each lateral half of the body develops 
 independently of the other. The jaws, like other members, are 
 influenced by the independent growth of the two halves, so that 
 each has its own peculiarities. Asymmetry, therefore, is caused 
 from an inharmonious lateral development of the parts. The 
 superior and inferior maxillary bones, growing independently 
 of each other, may be subjected to peculiar conditions of envi- 
 ronment so that the result of their development may be asym- 
 metry of the jaws. Extreme asymmetry of the lateral halves of 
 the human body is frequently observed. 
 
220 
 
 IRREGULARITIES OF THE TEETH. 
 
 Exact measurements of the maxillary bones will show lack 
 of harmony in the lateral halves; to be, observed in weight, 
 shape and size. The difference is generally not sufficient to 
 affect the contour of the face, but causes faulty articulation 
 to the teeth upon that side of the face. This is generally due 
 to the number of teeth that remain in the jaw late in life. Thus 
 a molar or bicuspid may never have developed upon one side, 
 wdiile the full number are in position upon the other side, or 
 they may have been extracted upon one side, while the full num- 
 ber remain upon the other. Again, owing to an irregularity of 
 the teeth in the anterior part of the mouth the posterior teeth, 
 
 Via. 78. 
 
 although all are present, may have moved forward. In any 
 of these conditions the alveolar process and jaw would become 
 shorter upon one side than upon the other, owing to absorption 
 of the alveolar process. The deformities of either lateral side 
 of the superior maxilla are not necessarily like those of the 
 inferior. Excessive growth or arrested development appear 
 upon both sides of the jaws, sometimes on the right and again 
 upon the left. Examinations of these deformities can be made 
 only when the second teeth have been extracted and the alveolar 
 process has been absorbed. 
 
 Fig. yy shows the superior maxilla after absorption has taken 
 place. If a line be drawn through the jaw at the median line, it 
 
DEVELOl'MF.NTAL NEUROSES OF THE MAXILLARY BONES, 221 
 
 will be seen that the left half is fully developed, while the right 
 half is contracted at the bicuspid region. The following statistics 
 show the deformities in the contour of jaws modeled by Ur. L. 
 P. Haskell, of Chicago : 
 
 UPPER JAW. 
 
 Total muiiber exaininod 298 
 
 Total number normal 137 
 
 Total nimiber abnormal, right side ']2) 
 
 Total number abnormal, left side 88 
 
 Fig. y^ illustrates the inferior maxilla after the teeth have 
 been extracted and absorption of the alveolar process has taken 
 place. By drawing a Hne through the center of the lower jaw 
 at the median line a wider space may be seen to exist between 
 the line and the left side than on the other side. 
 
 LOWER JAW. 
 
 Total number examined 154 
 
 Total number normal 54 
 
 Total number abnormal, right side 12 
 
 Total number abnormal, left side 88 
 
 rig. w). 
 
 Although no two cases of irregularities of the teeth are 
 exactly ahke, there is a general similarity of shape and outline 
 of alveolar process and jaw, owing to similar environments 
 during eruption of the teeth. Upon the hypothesis that the 
 two halves of the superior maxilla are developed in proportion 
 to the excess of food masticated on one side or the other, depend- 
 ing upon right and left handedness of the individual, it seemed 
 probable the case illustrated is that of a left-handed person, 
 as the left side of the jaw is larger. But it appears that this 
 side is normal in size and the right is deficient in development. 
 On examining carefully the contour of patient's teeth but few 
 arches are found uniform. While one side may be normal the 
 other will be depressed. Fig. 79 shows such a deformity. This 
 
222 IRREGULARITIES OF THE TEETH. 
 
 cut is taken from a model of an extreme case of irregularly- 
 shaped jaw. It represents a perfect semi-V-shaped arch. (I 
 find in my collection of models thirty-eight of this variety of 
 deformity, twenty-four of which are on the right side and four- 
 teen on the left.) Most of these irregularities are not quite as 
 depressed at the cus])id region as the cut indicates. No two 
 are exactly alike as regards the position of the teeth and yet 
 the similarity is so complete that a non-professional man would 
 immediately take notice of it. The asymmetry of the jaw illus- 
 trated in Fig. 77 is probably caused by the peculiar arrangement 
 of the permanent teeth in the arch, since the deformity is not 
 apparent during the first set of teeth, the alveolar process and 
 maxillary bones being molded into this peculiar shape thereby. 
 Since but few people are left-handed, this percentage is very 
 large, showing twenty-four out of thirty-eight cases with defi- 
 ciencies on the right side, when we might look for normal or 
 excessive development on that side. The cause of this irregular- 
 ity is of local origin, viz., too early extraction of the temporary 
 teeth upon the affected side, thus showing that one side is as 
 liable to be afifected as the other. The mechanism of this irregu- 
 larity will be found under the head of local causes. 
 
 The asymmetry upon the lower jaw may be traced to two 
 causes : 
 
 First : The full number of teeth retained upon the long side 
 If the third molars should develop on one side only, the jaws on 
 that side would expand by the crowded condition of the teeth 
 and extend farther from the median line than otherwise. The 
 loss of the third molars by extraction or non-development would 
 prevent the other side from increasing to the natural size. 
 
 Second : The relation of the upper teeth to the lower teeth. 
 The articulation of the inferior maxilla with the cranium is so 
 remote and the contour of the two bones so unlike, that uni- 
 formity of bone-structure cannot be looked for. When the com- 
 plexity of the development of bone-tissues, first of the maxillary 
 bone, then of the alveolar process and lastly of the two sets of 
 teeth, is remembered, it is a wonder that harmony ever pre- 
 vails. 
 
DEVELOPMENTAI. NEUROSES OF THE MAXILLARY BONES. 223 
 
 Haskell's deformity.^ On examining models of the superior 
 maxilla after absorption of the alveolar process has taken place, 
 it is observed that in the cuspid and bicuspid region, high above 
 the alveolar border, a marked depression exists on either §ide. 
 Fig. 80 shows a base plate which has been formed over such a 
 model. The plate is more depressed at the left than at the right 
 side. This peculiar deformity is familiar to the operator who 
 arranges teeth and waxes up plates for the purpose of restoring 
 the contour of the face. Upon closer inspection of the model 
 it will be seen that there is asymmetry of the lateral halves of 
 the maxillary bones. With Haskell's assistance, I examined 
 298 models, finding 268 out of the number with marked depres- 
 
 Fig. 80. 
 
 sion on the left side, and twenty-four with the depression 
 on the right side. Only six cases on both sides were alike. 
 This depression is due to an asymmetry of the maxillary bones. 
 An asymmetry so slight as to be hardly recognizable may pro- 
 duce it. As the body has passed from left-handedness to right- 
 handedness, the left side being the weaker as least used a large 
 proportion of cases of this depression are necessarily found on 
 the left side. 
 
 For many years Haskell has observed a marked. difference 
 between the right and left sides of models of both the upper 
 
 " I have named this deformity "Haskell's Deformity" for the reason 
 that Dr. Haskell first called the attention of the profession to this peculiar 
 condition of the maxillary bones years ago. 
 
224 IRREGULARITIES OF THE TEETH. 
 
 and lower jaws, but more especially noticeable in the upper jaw. 
 It is not so apparent upon a casual glance at the model, for it 
 is not so much in the alveolar process as in the maxillarv bones. 
 But .a plate swaged upon a model from an impression taken 
 high over the region of the cuspids (as ought always to be done) 
 shows at once the depression of the left side, which occurs, 
 to a greater or less extent, in ninety-five per cent of cases. The 
 difference becomes apparent in arranging artificial teeth. 
 Experienced dentists will have noted that greater length of teeth 
 and gums is required upon the left side than upon the right. 
 How often it is seen that the left side of the lip rises higher in 
 talking arjd laughing than the right side. The difference in the 
 two sides of the lower jaw does not occur as often, but fs 
 apparent in the divergence of the left side from a line drawn 
 through the center of the model so that the posterior teeth on 
 that side must be set farther in upon the plate. 
 
 My own observation of models and patients has indicated that 
 the majority of deformities of this nature exist on the left side. 
 Man, like some other animals, usually moves the lower jaw 
 from right to left in mastication. (As people are sometimes 
 left-handed, so it is possible to find cases where the jaws moved 
 from left to right). The constant friction of the lower teeth 
 against the upper, and the crowding of the teeth into place while 
 erupting, carries the superior arch with the alveolar process 
 toward the right or left. By pressing the index finger over the 
 cuspid and bicuspid roots, above the alveolar process it is shown 
 that the majority of mouths contain teeth with their roots stand- 
 ing out more prominently upon the right side than upon the left 
 side. The right superior dental arch, like the arch of a bridge, 
 resists such inward force because of the lateral contact of its 
 teeth. On the contrary, the left superior dental arch may thus 
 be carried slightly forward. The limited lateral motion during 
 occlusion prevents the teeth and alveolar process from being 
 carried farther. The cuspid tooth may be prevented from being 
 carried in as far as it otherwise would be owing to the lateral 
 motion of the lower jaw to the left. The alveolar process is thus 
 carried beyond the border of the maxillary bones. After the 
 teeth have been removed, absorption of the alveolar process 
 
DEVELOPMENTAL NEUROSES OF THE MAXILLARY HONES. 225 
 
 occurs, leaving only the alveolar ridge. The ridge then over- 
 hangs the maxillary bone, thus producing a depression upon the 
 left side. This is the reason that in arranging artificial dentures 
 in many cases the teeth are carried over the alveolar border 
 farther than upon the right side to obtain proper articulation 
 with the natural teeth upon the lower jaw. 
 
 On examining the model upon which the base-plate was 
 formed, it will be seen that both the right and left alveolar bor- 
 ders are symmetrical. The alveolar border in most cases indi- 
 cates the contour of the teeth when in position. 
 
 A case seen with G. Frank Lydston is a marked illustration 
 of congenital maxillary asymmetry. The man is thirty years 
 of age. The inferior maxillary is small and the chin pointed 
 and narrow. There is a difiference of one-half an inch in the 
 length of the rami, the left ramus being the shortest. The 
 difference is sufficient, when the face is smoothly shaven, to 
 produce a noticeable deformity. The teeth are irregular in both 
 jaws, the irregularity, however, being most marked in the 
 superior jaw. The cranium partakes of the asymmetry and the 
 frontal suture is plainly marked. Numerous irregularities of the 
 surface of the skull are observable. The larynx is displaced at 
 least one-half an inch from the median line toward the left side. 
 There is no history of injury and a point of interest in this case 
 is the fact that the asymmetrical and small jaw is a family char- 
 acteristic and has been noticed for several generations. The 
 jaw, in this case, resembles the father's, while the arrangement 
 of the teeth is similar to that of the mother. The upper portion 
 of the body appears to have been developed in two lateral halves 
 and when brought together the left side of the body was higher 
 than the right side. The cranium and maxillary bones show this 
 deformity quite conspicuously. The teeth, which are compara- 
 tively sound, are all present. The left superior maxilla is con- 
 siderably higher than the right. Occlusion is perfect, thus 
 compensating for the short left ramus. 
 
 Another similar case is that of a twenty-year-old woman, 
 who has arrest of development of the upper jaw. The body 
 of the lower jaw is excessively developed. Length of right 
 ramus, 2.25 inches; left, 1.50 inches. The result is that the lower 
 
 16 
 
226 IRREGULARITIES OF THE TEETH. 
 
 jaw is thrown to the left the width of the right central incisor 
 tooth. Her father and uncle have a similar deformity. 
 
 A seventeen-year-old girl came for treatment September 
 14th, 1888. She had quite a prominence upon the right side of 
 the lower jaw and another, although not so marked, upon the 
 left upper jaw. The left corner of the mouth was nearly one- 
 quarter of an inch higher than the right. The face was full 
 and had a peculiar expression, owing to the mouth and jaw 
 being at an angle when closed. Upon examination, the left 
 superior maxilla was found one-quarter of an inch higher than 
 the right side. The alveolar process and teeth shared the same 
 irregularity, thus placing the line of the teeth on the same plane 
 as the lips. The body of the inferior maxilla, from the symphy- 
 sis to the angle, seemed to be longer upon the left side than upon 
 the right. When the jaw closed, the median line of the lower 
 jaw was half an inch to the right of the upper. The lingual 
 cusps of the bicuspids and molars on the right side of the lower 
 jaw occluded with the buccal cusps of the bicuspids and molars 
 of the upper and vice versa upon the left side. 
 
 Asymmetry may be due to excessive development of the 
 body of the jaw on one side and arrest of development on the 
 other. 
 
 In the two cases described, while the causes and the external 
 appearance of the face are entirely different, the alveolar proc- 
 esses and the occluding surfaces of the teeth are on the same 
 angle, the inclination being in the same direction. This deform- 
 ity is found in the mouths of patients over forty years of age, 
 where all the teeth have been removed upon the side of one jaw 
 and upon the opposite side of the other, the alveolar processes 
 containing the teeth elongating upon the side where there is 
 no antagonism and throwing the occluding line of the teeth out 
 of position at an angle similar to that above described. 
 
 On examining 1,977 idiots (Table XIV) there were found 
 to be 159 with protrusion of the superior maxilla and 92 
 with protrusion of the inferior maxilla. These deformities do 
 not exist to such an extent among healthy individuals. This 
 inharmonious development of the maxillary bones may extend 
 from the articulation to the incisor teeth. Such deformities are 
 
DEVELOPMENTAL NEUROSES OF THE MAXILLARY BONES. 
 
 227 
 
 rarely found in connection with the first set of teeth. When 
 the alveolar process protrudes during the period of the tem- 
 porary teeth, it is usually caused by thumb-sucking or an arrest 
 of development of the inferior maxilla. Protrusion of the inferior 
 maxilla is the result of the abnormal development of the rami 
 or body of the jaw or an arrest of development of the superior 
 maxilla. As these abnormal conditions usually correct them- 
 selves when the temporary teeth are shed, they consequently 
 receive little attention. But when these deformities arise during 
 second dentition the jaws are determined toward false positions, 
 thus endangering the beauty of the face. Occasionally in acro- 
 
 Pior. 81. 
 
 megaly and other hypertrophic states occurs excessive growth or 
 there is physiologic hypertrophy of the superior maxilla, when 
 the inferior maxilla is unusually developed. When the teeth 
 are normal in size they appear small in proportion to the abnor- 
 mally large jaw. They are carried forward with the alveolar 
 process to such a degree that the teeth and lips may protrude. 
 In such cases it appears as if the body or rami of the inferior 
 maxilla were much shorter than is natural, but by close inspec- 
 tion we shall see that the inferior maxilla is normal and quite 
 a space exists between the superior and inferior central incisors. 
 A slight protrusion of the superior teeth is a common defect 
 and is usually accompanied by depression of the face at the root 
 
228 
 
 IRREGULARITIES OF THE TEETH. 
 
 and alse of the nose and protrusion of the anterior alveolar 
 process and upper lip. If the maxillary bones as well as the 
 alveolar process be enlarged, the teeth will stand perpendicu- 
 larly with the alveolar process. If the superior maxillary bones 
 be small, the teeth will ])rotrude from the perpendicular to an 
 angle of 45 degrees. Such a case is illustrated in Fig. 64, page 
 131 (Kingsley's "Oral Deformities"). This is a deformity fre- 
 quently met with in practice. A connnon cause of protrusion 
 of the superior maxilla is illustrated in Fig. 81. The teeth in the 
 upper jaw are fully erupted but are directed downward and 
 forward ; the teeth in the lower jaw are in their proper ]iosition. 
 Here the rami of the jaw are inharmoniously developed, the 
 
 Fig. 82. 
 
 rami being so short when the jaws» close that the occlusion 
 throws the superior teeth and alveolar process forward. In 
 this case the alveolar process is quite thin, because the arch is 
 high and the teeth, having long slender roots, are easily carried 
 forward. The inferior maxilla is large, the structure dense and 
 hard and the teeth firmly fixed in position in the jaw. When 
 occlusion takes place, the weaker structure (the superior maxilla) 
 is carried forward by the stronger (the lower maxilla), thus forc- 
 ing the alveolar process forward^ producing harmony through- 
 out the articulation. The shortness of the rami of the inferior 
 maxilla, causing improper closing of the jaws, is a feature 
 strongly impressed upon the dentist who undertakes to insert 
 
DEVEI.OrNrENTAT, NEUROSES OF THE MAXILLARY BONES. 229 
 
 artificial dentures. The tendency of the lower jaw to force an 
 upper denture out of the nioutli, by striking the teeth at an 
 angle instead of perpendicularly, is a marked illustration of the 
 inharmonious development of the jaws. The same difficulty is 
 frequently experienced with the partial lower plate when it 
 presses against the anterior teeth and alveolus, forcing them 
 both forward by improper articulation. The occasional grinding 
 of the surfaces of the artificial molars to produce proper articu- 
 lation is another illustration of the effects of this inharmonious 
 development. 
 
 Fig. 82 illustrates a deformity produced by the before-men- 
 tioned cause with very different results. The case is that of a 
 fourteen-year-old boy. Before the eruption of the second molars 
 the articulation was perfect; but as soon as the second molars 
 occluded the jaws were forced open. The rami are so short 
 that when the second molars and the alveolar processes of the 
 superior and inferior maxilla come together a space exists 
 between the central incisors. 
 
 Unlike the former case, the superior alveolar process is 
 remarkably well developed and the teeth are firmly fixed in the 
 jaw. The vault of the mouth is quite low. The position of the 
 teeth in the alveolar process is such that when the lower teeth 
 occlude they strike directly on a line with the long axis of the 
 roots, thus preventing the forward movement of the teeth and 
 alveolar process. The inferior maxilla is not well developed, 
 nor has it the power to overcome the resistance and force the 
 superior alveolar process and teeth forward, as exemplified in 
 Fig. 81. When the rami are so short that they do not harmonize 
 with the maxillary bones the movement of the jaws may be lik- 
 ened to the arms of shears ; the farther the points are from the 
 center, the greater the distance they have to travel. A slight 
 movement at the center will cause them to move a considerable 
 distance. In a similar manner a slight excessive protrusion of 
 a molar will cause the anterior teeth to become separated. The 
 shorter the rami, the less the harmony between the jaws and 
 teeth ; the farther back the protruding molar and the more it 
 projects, the greater the anterior separation of the jaws. The 
 excessive eruption of the second and third molars is very often 
 
230 
 
 IRREGULARITIES OF THE TEETH. 
 
 due to the persons sleeping with the mouth open; the pressure 
 upon the posterior teeth being removed, the teeth and even the 
 alveolar process will elongate. Not infrequently the mal-occlu- 
 sion of the teeth is due to the inability to close the jaws on 
 account of the inharmonious development. Occasionally there 
 are mouths in which the molars and bicuspids occlude and there 
 is just enough space between the centrals to admit a thin spatula. 
 January, 1887, a patient was brought for advice whose jaws when 
 closed showed a space of half an inch between the incisors. Such 
 cases are due to arrest of development of the anterior alveolar 
 process, the superior dental arch being too small for the inferior. 
 The pressure of the jaws upon the molar teeth is, in some 
 
 '■ Fig. 83. 
 
 instances, so great that normal eruption is impossible. In such 
 cases the molars will protrude through the gum and the superior 
 and inferior processes will occlude when the jaws meet. 
 
 Protrusion of the inferior maxilla, since it produces a most 
 repulsive deformity of the face, should be corrected as early in 
 life as possible. When caused by or associated with arrested 
 development of the superior maxilla, it is extremely difficult to 
 restore the features to a natural expression. A case (Fig. 83) 
 came to my notice in 1887, of a commercial traveler from New 
 York, who called for the purpose of having a gold crown reset. 
 There was marked deformity in the jaws, consisting of a depres- 
 
DEVELOPMENTAL NEUROSES OF THE MAXILLARY HONES. 231 
 
 sion at the alae of the nose and an unusual protrusion of the 
 inferior maxilla. Upon examination, the second molar on the 
 upper jaw and the third molar on the lower jaw were found to 
 be the only teeth that occluded. This was caused by arrest of 
 development of the bones of the face and an excessive length 
 of the rami of the lower jaw. The body was normally devel- 
 oped, but was carried forward by a lengthening of the rami. To 
 add to this deformity, there was marked arrest of development 
 of the bones of the face. There are cases where the lower jaw 
 projects beyond the upper ; but on closely examining the deform- 
 ity another cause is found for this appearance. 
 
 Fig. 84. 
 
 A girl fifteen years of age was sent for treatment by a dentist 
 from a neighboring state. He desired me to "force the inferior 
 maxilla back into place." The rami and body of the jaw were 
 apparently normal. The external appearance of the chin and 
 cheeks was in keeping with the outline of the face. The upper 
 lip was much depressed and deep lines extended from the 
 alse of the nose to the corner of the mouth. The cheek bones 
 were also undeveloped. Upon opening the mouth, arrest of 
 development of the superior maxilla was found. The superior 
 incisors closed inside of the inferior incisors ; the first and second 
 bicuspids, first and second molars, were in position, but had 
 crowded forward close to the lateral incisors. The cuspids were 
 quite outside the arch. The superior dental arch had to be forced 
 
232 
 
 IRREGULARITIES OF THE TEETH. 
 
 out, instead of carrying- the inferior maxilla in, which would 
 tend to further complicate the case. 
 
 In the case of a young man was found what had been regarded 
 as a "prognathous lower maxilla." This was caused by arrested 
 development of the upper maxilla. Five years had already 
 been spent in trying to reduce the deformity. Had the attempt 
 succeeded the deformity would have been greater than it was. 
 Instead of moving the lower teeth back the upper teeth should 
 have been moved forward. After six months' treatment on 
 this plan the teeth were corrected and the face greatly improved. 
 
 Fig. 85. 
 
 In the majority of cases which appear tc result from a pro- 
 trusion of the lower jaw, the lower maxilla does not project 
 abnormally but the superior maxilla being arrested in its devel- 
 opment, gives the protruding appearance to the lower jaw. 
 Before undertaking to correct such a deformity the general con- 
 tour of the face should be carefully studied. 
 
 A peculiar and common • deformity of the inferior maxilla 
 (Fig. 84) is that where the body of the jaw is very short. A 
 line dropped perpendicularly and touching the chin at the median 
 line would pass through the bicuspid region of the superior 
 maxilla. A front view of such a deformity has an appearance 
 
DEVELOPMENTAI, NEUROSES OF THE MAXILLARY BONES. 233 
 
 as though the lower jaw were absent and a side view throws 
 the nose out prominently while the chin and forehead retreat. 
 The rami of the jaw are larger than the body. The articulation 
 is good, the defect being that the teeth in the incisor region 
 strike quite a distance posterior to the superior incisors. Arrest 
 of development of the lower jaw frequently result when the 
 superior incisors are crowded inward irregularly, or when there 
 is arrest of development of the superior maxilla, the lower incis- 
 ors coming in contact with them, thus preventing the forward 
 development of the body of the jaw. The anterior portion of 
 the lower jaw remains stationary, while the development is in 
 the posterior direction. 
 
 Fig. 86. 
 
 Fig. 85 represents jaws such as are frequently seen. The 
 long body and protruding chin, narrow and contracted alveolar 
 process on the lower jaw, a small superior maxilla and thin 
 protruding alveolar process are in keeping with the thin faces 
 and sharp features of the class. The body of the inferior maxilla 
 is small, thin and very delicate ; the rami unusually short — just 
 opposite to the one last described. A line drawn parallel with 
 the occluding surfaces of the teeth would meet the angle of the 
 jaw, which in a normal jaw would extend from one to one and 
 a half inches below the line. Naturally slender, delicate muscles 
 and tendons are associated with such bones. In these cases 
 dislocation of the inferior maxilla is liable to occur while yawn- 
 ing or during dental operations, so great is the leverage. In 
 this instance the length of the jaw compensated for the width. 
 
234 
 
 IRREGULARITIES OF THE TEETH. 
 
 SO that in this particular case the teeth are not irregular; 
 although irregularity frequently accompanies this peculiar for- 
 mation of the jaw. This is particularly the case with the saddle 
 or V-shaped arches on the upper jaw and the saddle-shaped 
 and forward inclination of the molars, bicuspids and cuspid teeth 
 on the lower jaw. The roof of the mouth is also very high and 
 the alveolar process very thin, giving the roots of the teeth but 
 slight support. The same principle of organization and structure 
 is operative in the alveolar process and teeth of the lower jaw. 
 Fig. 86 represents the jaws of a patient, twenty-six years 
 of age, in whom, on examination, was found a small normal 
 inferior maxilla, well protruded and in harmony with the other 
 
 Fig. 87. 
 
 features of the face. The superior maxilla and alveolar process 
 were excessively developed, the first molar and anterior teeth 
 describing a much larger circle than the lower. The second 
 molars were the only teeth that articulated properly. The 
 anterior alveolar process had taken on a profile deposition of 
 bone-cells until the teeth impinged upon the gum of the lower 
 jaw, producing absorption and expansion. The upper lip was 
 covered with a mustache which completely hid the deformity. 
 Under such conditions a prominence is observed at the alae of 
 the nose — the upper lip being drawn over the alveolar process. 
 
 Fig. 87 represents a case rarely met with. The body of the 
 inferior maxilla is excessively developed, the extent of the irreg- 
 ularity depending on the degree of development. When only a 
 
DEVELOPMENTAL NEUROSES OF THE MAXILLARY BONES. 235 
 
 slight protrusion exists the incisors strike beyond the superior 
 incisors. In extreme cases only the molars articulate. When 
 the anterior teeth articulate the alveolar process develops so 
 that the teeth extend to the superior alveolar process. The 
 features may be otherwise quite regular. Asymmetry of the jaws 
 often continues to develop until the osseous system has obtained 
 its growth. 
 
 Complete absence of the inferior maxilla, as Gould remarks, 
 is much rarer in man than in animals. Nicolas asd Prenant 
 have described a case of this in a sheep. Gurlt has observed 
 cases with total or partial absence of the inferior maxilla, 
 agnathes or hemignathes. Simple atrophy of the inferior maxilla 
 occurs in man and the lower animals, but is much less frequent 
 than atrophy of the superior maxilla. Langnebeck reports the 
 case of a young man who had the inferior maxilla so atrophied 
 that in infancy it was impossible for him to take the breast. 
 The patient had nearly complete immobility of the jaws. Boul- 
 lard reports a facial deformity with deficiency of the condyles 
 of the lower jaw. Maurice has reported a vice of conformation 
 of the lower jaw which rendered lactation impossible. Tomes 
 describes a lower jaw, the development of the left ramus of 
 which had been arrested. Canton describes an arrest of devel- 
 opment of the left perpendicular ramus of the lower jaw com- 
 bined with external malformation. The bull dog seemingly 
 displays inferior maxillary prognathism, but here the deformity 
 is really superior brachygnathism, as he, E. C. Kirk and others 
 have shown, the superior maxilla being arrested in development. 
 As the bull dog here illustrates a degeneracy likewise occurring in 
 man, its value as an understudy in jaw and tooth irregularity 
 is obvious. 
 
CHAPTER XXHI. 
 
 DEVELOPMENTAL NEUROSES OF THE VAULT. 
 
 Many years ago Langdon Down, in a paper read before the 
 British Odontologic Society, stated with regard to the idiots in 
 the Earlswood Asyhim that : "Of the most significant value, 
 however, is the condition of the palate. I have made a very large 
 number of careful measurements of the mouths of the con- 
 genitally feeble-minded and of intelligent persons of the same 
 age, with the result of indicating, with some few exceptions, 
 a markedly diminished width between the posterior bicuspids 
 of the two sides. One result, or rather one accompaniment, 
 of this narrowing is the inordinate vaulting of the palate. The 
 palate assumes a roof-like form. The vaulting is not simply 
 apparent from the approximation of the two sides ; it is absolute — 
 the line of juncture between the palatal bone occupying a higher 
 plane. Often there is an antero-posterior sulcus corresponding 
 to the line of approximation of the two bones. An appeal to 
 the condition of the mouth is an important aid in determining 
 whether the lesion on which the mental weakness depends is 
 of intra-uterine or post-uterine origin. In the event of the 
 mouth being abnormal it indicates a congenital origin; while if 
 the mouth is well formed and the teeth are in a healthy condi- 
 tion, it would lead to the opinion that the calamity had occurred 
 subsequently to embryonic life." 
 
 These conditions, when present in children, were patho- 
 gnomic of idiocy, according to Langdon Down. Further inves- 
 tigation showed while many idiots and imbeciles possessed low, 
 narrow vaults, many sane people had high vaults and V and 
 saddle-shaped arches. Clay Shaw^ decided from the results of' 
 his researches that while there is no necessary connection 
 between a high palate and a degree of mental capacity of the 
 individual a high palate is invariably associated with narrow 
 pterygoid width and a narrow skull. On examination of Clay 
 Shaw's results it ' is evident that the intellectual standard he 
 
 ^Journal of Mental Science, July, 1876. 
 
 236 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 237 
 
 adopted was too limited to admit of his sweeping assertions in 
 regard to mental capacity. Furthermore that the claim anent 
 narrow skull and high palate is a sweeping assumption based 
 on a few selected cases. Examination of the skulls in any 
 moderately sized anthropologic collection will disprove this 
 assertion. Cuylitz,- of Belgium, accepting the claim of the con- 
 nection of high vaulted palates with mental deficiency, asserted 
 in explanation that "the brain tends to develop transversely, 
 but it meets in some cases a resistance in the parietal region 
 which crowds it back. This pressure is transmitted by the zygo- 
 matic temporal and malar processes pushing together the alve- 
 olar borders of the superior maxillary like a workman's tongs 
 (the approximation of the main branches of which is that of the 
 parietals) brings the ends together; the hinge being represented 
 by the body of the sphenoid and the occipital. This bringing 
 together, therefore, of the alveolar borders or the original palate 
 is only the expression of a cerebral collapse or abnormal effort 
 which in the psychic life reveals itself by degeneracy." 
 
 While this explanation is exceedingly ingenious, it is as yet 
 in the earliest stages of a working hypothesis. Idiocy, it should 
 be remembered, is but a bud on the tree of degeneracy and 
 many conditions of checked development found in it are found 
 in other forms of degeneracy as well. 
 
 It is not surprising that practices among idiots should have 
 been charged with producing palatal deformities really due to 
 checked development. Ever since Imrie's^ time, the opinion the 
 "rabbit mouth is due to keeping the thumb in the mouth for 
 hours after going to sleep" has, with various modifications, but 
 without careful analysis, been repeatedly reiterated in parrot-hke 
 fashion. The first attempt to corroborate Imrie was that of 
 Thomas Ballard, who, in a paper on the "Constitutional Ill- 
 effects of Fruitless Sucking and the Diagnostic Value of De- 
 formed Jaws in Relation Thereto," read before the British Odon- 
 tological Society in 1864, claimed that "as in idiots are seen the 
 worst forms of defective growth, so also do they exhibit the most 
 aggravated forms of deformed jaws and teeth ; the habit of suck- 
 ing being retained by them to an advanced age." 
 
 2 Annales M^dico-Psychologiques, XVII, 1885. 
 8 Op. Cit 
 
238 IRREGULARITIES OF THE TEETH. 
 
 When the size of the vault, especially its antero-posterior 
 diameter, is compared with the thumb, lip, tongue, sugar teat, 
 etc., it seems absurd to suppose for a moment there was any 
 comparison in size between the two or that depression made by 
 any of these could produce uniform width and height through- 
 out the entire length of the vault. 
 
 Children commence to suck their fingers soon after birth. 
 As absorption and deposition of bone cells take place faster at 
 this time than at any other in the life of the individual, one 
 would naturally expect to find high, narrow, deformed vaults in 
 connection with the first set of teeth or before the sixth year, 
 but such is not the case. Children with the habit of finger suck- 
 ing often have very low vaults. 
 
 Clouston,* a decade ago, attempted study of the palatal stig- 
 mata of degeneracy from a very limited standpoint. As he 
 completely ignored all previous results his conclusions, while 
 not undeserving of attention, require critical analysis. He divides 
 vaults into three groups : Typical (or Normal), Neurotic and 
 Deformed. The first has a low but regular wide dome (Fig. 88, 
 No. i). The second type (Fig. 88, No. 2) is designated as "neu- 
 rotic" because, according to Clouston, the "deformity of the 
 palate occurs during the brain growth, early in the life, prob- 
 ably in utero." In Clouston's opinion this indicates "bad initial 
 neurotic heredity." The third type (Fig. 88, No. 3) is designated 
 as "deformed." 
 
 The conclusions of Clouston, however, need not be discussed 
 at length, since they are largely based on preconceived notions 
 which ignore the researches of comparative anatomists, of alien- 
 ists of world-wide fame, of embryologists, of ethnologists and 
 of criminal anthropologists. They are quoted here in illustra- 
 tion of the confused contributions on this subject. In a general 
 way, Clouston adopts the theory of Langdon Down in 1871 
 and Cole in 1881, that "excessive vaulting of the palate is due 
 to arrest of development of the sphenoid bone" and "premature 
 ossification of the suture at the base of the skull." In consid- 
 ering the palate and upper maxillary bone, one must take into 
 account, Clouston remarks, the following considerations, viz. : 
 
 * Journal of Mental Science, 1890. 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 239 
 
 Cloustoni C(a55ificcirfon 
 
 Neurofic 
 
 Deformed. 
 
 Fig. 88. 
 
240 IRREGULARITIES OF THE TEETH. 
 
 Its relations to the base of the skull in man. This relation is 
 seen to be close and absolute as compared with the lower ani- 
 mals. If a perpendicular line is drawn, marking the most 
 anterior point of the brain, it is seen to fall, in man, through the 
 center of the hard palate, while in the monkey it only just 
 touches its posterior margin. In man it thus has a direct rela- 
 tionship to the brain base and its shape would be dominated by 
 the width of this; while in the monkey it is nearly a part of the 
 alimentary system, having little relationship to the base of the 
 brain at all. No one can compare the two without seeing that its 
 conformation in man will naturally follow any changes that take 
 place during development in the skull-base. If the skull, in its 
 growth, size, shape, dome and base, is absolutely dominated by 
 the brain it contains and on which it depends, then the brain- 
 growth will, in this way, secondarily determine the shape of the 
 upper maxillary bone and palate." 
 
 If the intervening space between the base of the brain and 
 the vault were solid, a change in the shape of one might exert 
 influence upon the other. The space occupied by the nares 
 being located between the two, with two strong pillars of the 
 superior maxillary bone upon either side, as a resistance pre- 
 cludes such a theory. The fact that the jaw has become less 
 normal, or that the anterior lobes of the brain have developed 
 and become more prominent, would tend to the belief the roof 
 of the mouth should be less vaulted, or in other words, the 
 base of the skull, which is situated above the vault instead of 
 posterior to it, would occupy much of the space necessary for 
 the anterior and posterior nares, thus crowding down the vault. 
 That any force, produced by the development of the bones at the 
 base of the skull, or early or retarded ossification of suture in 
 that locality, could exert any influence through the vomer is not 
 well taken. 
 
 The fact that the vomer does not ossify until puberty, the thin- 
 ness of the bone after ossification has taken place, and that it 
 is most always crimped or deflected in one direction or another, 
 is evidence that no effect could be produced upon a vault of 
 bone supported by the anterior alveolar process and with a rib 
 or suture extending its entire length, which ossified years before 
 
DEVELOl'MENTAL NEUROSES OF THE VAULT. 241 
 
 any changes in the vault were noticed. The ridge and the two 
 vaults, one on either side, often extend anteriorly through the 
 alveolar process nearly or cjuite to the incisor teeth. No one 
 would claim for a moment that the vomer could exert any influ- 
 ence upon the palate either up or down through the maxillary 
 bone and alveolar process. If the argument were true, the vomer 
 before it could draw up the vault would necessarily have to be 
 drawn taut, but such a condition is rarely seen, although high 
 vaults be numerous. 
 
 According to Clouston, "Those palates, where the deformity 
 consists in a ridge down the center antero-posteriorly, seem to 
 show that in them the deformity took place at a later period 
 than in other deformed palates where the nasal septum was 
 getting stronger and kept the center of the palate down, while 
 on each side of it the palate was drawn up, making two vaults, 
 side by side, instead of one." 
 
 This is based on an erroneous theory. This deformity in 
 the center of the vault may be present as early as the second 
 year, or at the time 'of ossification. If the theory were correct, 
 that contraction at the base of the skull, producing pressure 
 through the vomer, causes the high vault, when vomer ossifica- 
 tion stops this, what carries up the sides of the vault? In such 
 case the vomer would be perfectly straight, which is not the 
 fact. 
 
 Clouston reiterates the claim many times, that "the deformity 
 of the palate (which, of course, must include the jaw) occurs 
 during brain-growth, early in life, probably in utero." This is 
 not a well based hypothesis, since the brain continues to grow 
 until the seventh or eighth year. Moreover, the vault does not 
 change very much in height till after the sixth or eighth year; 
 hence a high vault cannot be said to develop early in Hfe, much 
 less in utero. 
 
 Adopting the old, pretty generally exploded medical notion 
 of the pathologic and physiologic importance of temperaments, 
 Dr. Robert S. Ivy'* views "dental and facial types as part of the 
 morphology of the temperaments." 
 
 "The shape of the alveolar arch and the dome of roof of the 
 
 ^ American System of Dentistry. 
 17 
 
242 IRREGULARITIES OF THE TEETH. 
 
 mouth, also the articulation of the teeth, and the manner in which 
 the gum is festooned over each tooth, are all indicative of 
 the several temperaments and present varieties worth attention. 
 (Fig. 89.) 
 
 The arch of the bilious temperament, from cuspid to cuspid, 
 is almost flat, the lines backward from these points slightly 
 diverging in an almost straight line. The dome of the mouth 
 is high and almost square. When articulated, the upper central 
 incisors overlap the lower and are closely locked. In general 
 form the teeth are large, the corners tending to squareness and 
 are rather long in proportion to their breadth ; in texture they are 
 dense and strong. The proximal surfaces are in close contact 
 two-thirds of the distance from the cutting edge to the neck, ren- 
 dering the festoon of the gum short and heavy. 
 
 The sanguine arch resembles a horseshoe in shape. The 
 dome of the mouth is high and semi-circular. The articulation 
 of the teeth is close and firm and their structure is dense. The 
 masticating surfaces of the teeth in this class frequently bite 
 edge to edge and as age advances they are gradually worn down 
 to the gum unless protected by artificial means. In general 
 form they are well proportioned, length predominating in less 
 degree over breadth, and their outlines are rounded and curved. 
 The distal and mesial surfaces are in contact a little more than 
 half the distance from the cutting edge and the festoon is long 
 and delicate in outline. 
 
 The arch of the nervous temperament presents a strong 
 contrast to either of the two preceding and is sometimes spoken 
 of as Gothic from its pointed character. From the central 
 incisors, w'hich often overlap for want of space, the line of 
 remaining teeth continues backward with a slight curve, the 
 greatest prominence being between the cuspid and the first bicus- 
 pid. The roof of the mouth partakes of the same curve and 
 angles as the arch. The articulation of the teeth is not close, 
 but long, and the teeth belonging to this temperament are of 
 average density and structure. In shape, length predominates 
 over breadth ; the distal corner of the centrals is rounded, giving 
 the whole tooth almost the appearance of a lateral and the cusps 
 and cutting edges are long and fine. The point of contact of 
 
DKVEI.OPMENTAI, NEUROSES OF THE VAULT. 243 
 
 Ivy5 dqs^iftcqtion. 
 Bilious. 
 
 Sanguinary: 
 
 Lymf-ihal'ic 
 
 Fig. 89. 
 
 Sanguinary should be sanguine. 
 
244 IRREGULARITIES OF THE TEETH, 
 
 the proximal surfaces is near the cutting edge, giving a long, 
 delicate festoon to the gum. 
 
 The lymphatic arch is almost semi-circular in its outline and 
 somewhat resembles that of the sanguine temperament. The 
 dome or roof of the mouth is flat and low. The articulation 
 is irregular and the front teeth are apt to protrude. In shape, 
 breadth predominates over length and the normal depressions 
 and elevations are either entirely absent or undefined. The fes- 
 toon of the gum is thick and indefinite in outline. The lateral 
 on either or both sides is frequently out of line." 
 
 The temperament, even accepting the older notions, has 
 nothing to do even with the shape, size and character of the 
 jaws and teeth. The vault, above all, cannot be viewed from 
 such standpoints. 
 
 In mouths of the bilious, sanguine, nervous or lymphatic 
 forms of temperaments dental arches in each temperament may 
 measure 2.50 across from the inner surface of one second bicus- 
 pid to the inner surface of the other. The dental arch may range 
 do^^■n to .96 in width and the antero-posterior diameter from 
 1.86 to 2.43. The vaults must necessarily range in height and 
 shape to correspond to the width and length of the dental arch. 
 
 From hereditary standpoints temperament should not have 
 much to do with the shape of the dental arch. Two individuals, 
 one of nervous, the other of lymphatic, bilious or sanguine tem- 
 perament, are married; the offspring inherits the jaws of one, 
 the teeth of the other and the temperament of the child is 
 changed. The local condition is such that shape of the jaw may 
 change type of the vault. One child may possess a broad dental 
 arch, but very short, another a very narrow, long dental arch. 
 Hence, classification of the dental arch and vault by tempera- 
 ment is out of the question. 
 
 In order to test this question, however, I made a number 
 of examinations along the lines indicated by Ivy, and with the 
 assistance of a medical consultant, as to these temperaments. 
 Under brachycephalic, mesocephalic and dolichocephalic, sixty 
 illustrations (Plates 13 to 22) were made and classified from 
 models of white individuals. The height of vault varies from 
 .31 to .81, with a width from i to 1.86; the antero-posterior 
 
DKVKI.OPMKNTAI. NKUROSES OK THE VAULT. 245 
 
 ranges from 1.87 to 2.50. The illiistrations in outline are as dif- 
 ferent as it is possible to make them and not produce a deform- 
 ity. Tims in the anlcro-posterior direction (Figs, j and 7, plates 
 13 and 15) a brachycephalic with only a difference of .03 in 
 width of head, has its highest part in the vault about the second 
 molar, while another (Fig. 6, plate 13) has its highest at the 
 first and second bicuspids. A mesocephalic (Fig. 6, plate 17) 
 has its highest part midway between the highest part of (Figs. 
 6 and 7) the brachycephalic. 
 
 Viewed from the lateral outline, some brachycephales (Figs. 
 1 . 2 and 6, plate 14) are seen to be pinched or contracted, and this 
 contraction is not uniform upon both sides. Other brachy- 
 cephales (Figs. 3 and 7, plates 14 and 16) and mesoceophales (Fig. 
 6, plate 18) are broad. Some cases (Figs. 3 and 7) are not uniform 
 upon both sides, while the teeth do not stand in the same direc- 
 tion ; some vertical, others at an angle of 45 degrees. 
 
 Brachycephales (Figs. 11 and 12, plate 16), mesocephales 
 (Figs. I, 3 and 4, plate 18) and dolichocephales (Figs. 4 and 5, 
 plate 21) are sanguine. 
 
 Could there be a greater dilTerence possible than is evident 
 in the antero-posterior and lateral illustrations? One (Fig. 12, 
 plate 16) is very high at the middle or about the first perma- 
 nent molar, wliile mesocephale (Fig. 4, plate 17) and dolicho- 
 cephale (Fig. 4, plate 21) are very flat. The soft palate of a doli- 
 chophale (Fig. 4, plate 21) extends back considerably farther 
 than mesocephale (Fig. 4). 
 
 Some (Figs, i, 3, 5 and 11) possess graceful curves, but not 
 on the same circle. The teeth also stand at different angles, as in 
 the last group. In the lateral illustrations a (Fig. 4) mesocephale 
 and a (Fig. 5) dolichocephale possess a slight resemblance, 
 although the width and height vary .12 and .31 of an inch, respec- 
 tively. The lowest vault has the widest jaw, while the highest 
 vault the narrowest. There is a depression at the median line 
 which is quite marked in the antero-posterior illustration (Fig. 
 4. mesocephalic) that is not in the other. The sides of the arch 
 (Fig. 4) diverge to a greater extent than those in doHchocephale 
 (Fig. 5). No two resemble each other. 
 
 The neurotics are said to possess the highest vaults. Brachy- 
 
246 IRREGULARITIES OF THE TEETH. 
 
 cephales (Figs. 8, 9 and 10) and mesocephales (Figs. 2, 7 and 
 10) and dolichocephales (Figs, i and 6) alike have a nervo-bilious 
 or neurotic temperament. The extreme highest vault is .75, the 
 extreme lowest .37. In the lateral measurement the extreme 
 narrowest i and the extreme widest, 2.50. As far as the shape of 
 the dental arch and teeth are concerned these observations do 
 not correspond with Ivy's in the slightest degree. 
 
 To illustrate the wide difiference in two individuals of the 
 same temperament take (Figs. 3 and 4) two mesocephales of 
 sanguine temperament. One (Fig. 3) weighs 195 pounds, is six 
 feet two inches, while the other (Fig. 4) weighs 163^ pounds and 
 is five feet eight inches. Both measure seventy-nine lateral 
 index. The two heads are exactly alike. The width of vault in 
 (Fig. 3) is I, in the other (Fig. 4) 1.37. Height of vault (Fig. 3), 
 .56; (Fig. 4), .50. The smaller man possesses the widest and 
 lowest arch. The shape of the dental arch, the gums and teeth, 
 are wholly unlike. The smaller man has the larger teeth, while 
 the gums are long and pointed. The larger man has short, broad 
 gums. 
 
 There were three lymphatic individuals, a brachycephale 
 (Fig. 5, plate 14), a mesocephale (Fig. 9, plate 20) and a dolicho- 
 cephale (Fig. 3, plate 21). Fig. 5 shows height of vault, .62; 
 Fig. 9, .44; and Fig. 3, .75 ; while the width of vault is. Fig. 5, 
 1.25; Fig. 9, I, and Fig. 3, 1.25. 
 
 Some of the illustrations neither resemble Ivy's illustrations 
 nor each other. The same rule holds good in the lymphatic 
 temperament as in the others. There is no uniformity in shape, 
 size or height. 
 
 The shape of the vault is said to resemble the shape or con- 
 tour of the head. Thus a brachycephalic or broad head is said to 
 contain a large, broad jaw with a low vault, while a dolicho- 
 cephalic or long, narrow, high head should possess a long, nar- 
 row jaw with a high vault. To study the relation of the shape 
 of the vault with the contour of the head, numerous models were 
 secured and measurements of the head taken. The shape of the 
 jaws were taken in modeling compound in such a manner that 
 the soft palate could also be outlined. From these impressions, 
 plaster models were obtained, measurements then taken and the 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 247 
 
 models sawed at the median line. One-half was placed upon 
 paper and an outline obtained. The two halves were then put 
 together and the saw passed through the model laterally between 
 the second bicuspid and first permanent molar. The anterior 
 half was then outlined. 
 
 The shape of the head was obtained by the use of a heavy 
 strip of lead carefully moulded to the head in the antero-posterior 
 direction from the nose to the base of the skull, then removed, 
 laid upon paper and outlined. The lateral contour was obtained 
 by moulding the lead over the head just back of the ears. These 
 outlines were reduced by means of the pantagraph to about one- 
 third the natural size. A standard as to skull types is needed. 
 
 According to Vogt,'^ " Taking the tables of Welcker as a 
 basis, and assuming the longitudinal diameter of the skull — lOO, 
 the following results are obtained for the various races : where 
 the mean of the transverse diameter is below /2, they may be 
 termed- long heads; where it exceeds 8i, short heads; where it 
 varies between 74 and 81, middle heads." 
 
 Later craniologists, as already shown, generally assume two 
 fundamental types, the dolichocephalous or long horizontally, 
 that is, from back to front, and the brachycephalous or approxi- 
 mately round horizontally. 
 
 My own results support Keane. Dolichocephaly was found 
 to be exceedingly rare in the white and very infrequent among 
 the fiegroes. The results are to be found in the appendix. 
 
 Examination of the brachycephalic whites show's the first six 
 lateral indexes are 84. The width of the dental arch varies from 
 2.12 to 2.62; outside second bicuspids, from 1.75 to 2.37; Avidth 
 of vault between second bicuspids from i to 1.37; antero- 
 posterior, from 1.87 to 2.27, while the height of the vault varies 
 from .44 to .62. In the mesocephalic, white, the range varies 
 from 2 to 2.50 in width of dental arch ; width outside of second 
 bicuspids, from 1.62 to 2.25 : width inside second bicuspids from 
 I to 1.86; antero-posterior from 2 to 2.37, and height of vault 
 from .31 to .68. Dolichocephalic: The range width of dental 
 arch is from 2 to 2.37: width outside second bicuspids, 1.87 to 
 
 * Lectures on Man. 
 
248 IRREGULARITIES OF THE TEETH. 
 
 2.12; width betwen second bicuspids, from 1.25 to 1.50; antero- 
 posterior from 2.12 to 2.31 ; height of vault from .62 to .81. 
 
 The range of figures in each group is so great and differs 
 so much from each other that no two seem to resemble each 
 other. By comparison of one group with another, it is seen 
 there is very little difference as regards width and length of 
 dental arch and width of vault. There is, however, a difference 
 in height of vault. 
 
 The figures in the table of the lateral index do not show the 
 slightest resemblance in width, height or temperament, nor the 
 least agreement in contour of the vault and head. The shape 
 of the vault is said to be influenced by the intellect of the indi- 
 vidual ; that is, the most intellectual people possess the highest 
 vaults. To test this theory, six brachycephalic (Plates 23 and 
 24), six mesocephalic (Plates 25 and 26), and six dohchocephalic 
 (Plates 27 and 28), negro waiters in hotels and restaurants, were 
 measured. The whites were bankers, editors, medical men, stu- 
 dents, architects, bookkeepers. 
 
 By comparing the brachycephalic heads we notice that the 
 highest lateral index in the white individuals is 84. in negro 87. 
 The highest width, outside of first permanent molar, is white, 
 2.62; colored, 2.87. This seemed to be quite remarkable. The 
 lowest white 2, negro 2.25. In width of vault between second 
 bicuspids, highest white 1.37, negro 1.62; lowest white i, negro 
 1.31. Antero-posterior greatest length, white 2.50. negro 2.25. 
 Height of vault, highest white 68, lowest 37, with an average of 
 54; negro highest 75, lowest 50, with an average of 61. 
 
 Mesocephalic — Highest lateral index, white 79, colored 80. 
 Highest width outside first permanent molar, white 2.50, negro 
 2.81 ; lowest, white 2, negro 2.12. Width of vault between sec- 
 ond bicuspids, highest, white 1.86, colored 1.62; lowest, white i, 
 negro 1.3 1. Antero-posterior, highest, white 2.37, nego 2.37; 
 lowest, white 2, negro 2. Height of vault, highest, white .68, 
 negro .62; lowest, white .31, negro .50; average, white .52, 
 negro .60. 
 
 Dolichocephalic — Highest lateral index, white 72, negro 70. 
 Greatest width outside first molar, white 2.37, negro 2.50; low- 
 est, white 2, colored 2.12. Width of vault between second 
 
DEVELOI'MKNTAL KEUROSES OF THE VAULT, 249 
 
 bicuspids, highest, white 1.50, negro i./S; lowest, white 1.25, col- 
 ored 1. 18. 
 
 Antero-postcrior — Greatest length, white 2.31, negro 2.37; 
 smallest, white 2.12, negro 2.18. Height of vault, highest, white 
 .81, negro .68; lowest, white .62, negro .56; average, white .74, 
 negro .62. 
 
 The negro has the roundest heads, while the width of jaws 
 is larger in white, but in the other divisions, the jaws are more 
 uniform in width. The jaw does not diminish in the negro in 
 width anterior to the first permanent molar as it does in the 
 Caucasic race. The height of vault is much higher in the negro 
 than in the white, with the exception of the dolichocephalic 
 heads, where it is higher in the white. The height of vault, 
 like other measurements, is more uniform in the white. Com- 
 paring the figures of the negro with the white people, it will be 
 seen, in the average that the width and antero-posterior meas- 
 urements of the negro are the largest. 
 
 Since the highest vaults in the brachycephalic and meso- 
 cephalic heads are found in negroes and in the dolichocephalic 
 among the white, it is evident that intelligence has no relation 
 with the contour of the vault. Comparison can no more be made 
 between the vault and the contour of the heads in negroes than 
 there is in whites. 
 
 Mouth breathing has been advanced as a cause of high 
 vaults. This view is till held by dentists and medical men. 
 Mouth-breathing is caused by sleeping with the mouth open, 
 by enlarged tonsils, by adenoid growth, by hypertrophy of the 
 mucous membrane of the nose and turbinated bones and by 
 arrest of development of the bones of the jaw and nose. When 
 the mouth is opened, pressure is said to be produced upon the 
 sides of the jaws and teeth by tension of the buccinator muscle, 
 causing contraction of the sides of the jaw, protrusion of the 
 teeth and elevation of the vault. 
 
 The superior maxillary bones are fused at the median line. 
 Their under surfaces have imposed upon them the alveolar proc- 
 esses. The maxillary bones proper are made up of dense, com- 
 pact tissue and are so arranged as to best resist certain forces. 
 The outer surface of the bone is fortified and supported by the 
 
250 IRREGULARITIES OF THE TEETH. 
 
 malar process, which is situated midway between the maxillary 
 process and the canine eminence at the first permanent molar. 
 At the canine eminence is the strong, thick plate of bone extend- 
 ing from the bridge of the nose to the alae, the mesial portion 
 forming the outer surface of the nasal cavity. The nasal septum 
 is situated at the center of the nares and is attached to the 
 maxillary bone at and along the place of union of the two halves 
 of the maxillary bone. A saw passed through from one canine 
 fossa to the other discloses in the section the strong trilateral pil- 
 lars of bone which go to make up the outer surfaces of the nasal 
 cavity. These strong pillars of bone are situated just at the point 
 of the location of the permanent cuspids and, together with the 
 nasal septum, form a strong support to the hard palate. 
 
 Maxillary bones are for the attachment of muscles and the 
 resistance of force in masticating food. The hard palate does 
 not assume the normal shape until the twelfth year, or after the 
 teeth are all in position. The vault may be high or low, ranging 
 from one inch vertically from the alveolar plane on a transverse 
 line intersecting the alveolar crests between the second bicus- 
 pids and first molars down to one-quarter of an inch from the 
 plane. In either case the vault may be normal, since each variety 
 depends upon the shape of the maxillary bones and teeth for its 
 peculiar form. 
 
 The alveolar process, consisting of soft, cancellated structure, 
 is solely for the purpose of protecting the germs of the teeth 
 before they have erupted, and for supporting the teeth after 
 they are in place. From the time the teeth make their appear- 
 ance until they are shed, the alveolar process has developed and 
 been absorbed three times. The alveolar process being solely 
 for pl-otection and support of the teeth, its position and shape 
 must depend upon the location of the teeth. The bone proper 
 is not influenced to any great extent by the movement of the 
 teeth. 
 
 The buccinator is a voluntary muscle, penniform in shape. It 
 has its origin and insertion along the body of the jaws, above 
 the alveolar process on the upper and below the alveolar process 
 on the lower jaw. It extends from the first bicuspid anteriorly 
 to the wisdom-tooth posteriorly. The center of the muscle in 
 
DEVELOPMENTAI- NEUROSES OF THE VAULT. 
 
 251 
 
 one direction is therefore on a line with the j^Hnding surface of 
 the teeth and in a transverse direction at the first permanent 
 molar. Its chief function is to convey and hold the food under 
 the teeth during mastication. 
 
 In many cases of contracted arches and high vaults, mouth- 
 breathing does not occur. In many cases of normal arches and 
 vaults it co-exists. Mouth-breathing frequently commences very 
 early in life ; contracted jaws, on the other hand, never begin 
 until the seventh or eighth and in most cases the tenth year, 
 except monstrosities or from traumatic causes. These conditions 
 when existing are wholly unlike the usual contracted arches, can 
 
 Fig. 90. 
 
 be diagnosticated at once, and therefore they should not enter 
 into this discussion. Contracted arches are of two kindsi — V 
 (Fig. 90), and saddle-shaped (Fig. 91) — all other varieties being 
 modifications of these two. The cause which produces the one 
 cannot produce the other. There are two-thirds more V and 
 saddle-shaped arches among the low vaults than among the 
 high vaults, taking .58 of an inch as the average. One of these 
 deformities with a high vault is always more marked, since in 
 the high vault the alveolar process is long and thirr, with very 
 little resistance, and the teeth are more easily carried in one 
 direction or the other. 
 
252 
 
 IRREGULARITIES OF THE TEETH. 
 
 In the V-shaped arch, commencing at the first permanent 
 molar, there is a gradual narrowing of the dental arch and alveo- 
 lar process toward the median line, where the incisors may 
 approximate a V point or may stand in their normal position 
 to each other. Invariably there is protrusion of the teeth and 
 alveolar process, not of the jaw. In the saddle-shaped arch the 
 bicuspids are carried inward and the deformity is invariably 
 situated between the first permanent molar and the cuspid. 
 Unlike the V-shaped variety, the anterior teeth and alveolar 
 process never protrude in this class of deformities. The con- 
 tracted hard palate is always associated with the V-shaped 
 
 lilli lijiil^^ "'""limWII* 
 
 Fig. 91. 
 
 variety, in most cases extends backward to the second bicuspid 
 and is never seen with the saddle-shaped variety. 
 
 The high vault is never seen in the first set of teeth, nor does 
 it develop until the second set are all in place, which is at the 
 twelfth year. The vault commences to slope slightly from the 
 neck of the incisor until it reaches an imaginary line drawn across 
 the roof of the mouth from the right first bicuspid to the left 
 first bicuspid, here it gradually or abruptly slopes upward until 
 a point is reached which is central and vertical to a line drawn 
 across the jaw from crest to crest between the second bicuspids 
 and first molars. From this point posteriorly to the soft palate 
 the dome is usually nearly level and parallel with the plane of 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 253 
 
 the alveolar crests of the bicuspids and molars when it gradually 
 slopes and unites with the soft palate. Occasionally there is a 
 slight depression and sometimes a corresponding slight eleva- 
 tion. These arc so inconsideratable as to escape notice unless 
 looked for. d | - j 
 
 In mouth-breathing the lower jaw usually drops only suffi- 
 ciently for the passage of the same volume of air that would 
 pass through the nasal cavities when in a normal condition. Each 
 of the openings to which is equal to about one-half an inch in 
 transverse area. Old people often sleep with the mouth open 
 and to the fullest extent. These deformities of the jaws and 
 teeth never occur after the eruption of the teeth, about the 
 twelfth to fifteenth year. 
 
 On opening the mouth there is a sense of tension of the 
 orbicularis oris, but not of a pressure of the buccinator, no matter 
 how widely the mouth may be open. This muscle being under 
 the control of the will, is always passive, except in the act of 
 blowing or eating. Contraction during sleep is out of the ques- 
 tion. As the buccinator muscle extends anteriorly to the first 
 bicuspid only, it cannot be productive of the V-shaped variety 
 of deformity, in which is also found the contracted vault. There- 
 fore the only deformity that might be so produced is the saddle- 
 shaped variety. The orbicularis oris muscle cannot produce the 
 contraction, because when the mouth is open the pressure on the 
 six anterior teeth is backward. Thus the teeth should be carried 
 in the opposite direction from that which must be taken to 
 produce this deformity. The pressure is just as great upon the 
 incisors as upon the cuspids, thus holding them in place. More 
 force is exerted by the orbicularis oris upon the six anterior 
 teeth when the mouth is open than could be exerted by the 
 buccinator muscle, which would tend to hold the anterior teeth 
 in place. Apices of teeth rarely move when pressure is brought 
 to bear upon their crowns for the purpose of regulating them. 
 Teeth having long roots like the cuspids are hence less liable 
 to move than teeth with short roots like the lateral incisors and 
 bicuspids. Since in moving a tooth the greatest change takes 
 place at the neck the greatest absorption and deposition of bone 
 must take place at that point. The roots of the cuspids are 
 
254 
 
 IRREGULARITIES OF THE TEETH. 
 
 larger and longer than those of any other teeth in the jaw. Un- 
 like other teeth, the germs are situated considerably higher and 
 farther toward the outside of the alveolar process, hence when 
 they come closely into position they diverge from the apices tp 
 the crowns. All other teeth stand nearly or quite perpendicular, 
 hence the roots of these teeth do not influence the hard palate. 
 The first permanent molar and the teeth posterior to it are never 
 involved, except from local causes. The center of the buccinator 
 muscle in both directions is located at this tooth. How. then, 
 since all the teeth are covered by the muscle upon one side, 
 can half be carried inward and the other half remain normal? 
 
 Fig. 93. 
 
 Again, were mouth-breathing the cause of the contraction, 
 both sides should contract alike, and the deformity be uniform 
 upon both sides. This is never the case. The want of uniformity 
 of the two sides is easily recognized. Muscles cannot contract 
 to a degree sufificient to induce the pressure necessary to produce 
 a deformity. Some of the muscles of the chest exert much more 
 pressure in respiration than it is possible for the buccinator to 
 do during sleep, yet no one would expect to find the ribs mod- 
 ified by this process. Pressure of the contractile tissue upon 
 the crowns of teeth is not sufificient to affect the alveol-r 
 process through the roots of the teeth. Even if it could modify 
 that spongy structure, its force must stop there and would not 
 extend to the osseous vault and result in bending it out of shape. 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 
 
 255 
 
 In most cases the diameter of the superior maxilla, its alveolar 
 process and teeth is less than that of the inferior maxilla, alveo- 
 lar process and teeth. This is al\va\ s the case in the worst forms 
 of irregularities of the teeth. In such cases, the muscles and 
 cheek could not press upon the teeth and alveolar process of the 
 upper jaw. The changes which take place in the bone are not 
 a bending in at one place and a forcing out at a weaker point to 
 compensate for the space lost, but an absorption and deposition 
 of bone at the point of pressure. Even if these last conditions 
 were the case, the strong pillar of bone situated at the very point 
 of contraction of the alveolar process, together with the nasal 
 
 Fig. 93. 
 
 septum would constitute a strong bulwark for resistance to the 
 pressure, w'hich is suppositiously acting at a distance from the 
 top of the vault. It would be as impossible to produce sufficient 
 pressure to break the dental arch as it would be for the weight 
 of a building to break the arch of a door or window. The tongue 
 exerting much greater force in the act of swallowing, would 
 prevent inward movement of the teeth if the slight pressure 
 from the cheek muscles were the cause of the deformity. 
 
 Were it possible for the buccinator muscle to produce this 
 contraction, the modification of the osseous structures must be 
 uniform. This would shut out the semi-V-shaped (Fig. 92) and 
 semi-saddle-shaped arches entirely (Fig. 93), and a majority of 
 
256 
 
 IRREGULAKITIES OF THE TEETH. 
 
 Other irregularities of the teeth in which there is bilateral asym- 
 metry. The bilateral muscle cannot act on one side while that 
 on the opposite side remains passive. Partial V-shaped (Fig. 94) 
 and partial saddle-shaped (Fig. 95) arches make the theory still 
 less tenable. In these varieties are sudden bends inward where 
 only one or two teeth may be involved. These aberrations could 
 only be produced by a centralization of force on one given point 
 or fiber of muscle. The muscle being penniform in shape, it 
 would be impossible for one or two fibers of the muscle to exert 
 their influence upon a bicuspid. It would naturally lap two or 
 more teeth. Lastly, if the buccinator acts as all muscles do — 
 
 Kig. 94. 
 
 uniformly throughout its extent of contraction — it is just as 
 efficient below a median bisecting line in producing a narrow, 
 contracted arch as in its upper portion. Therefore, the lower 
 maxilla should be contracted whenever the upper one is, an 
 evident impossibility. A V-shaped arch can never occur upon 
 the lower jaw if the teeth articulate normally, because these 
 teeth strike inside of the upper and are thus prevented from 
 moving forward. A saddle, partial saddle or semi-saddle arch 
 may occur on the lower jaw, but these deformities are not often 
 seen. When they do occur, they are the result of improper 
 occlusion with the teeth of the upper jaw. In semi-V and 
 partial V-shaped arches the alveolar process is always contracted 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 
 
 257 
 
 upon the side of the deformity. If one side of the arch be 
 contracted more than the other, the alveolar process is con- 
 tracted in proportion to the amount of deformity ; the vault on 
 that side is not carried up beyond the other side, which is normal. 
 In the saddle, semi-saddle and partially saddle-shaped arches, 
 the alveolar process is built up about the teeth in precise con- 
 formity to the nature of the shape of the arch. If three thousand 
 models of the upper jaw were arranged in groups according to 
 the forms here represented and the arrangement of the teeth in 
 each group examined very closely, no two are alike in either 
 group. An external force acting upon the jaws from the outside 
 
 Fig. 95. 
 
 could hence not possibly be a cause. If that were possible all 
 models of one variety would have a definite type (Table XXIX). 
 
 In order to further settle the question of mouth-breathing, 
 I present the following models of patients over twelve years of 
 age. They number from i to 24, the order in which the impres- 
 sions were taken. A sufficient number of cases are here illus- 
 trated to show the general outline of the jaws and teeth of the 
 average mouth-breather. 
 
 Very few of these cases have contracted arches, as a rule, the 
 vaults are less than the average in height. No two cases are 
 exactly alike, which would be the case if the contracted jaws 
 were caused by lateral pressure of the cheeks. Many cases were 
 seen in consultation with Hawley, H. H. Brown and Pynchon. 
 
 18 
 
258 IRREGULARITIES OF THE TEETH. 
 
 Case I, Fig. 96. A thirteen year old boy of Canadian-French 
 extraction, born in Chicago. Height of vault, .53 of an inch. 
 Has always breathed through the mouth. Adenoid growth in 
 post-nasal spaces. Collapsed condition of alae nasi. The teeth 
 were late in erupting. The bicuspids were all through upon the 
 right side. The cuspid was just coming into place, while upon 
 the left side the second temporary molar was yet in position. 
 The first molar had just been removed. The first bicuspid was 
 coming in its place. The cuspid was not so far developed as 
 its fellow of the opposite side. The second permanent molars 
 should have been in place, but were tardy in development. 
 
 FiR. 'JG. 
 
 While the general contour of the jaw was normal posterior to 
 the cuspids, there was a tendency of the incisors to contraction, 
 with a protrusion of the mesial surface of the centrals. The 
 cuspids were erupting anterior to their normal position, thus 
 crowding the incisors together. 
 
 Case H, Fig. 97. A nineteen year old boy, American. Height 
 of vault, .75 of an inch. He commenced to breathe through 
 the mouth at the age of nine years, at which time his nose was 
 broken. There was arrest of development of the bones of the 
 nose. There were adenoid growths. Hearing and eyesight were 
 poor. 
 
 The jaw in this case was well developed with a normal palate, 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 
 
 259 
 
 but higher than the average, being three-fourths of an inch in 
 height. All the teeth had erupted. The anterior teeth had a 
 tendency to contraction, due to tendency of the teeth to push 
 forward. The central incisors did not protrude, as in Case I, 
 because the lateral incisors overlapped them. The right side of 
 the arch tended to assume the saddle-shaped deformity from the 
 position of the bicuspids, caused by too long retention of the 
 temporary teeth. The two sides were markedly asymmetrical. 
 This case shows that were contraction of the jaw due to con- 
 traction of muscles in mouth-breathing, both sides would be 
 alike. 
 
 Fig. 9' 
 
 Case III, Fig. 98. A thirteen year old American girl. Height 
 of vault, .46 of an inch. She had scarlet fever at the age of five 
 years and commenced to breathe through the mouth at eight. 
 There was arrest of development of the bones of the face and 
 
 nose. 
 
 This was a well-marked case of defective development of the 
 superior maxilla and arrest of development of the bones of 
 the face and nose. As in Case I, the second molars had not yet 
 made their appearance. The central incisors overlapped, but did 
 not protrude. The right side of the arch tended to assume the 
 saddle-shaped deformity from the position of the bicuspids. The 
 cuspid had not fully erupted on this side and was still more 
 
260 
 
 IRREGULARITIES OF THE TEETH. 
 
 tardy in its appearance on the left. The two sides were asym- 
 metrical and the height of the vault a little less than the average. 
 When the second and third molars appear, an unusual protrusion 
 of the anterior teeth must necessarily result in order to give 
 sufficient room for the molars. If this were allowed to progress 
 without mechanical interference a marked V-shaped deformity 
 would result. 
 
 Case IV, Fig. 99. A twenty-one year old American. Height 
 of vault, .68 of an inch. He had been a mouth-breather all his 
 life. There was deflection of the septum nasi which at the age 
 of fourteen was operated upon without any result. The bones of 
 
 Fig. 98. 
 
 the nose were well developed. Those of the face were slightly 
 arrested. 
 
 While the jaw was not quite as large as normal, the teeth 
 were regular, well developed and without a cavity. A more 
 nearly perfect arch is rarely found. The articulation with the 
 inferior maxilla was at all times exact. 
 
 Case V, Fig. 100. A fifty-two year old American. Height 
 of vault, .43 of an inch. He always breathed through the mouth. 
 The bones of the nose and face were well developed. A year 
 before coming under care had had hypertrophied bone removed 
 from nose. Eyesight and hearing are good. The jaw is well 
 developed and shows no deformity. 
 
 Case VI, Fig. loi. A seventeen year old American girl. 
 
DEVELOPMKNTAI, NEUROSES OF THE VAULT. 
 
 261 
 
 Height of vault, .65 of an inch. She has not always breathed 
 through the mouth. She had adenoid growths. She had had 
 measles and chicken-pox. This jaw was considerably contracted 
 throughout, but more noticeably through its lateral diameter. 
 The alveolar process was hypcrtrophied on either side, the 
 hypertrophy being more marked on the right side. 
 
 Case VII, Fig. 102. A seventeen year old American girl. 
 Height of vault, .65 of an inch. She had always breathed through 
 the mouth and had had post-nasal catarrh. She had had measles 
 and whooping-cough. The jaw was arrested in its development. 
 The first bicuspids had been extracted to make room for other 
 
 Fig 99. 
 
 teeth. The lateral incisors overlapped the centrals because of a 
 lack of room before extraction of the bicuspids. The jaw was 
 asymmetrical, the left side diverging to allow eruption of second 
 molar. 
 
 Case Vni, Fig. 103. ^n eighteen year old American boy. 
 Height of vault, .59 of an inch. He always breathed through 
 the mouth. He had scarlet fever at eighteen months. He received 
 a blow upon the nose which caused left deflection of the septum 
 nasi. The left nostril was entirely closed by hypertrophy of 
 bone and mucous membrane. There was slight hypertrophy of 
 the mucous membrane of the right nostril and hypertrophy 
 of the mucous membrane in the post-nasal space. There was 
 
262 
 
 IRREGULARITIES OF THE TEETH. 
 
 arrest of development of the bones of the nose. This case has 
 marked arrest of development of the entire jaw. The anterior 
 teeth were much crowded. On the left side the left lateral incisor 
 had rupted within the arch ; that of the right side partially. The 
 cuspids had erupted outside of the arch. On the right side the 
 sixth year molar had been extracted, in consequence of which the 
 second molar had been pushed forward. 
 
 In this case the small jaw was inherited from the mother and 
 in harmony with the bones of the face. The teeth which were 
 exceedingly large and had long roots were inherited from the 
 father. They were so out of proportion to the small jaw that 
 the posterior teeth had moved forward and filled the spaces 
 intended for the cuspids. 
 
 Fig. '.100. 
 
 Case IX, Fig. 104. An American medical student, aged 
 twenty-five. Height of vault, .71 of an inch. He commenced to 
 breathe through the mouth at ten. There was marked arrest 
 of development of the bones of the face and nose. The nasal 
 cavities were small. The nasal septum was deflected slightly 
 to the right. There was hypertrophy of cartilage on the left 
 side. The mucous membrane was slightly thickened. The pos- 
 terior nasal cavities were clean. 
 
 The patient had measles, chicken-pox, mumps and two 
 attacks of pneumonia. He had severe rheumatism at twenty- 
 one. At the time of examination there was tuberculosis of the 
 left ankle. 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 
 
 263 
 
 On examination of the jaws, it was found that ; The lower 
 jaw was excessively large. Although all of the teeth of the 
 lower jaw tip inward, yet the outer cusps of the upper teeth 
 just touch the inner cusps of the lower teeth. There was 
 marked arrest of development of the upper jaw. On the right 
 side the arch had a tendency to assume the saddle-shaped 
 deformity. On this side the cuspid had erupted externally to 
 the arch. Between the central and the lateral incisors its mesial 
 surface was directed inward. The lateral incisor was internal to 
 the other teeth. The lateral incisor on the left side was situated 
 internally to the central incisor and cuspid. It had caused a 
 slight rotation of the central incisor. The second molars were 
 
 Fig. lOL 
 
 small and had erupted externally to the first molar on account 
 of lack of room in the jaw. The alveolar process and mucous 
 membrane were hypertrophied. At the time of formation of the 
 irregularities of the teeth the alveolar process and mucous mem- 
 brane began to hypertrophy. Coincidently with these there 
 was arrest of development of the bones of the face, nose and 
 jaw and the habit of mouth-breathing was formed. 
 
 Case X, Fig. 105. A thirty-four year old German. Height 
 of vauh, .71 of an inch. He had always breathed through the 
 mouth until an operation four years previous to examination. 
 He had had scarlet fever and measles. This jaw was well devel- 
 
264 IRREGULARITIES OF THE TEETH. 
 
 oped. The central incisors overlap slightly from the result of 
 interstitial gingivitis. The left side had a tendency to assume the 
 saddle-shaped deformity from the position of the bicuspids. This 
 was probably assumed because of too long retention of the tem- 
 porary teeth. The crowns of the molars had decayed and broken 
 oflf. The thickening of the mucous membrane was the result 
 of interstitial gingivitis. 
 
 Case XI, Fig. io6, A thirteen year old American boy. 
 Height of vault, .62 of an inch. He had breathed through the 
 mouth for six years, before coming under observation. There 
 was arrest of development of the bones of the face and nose. 
 The patient had considerable catarrh and had been treated for 
 irregularities of the teeth. The jaw was much contracted, espe- 
 
 Fig. 102. -> 
 
 dally in the anterior part. On the right side the lateral incisor 
 was deformed and represented by a conical tooth situated intern- 
 ally to the other teeth. Posterior to this was the temporary 
 cuspid. Because of retention of this tooth the permanent cuspid 
 was erupting externally to the other teeth and between the tem- 
 porary cuspid and permanent central incisor. On the left side 
 the lateral incisor was deformed in a similar manner to that on 
 the right, but its position was normal. The left temporary 
 cuspid remained. As there was insufficient room in the jaw for 
 the second molars, the teeth anterior to these moved forward, 
 producing the V-shaped projection of the central incisors. 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 
 
 265 
 
 Case XII, Fig. 107. A fifteen year old American. Height 
 of vault, .53 of an inch. There was deflection of septum nasi 
 and thickenintj: of nuicous mcmhrane. The initient had always 
 breathed throui^li the mouth. The small jaw was inherited from 
 the mother and the large teeth from the father. The dental arch 
 was contracted anterior to the cuspids and the anterior teeth 
 were crowded. Posterior to the cuspids the dental arch was 
 normal. The first bicuspid on the left side had been removed 
 to afford more room for the outer teeth. The corresponding 
 tooth on the right should also have been removed. As it was 
 allowed to remain it caused a crowded condition on that side. 
 The incisor passed beyond the median line of the jaw, encroach- 
 
 Fig. 103. 
 
 ing upon the other side. Because of insufficient room in the 
 jaw for the second molars, the teeth anterior to these had 
 pushed forward, producing the V-shaped protrusion of the cen- 
 tral incisors. 
 
 Case XIII, Fig. 108. A twenty year old man. Height of 
 vault, .71 of an inch. He had always breathed through the 
 mouth. The alveolar process was well developed. The max- 
 illary bones were arrested in their development. The left nostril 
 was entirely closed. There was hypertrophy of the mucous 
 membrane of the right nostril. He had had scarlet fever and 
 whooping-cough. There was arrested development of the max- 
 illary bones in this case, but no deformity had been produced as 
 
266 
 
 IRREGULARITIES OF THE TEETH. 
 
 the teeth had crowded the alveolar process upon the outer sur- 
 face of the bone, thus forming a large arch. The only irregu- 
 larity of the teeth was on the right side, where the lateral 
 incisor, by erupting slightly within the arch had pushed the distal 
 surface of the central incisor slightly outward. 
 
 Case XIV, Fig. 109. A thirty-nine year old Canadian. 
 Height of vault, .71 of an inch. He had always breathed through 
 the mouth until he came to Chicago, in 1884. since which time 
 he had gradually improved and could breathe at time of exam- 
 ination partially well. He had always suffered from catarrh. 
 When a cold is taken, the nasal mucous membrane becomes 
 
 Fig . 104. 
 
 inflamed and mouth-breathing resulted. There was a marked 
 arrest of development of the jaw. Because of the small size of 
 the jaw, the teeth anterior to the molars pushed forward and 
 became crowded when the molars erupted. Upon the left side 
 the second bicuspid had been removed, affording sufficient room 
 for eruption of the second molar on that side. 
 
 Case XV, Fig. no. An eight year old Canadian. Height 
 of vault, .43 of an inch. She had always been a mouth-breather. 
 She had suffered from catarrh for five years previous to coming 
 under observation. Her general health had improved since 
 removal to Chicago, six months previously. There was marked 
 arrest of development of the superior maxilla. 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 
 
 267 
 
 A case at the age of eight years is of unusual interest in con- 
 nection with the principles advanced in this work. The usually 
 low elevation of the vault was due to lack of development. The 
 normal height was reached at the proper age. The temporary 
 molars and cuspids upon the left side and the temporary second 
 molar upon the right side were extracted, just before securing 
 the model. Although the permanent bicuspids and cuspids 
 upon the left side were not visible yet the appearance of the 
 alveolar process led to the belief that their position will be 
 normal. Upon the right side all the teeth except the cuspid 
 belong to the permanent set. The cause and manner of the 
 
 ;.Fig.'.105. 
 
 production of the saddle-shaped arch upon this side of the jaw 
 was shown in the position assumed by the second bicuspid and 
 first permanent molar. Upon removing the temporary molar, 
 the crown of the bicuspid was seen to be exactly in the position 
 represented. The first permanent molar moving forward had 
 crowded the cuspid into the roof of the mouth. The V-shaped 
 appearance of the incisors was due to lack of room in the jaw for 
 their normal eruption. 
 
 Case XVI, Fig iii. A thirteen year old Hebrew-American 
 girl. Height of vault, .59 of an inch. There was adenoid growth 
 in the post-nasal space. She was unable to breathe through 
 the nose. The arrest of development was very marked and the 
 
268 IRREGULARITIES OF THE TEETH. 
 
 maxilla unusually small. The lateral incisors had never erupted. 
 The cuspids had moved forward and taken their places. The 
 jaw was very narrow across at the bicuspids and much contracted 
 anteriorly to them. The jaw was of marked V-shape. 
 
 Case XVII, Fig. 112. A thirteen year old American boy. 
 Height of vault, .62 of an inch. He had breathed through the 
 mouth for six years ere observation. There was considerable 
 arrest of development of the bones of the nose. The left nostril 
 had collapsed and the right nostril partially. The patient could 
 breathe through the left only and with difificulty. The jaw in this 
 case was well developed. The forward movement of the incisors 
 
 Fig. 106. 
 
 was due to a local factor of irritation, produced by the lower 
 teeth striking against the roof of the mouth. This caused a 
 deposit of bone-cells at that point. 
 
 Case XVIII, Fig. 113. A fourteen year old American boy. 
 Height of vault, .59 of an inch. He had always breathed through 
 the mouth. The septum nasi was deflected. There was hyper- 
 trophy of the mucous membrane. The left nostril was closed. 
 In this case the jaw was well developed. Although the teeth 
 were large there was no marked deformity. The central incisors 
 overlapped slightly. The anterior teeth protruded on account of 
 the pushing forward of the posterior teeth. A side view shows 
 this forward inclination of the teeth. 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 
 
 269 
 
 Case XIX, Fig. 114. A twenty-five year old American man. 
 Height of vault, .62 of an ich. He had been a mouth-breather 
 for twelve years. The left nostril was entirely closed, from a 
 blow at the age of thirteen. The jaw was well developed. The 
 slight saddle-shaped appearance of the right side was due to 
 the position of the second molar had crowded the first molar 
 forward and inward. On the left side the first molar had been 
 removed. The second molar had moved forward, partially fill- 
 ing the space. 
 
 Case XX, Fig. 115. A sixteen year old American. Height 
 
 Fig. 107. 
 
 of vault, .59 of an inch. Always has been a mouth-breather. 
 There was present a complete collapse of the nostrils. There 
 was a small jaw anterior to the cuspids. There was slight pro- 
 trusion of the anterior teeth and alveolar process. On the left 
 side the lateral incisor had erupted slightly inward relatively 
 to the central incisor and cuspid. There was marked asym- 
 metry; the left side was quite undeveloped. 
 
 Case XXI, Fig. 116. This woman patient had always been 
 a mouth-breather because of the thickening of the mucous mem- 
 brane of the nose. The development of the maxilla had been 
 arrested. There was considerable protrusion of the anterior 
 
270 
 
 IRREGULARITIES OF THE TEETH. 
 
 teeth and alveolar process, from lack of room. Associated with 
 this was interstitial gingivitis. The jaw was narrow and com- 
 pressed in the region of the bicuspids. On the right side the first 
 first bicuspid had been extracted to afiford room for the other 
 teeth. The left lateral incisor was small. The left bicuspids were 
 situated within the arch, erupting in this position because of 
 retention of the temporary teeth. This side approximated the 
 saddle-shaped deformity. 
 
 Case XXII, Fig. 117. A sixteen year old American boy. 
 Height of vault, .50 of an inch. He had been a mouth-breather 
 for ten years. The anterior part of the jaw was contracted, 
 
 Fig. 108. 
 
 approximating the V-shaped deformity. There was no irregu- 
 larity of the teeth. 
 
 Case XXIII, Fig. 118. A twenty-six year old American 
 man. Height of vault, .75 of an inch. He had always breathed 
 through the mouth. There was lack of harmony between the 
 size of the jaw. The teeth, in consequence of which the anterior 
 teeth had erupted irregularly. The central incisors overlapped 
 slightly. The approximal surfaces of the lateral incisors were 
 internal to the palatine surfaces of the centrals. Posterior to 
 the cuspids the dental arch was normal. 
 
 Case XXIV, Fig. 119. A twelve year old American girl. 
 Height of vault, .53 of an inch. She has always breathed through 
 the mouth. Septum nasi was deflected. The left nostril was 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 271 
 
 closed. The anterior part of the jaw was contracted. In conse- 
 quence of this contraction the central incisors protruded. The 
 lateral incisors were slightly internal to the centrals, lack of 
 room in the jaw preventing them from assuming their normal 
 position. The cuspids were erupting. On the left side the 
 second temporary molar was present. 
 
 Thirty-six impressions of the mouths of children, ranging 
 from six to twelve years (Plates i to 6, see third edition), for the 
 purpose of showing development of the vault. These impres- 
 sions were taken in modelling compound as the children came 
 who were not selected as regards conditions of themouth. Two 
 
 Fig. 109. 
 
 sets of models were prepared, one for the lithographer and the 
 other for study. A sufficient amount of compound was used 
 so that the surplus would extend backward and downward in 
 order that the contour of the soft palate could also be secured. 
 This was accomplished by the patients placing the tongue against 
 the compound and breathing through the nose. Measurements 
 were first taken of the models and then they were sawed at the 
 median line. One-half was placed upon paper and an outline 
 taken ; then the halves were glued together and the saw passed 
 through the model transversely, just anterior to the first perma- 
 nent molar, then the anterior part was outlined, thus, in this 
 manner, the illustrations were taken accurately. While litho- 
 
272 
 
 IRREGULARITIES OF THE TEETH. 
 
 graph plates do not give as accurate an illustration of a model 
 as might be desired, they are sufficiently exact to show relation 
 of the teeth to the jaw at the period indicated on each plate. 
 These, together with the antero-posterior (Plates i, 3, 5, 7, 9, 11) 
 
 Fig. no. 
 
 and lateral illustrations (Plates 2, 4, 6, 8, 10, 12), give a very 
 good idea of the progress of development from the development 
 of the first permanent molar through the period of shedding 
 the temporary teeth and their places filled with the second set. 
 The studies were begun at the sixth year, since jaw deformi- 
 ties are rarely before that period. The changes w'hich take place 
 
 Fig. 111. 
 
 in the jaws and vault are usually noticed between the ages of 
 six and twelve, they being dependent upon the time of the 
 eruption of the permanent teeth anterior to the first permanent 
 molars. There were three models at six years and three at seven 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 273 
 
 years. The changes in the vault are so sHght that more would be 
 useless. 
 
 Certain conditions in the contour of the vault which must 
 not be lost sight of, can be easily studied in these models. In 
 a general way the vaults are quite low and without character. 
 
 Starting at the median line of the cross sections (Plates 2, 
 4, 6, 8, 10, 12), the vault is quite narrow at the upper portion 
 and the lines in either direction diverge until the teeth are 
 reached. The teeth also diverge outward. \'ery few of the 
 models contain bicuspid teeth until the eleventh year. 
 
 The alveolar proces is quite thick in the sixth and seventh 
 
 Fig. 112. 
 
 year models, but lengthens and becomes thinner as age advances. 
 The thickness iarises from the antrum being located between the 
 inner and outer plate of bone, and the alveolar process not only 
 contains the roots of the temporary teeth, but the crowns of the 
 permanent teeth as well. 
 
 The height of vault is very low, while there is not always a 
 gradual advance from year to year, yet, taken as a whole, from 
 the sixth to the twelfth year there is quite an advance in height. 
 The normal height of vault is not reached until the permanent 
 teeth are all in place, which w^ould be after the twelfth year. If 
 a Hne should be dropped from the center of the arch, the two 
 lateral halves with but few exceptions would be nearly alike. 
 
 19 
 
274 
 
 IRREGULARITIES OF THE TEETH. 
 
 A slight ridge at the top of the vault extends along the median 
 line (Figs. 2, 5, 6, 8, 12, 16, 24, 25, 30, 33, 34 and 36). A much 
 more prominent ridge may occur in the mouths of children at 
 two years (Plate A). Upon either side of the ridge there is an 
 apparent groove, sometimes slight and again quite marked, 
 extending frequently only a short distance, then again quite an 
 extent and sometimes the full length of the suture. It is not 
 always in the same location, sometimes in the alveolar process 
 behind the incisors, again at the center and often at the posterior 
 part of the vault ; however, it is more frequently observed in the 
 anterior part of the vault than in the posterior, and sometimes 
 more marked upon one side than upon the other and again only 
 
 Fig. 113. 
 
 upon one side. In the cases illustrated by Figs. 3, 6, 12 and 19, 
 and Plates i, 2 and 4 (see third edition), the first permanent 
 molars have been extracted. 
 
 In the models of the eleventh and twelfth years, the second 
 bicuspids are seen coming down into place, although many of 
 the temporary teeth are still in the jaw. Unlike the temporary 
 molars, these teeth come down vertically. Although they have 
 not fully erupted, quite a change has taken place in the length 
 and width of the alveolar process and more character is evident 
 in both the antero-posterior and lateral curves. 
 
 In the antero-posterior section (Plates i, 3, 5, 7, 9 and 11) 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 
 
 275 
 
 the following changes are noticed: The temporary incisors are 
 (Fig. i) decayed down to the gums. The permanent central 
 incisors are (Figs. 5, 6, 7, 8 and 11) jnst making their appearance, 
 while in others they are ab<nit lialf way through or are fully 
 developed. 
 
 Just back of tlio incisors a thickening of the alveolar process 
 is evident: in sonic (|uite thick, in others tliin. This is due to the 
 relation of the temporary incisors to the permanent ones. If 
 the temporary tootii remain in the jaw until the permanent one 
 comes nearly through, the alveolar process is much thicker than 
 if the temporary tooth be removed earlier. It is the foundation 
 
 Fig. 114. 
 
 upon which the long, thin alveolar process builds when the 
 permanent teeth are in place. By following the line backward, 
 very little character is noticed in the curves. As the child grows 
 older the evolution of development becomes more pronounced. 
 Deviation in the curves results in varied ossification of the 
 suture. Sometimes the ossification is uniform throughout, in 
 which case the line will be uniform and graceful (Figs, i, 2, 3, 
 7, 9, 10, II, 15, 16, 17 and 21). If the ossification be irregular, 
 then the lines become wavy and irregular (Figs. 4, 5, 6, 8, 12, 
 13, 14, 18, 19 and 20). 
 
 The soft palate is very accurately illustrated in relation to 
 
276 
 
 IRREGULARITIES OF THE TEETH. 
 
 the hard palate. The older the patient grows the longer the 
 antero-posterior line becomes. This is to be expected, since 
 development of the jaw is posteriorly direction. Shape and 
 inclination of the soft palate depend upon the distance between 
 the posterior surface of the hard palate and the forces. 
 
 In the models (Plate i, see third edition, at six and seven 
 years) the six year molars are in place and all the temporary 
 ones (except in Figs. 3 and 6, where the temporary incisors have 
 all been removed) ; the left central (Fig. 6) is coming into 
 position. As far as contour of the teeth is concerned, it is normal. 
 
 Fig. 115. 
 
 At eight years (Plate 2, see third edition) the first permanent 
 molars and central incisors have erupted in all but one of the 
 cases (Fig. 12), where the first permanent molars have been 
 extracted. None of the other permanent teeth have yet made 
 their appearance. In this plate a change is seen taking place 
 in the shape of the vault. The V arch is beginning to develop 
 (Figs. 7 and 9), and in the semi-saddle (Fig. 11) local irregu- 
 larities of the teeth are observed (Figs. 8 and 19). 
 
 At nine years (Plate iii, see third edition) deformities of the 
 jaws are still more marked. A semi-saddle is nicely outlined 
 (Fig. 13), a V-shaped arch is noticed (Figs. 14, 15 and 16), 
 
DEVELOPMENTAI, NEUROSES OF THE VAULT. 
 
 277 
 
 while in others the permanent teeth are not far enough advanced 
 to tell what position they will occupy (Figs. 17 and 18). 
 
 At ten years (Plate 4, see third edition) the teeth are little 
 
 Fig. 116. 
 
 further advanced than at nine years. The bicuspids are just 
 pushing their way through and the jaw seems to be taking on 
 character. In one case the central incisors are crowding their 
 way to the right, producing a marked deformity of the jaw. In 
 
 Fig. 117. 
 
 another case (Fig. 20) the incisors are crowding to the right and 
 the left cuspid just coming through the gums, producing a semi- 
 V-shaped (Fig. 19) arch. The temporary teeth in another case 
 
278 
 
 IRREGULARITIES OF THE TEETH. 
 
 are shed (Fig. 21), and the bicuspids first coming through The 
 permanent teeth are not far enough advanced to decide exactly 
 what deformity will be produced. From lapping of the central 
 incisors, and eruption of both bicuspids before the cuspids, it 
 is safe to say that a V-shaped arch will occur. The permanent 
 teeth (Figs. 22, 23 and 24) are not far enough along to judge 
 what the results will be. 
 
 At eleven years (Plate 5, see third edition) the deformities 
 are still more easily traced. In one case (Fig. 25) a local irregu- 
 larity — a crowding inwards of the right central incisors — are due 
 to want of room, has been produced by the forward movement 
 
 Fig. 118. 
 
 of all the teeth on the right side. \' and saddle arches are well 
 illustrated (Figs. 28, 29 and 30). Arrest of development of the 
 maxillary bones has occurred (Fig. 28), and a marked \^ arch 
 will result. This model is from the model of a boy seventeen 
 years old. His body became arrested in development at nine 
 years of age by an eruptive fever. 
 
 At twelve years (Plate 6, see third edition) the temporary teeth 
 are yet noticeable in many of these illustrations. It is easy, 
 however, to outline the forms of irregularities that will be pro- 
 duced when all the permanent teeth are in place. 
 
 The date and the character of the vault deformities that will 
 
DEVELOPMKNTAr, NEUROSP:S OF THK VAULT, 
 
 279 
 
 be produced when all the permanent teeth are in place, namely, 
 between the sixth and twelfth year, or at the time of the develop- 
 ment of the permanent teeth, are shown as well as the fact that 
 vault deformity will depend upon the manner in which the teeth 
 came into the jaw and whether there will be a V or saddle- 
 shaped arch with their modifications, partial V or saddle, semi-V 
 or saddle. 
 
 The shape of the vault is also changed by local irregularities 
 of the teeth. Here any tooth may stand inside or outside the 
 dental arch and the vault will conform to the deformity. 
 
 The deformity of the vault is not observed until at or about 
 
 FiR. 119. 
 
 the sixth year, or the time of the eruption of the permanent 
 teeth. The ossification of the suture, uniting the maxillary bones 
 at the median line takes place at different intervals — sometimes 
 as early as the eighth week of intra-uterine life and as late as the 
 sixteenth. 
 
 Excessive development of the suture may occur as early as 
 the second, and as late as the thirty-sixth year. This excessive 
 development takes different shapes and forms ; 228 Peruvian 
 skulls, 240 Stone Grave skulls and twenty-one Mound-Builders' 
 skulls, sixteen Peruvians, thirty-nine Stone Grave and one 
 Mound-Builder's (all of which had large, well-developed jaws, 
 normal in shape) had a rope-like projection extending the entire 
 
280 IRREGULARITIES OF THE TEETH. 
 
 length of the suture. This development was unlike the excessive 
 development of modern skulls. It had the appearance of having 
 been first made and then glued upon the suture (Fig. 120, No. i). 
 
 The deformity of the suture (Nos. 2, 3, 4, 5 and 6) may vary 
 in proportion to the width of the arch, in the narow arch the 
 suture is low or thick, while in the normal arch it is flat. The 
 grooves of either side of the suture are not uniform, one side 
 being deeper than the other. 
 
 It has been claimed that these grooves are due to ossifica- 
 tion of the vomer, producing rigidity of the suture and the bone 
 upon either side is afterward carried up. 
 
 According to Clouston, "Those palates where the deformity 
 consisted in a ridge down the center antero-posteriorly, seemed 
 to show that in them the deformity took place at a later period 
 than in the other deformed .palates. When the nasal septum 
 was getting stronger and kept the center of the palate down, 
 while on each side of it the palate was drawn up making two 
 vaults side by side, instead of one." Six models are shown 
 (Plate A), ranging from two to six years. At two years there is 
 (Fig. I and 2) a ridge extending from a line drawn across the 
 vault at the cuspids, through the entire length of the jaw. This 
 may begin in the center of the vault at a line drawn across the 
 first temporary molar."' At three years of age (Fig. 3) there may 
 be a slight ridge just back of the incisors, extending only a 
 short distance, when the center of the vault is perfectly flat, and 
 the ridge begins again in the posterior part of the vault. At 
 four years (Fig. 4) the ridge may start at a line drawn across the 
 vault at the first molar and extending the entire length of the 
 suture. At five years (Fig. 5) a broad ridge may extend the 
 entire length of the vault. At six years (Fig. 6) a very narrow 
 ridge may extend the entire length of the vault. 
 
 As the vault ossifies as early as the first or second year, and 
 as the ridge is also found as early as the second year, the vomer 
 
 ■'^ I have a number of these models showing the ridge at thesecondyear 
 and observed many more in practice. Since the two halves of the maxil- 
 lary bones do not ossify till the eighth week of foetal life, it can readily be 
 seen that where ossification is not complete these ridges would form when 
 the child begins to masticate its food. 
 
DEVELOPMENTAL NEUROSES OF THE VAULT, 281 
 
 Deformed Vaulk. 
 
 Fig- 120. 
 
282 IRREGULARITIES OF THE TEETH. 
 
 not ossifying until later in life, Clouston's theory does not 
 explain the facts. The ridge takes so many different shapes 
 that when a number of models containing it are examined the 
 theory that the sides of the arch are drawn or pushed up appears 
 more and more untenable. Thus come models (Figs. 7 and 8, 
 Plate B) showing vaults similar to No. 2, Fig. 120, except the 
 grooves are deep and sharp. In Fig. 7 it extends from just back 
 of the incisors to opposite the second molars, where the arch 
 becomes perfectly smooth throughout the balance of the hard 
 palate. Fig. 8 it commences at the same point and stops opposite 
 the first permanent molar. These models demonstrate the fal- 
 lacy of this tlieory. since nothing could force the deep grooves 
 in the anterior alveolar process, as suggested by many authors, 
 since the vomer extends through and beyond the anterior surface 
 of the anterior alveolar process to form the nasal spine. If 
 such a thing were possible, the posterior part of the vaults, which 
 would easily yield to force would be affected. This is not the 
 case. The ridge extends to the second molar, or as far as the 
 grooves. One of the jaws is very small and contracted with 
 slight hypertrophy extending all around the inner surface, giving 
 the sharp appearance to the grooves ; the other is a little larger, 
 has not hypertrophy, hence the groove upon either side of the 
 suture is not so narrow, although fully as deep. In Figs. 9 and 
 10, Plate C are well developed jaws with very broad ridges. In 
 Fig. 9 the ridge commences about opposite the first bicuspid 
 and extends back as far as the second molar tooth. In Fig. 10 
 the ridge extends from the alveolar process just back of the 
 incisor to the second molar; both are about the same width. 
 The grooves upon either side are very shallow and about the 
 same depth of ridge. These are similar to those of Nos. 4. 5 
 and 6, Fig. 120. In Fig. 11. Plate D, is seen a very small jaw 
 with a marked ridge commencing in the alveolar process back of 
 the incisors and extending as far as the second molars ; the 
 grooves upon either side are very deep and sharp. This is due 
 to a small jaw and hypertrophy of the alveolar process. There 
 is occasionally a groove in the center of the vault running the 
 entire length of the suture in place of the ridge, as Fig. 12, 
 Plate D. This is du? to arrest of development of the suture 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 283 
 
 PLATE A. 
 
284 IRREGULARITIES OF THE TEETH. 
 
 and hypertrophy of the palate bones and mucous membrane 
 upon either side of the suture. This groove is sometimes shal- 
 low, again deeper, sometimes broad and again narrower, this 
 depending upon the extent of the hypertrophy. 
 , The two sides of the contracted arches are not uniform. 
 This is due to the location of the teeth in the alveolar process 
 more in upon one side than upon the other, carrying the alveolar 
 process with it. The sides of the palate are not carried up since 
 there is no force to move them. These deep grooves may be 
 situated entirely in the anterior alveolar process ; sometimes 
 entirely on one side ; sometimes in the center of the vault in the 
 anterio-posterior direction, and again in the posterior part of the 
 vault. 
 
 The location of these grooves, especially those in the alveolar 
 process, and the fact that sometimes they extend only .25 to .50 
 of an inch, renders such a theory untenable. If the sides were 
 carried up, owing to the very thin bone, a like projection would 
 extend into the floor of the nose. I have examined 1,367 skulls 
 with this deformity and I have yet to find the first instance of 
 this projection. In every case the floor of the nose and com- 
 mencement of the septum were smooth and evenly developed 
 throughout its entire length. How. then, are these deformities 
 to be accounted for? These projections are developed as early 
 as the second year, and as late as the thiry-sixth year. They 
 are, hence, the result of excessive development of the suture, 
 due to irritation set up at the time of ossification, by mastica- 
 tion. The lower jaw develops laterally faster than the upper, 
 thus crowding the superior maxillary bones apart. This occurs 
 in a large number of patients of which the following is a type. 
 
 A lady, thirty-six years of age. who has been under my care 
 for the past fifteen years, has a space between the central incisors 
 of .50 of an inch. No space was observed until she arrived 
 at the age of twenty years. The teeth filled the arch and all 
 antagonized. The lower jaw continued to delevop and the act 
 of mastication carried the superior maxillary bone laterally 
 widening the suture, the space filling in and producing quite 
 a ridge (Fig. 120, Nos. 4, 5 and 6). The depth of the ridge 
 depends upon the amount of irritation. The height of the groove 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 285 
 
 PLATE B. 
 
286 IRREGULARITIES OF THE TEETH. 
 
 PLATE C. 
 
DEVELOPMENTAL NEUROSES OF THE VAULT. 287 
 
 on either side depends upon the depth of the ridge. When there 
 are grooves upon cither side the jaw is ahvays contracted, the 
 alveolar process being nearer the center of the vault. This, 
 together with the ridges, produces the groove. Were it not 
 for excessive development of the median suture and contracted 
 arch, the vault would take the shape of the dotted lines and 
 would be of normal development. 
 
 Deformed vaults are due (i) to an irregularity in the arrange- 
 ment of the dental arch, (2) hypertrophy of the alveolar process 
 and maxillary bones, and (3) to excessive development of the 
 palatine suture. Irregularities of the dental arch are the result 
 of (i) neurosis of development, producing arrest of develop- 
 ment of the maxillary bone ; (2) local causes accidental or other- 
 wise. Those produced by an arrest of development take typical 
 forms, classified under the heads of X, partial \', semi-Y, saddle, 
 partial saddle and semi-saddle. The irregularities of the teeth, 
 produced by local causes, do not take typical forms, they are 
 as numerous as the number of cases. 
 
 Hypertrophy of the alveolar process may afifect the whole 
 dental arch, or ma}- attack one particular locality in which only 
 one, two or three teeth may be involved. The shape of the 
 vault in such cases depends entirely upon the extent of the 
 hypertrophy, but does not take the typical form. The position, 
 occupied by the teeth in the dental arch, and the manner of their 
 formation should be studied under their respective heads. The 
 deformed vault should be compared with the normal vault. For 
 this purpose I secured models from dental practitioners in Chi- 
 cago, consisting of six V-shaped (Plates 29 and 30), six semi-V 
 (Plates" 31 and 32), six saddle (Plates 33 and 34), and six semi- 
 saddle-shaped (Plates 35 and 36). These were prepared in the 
 same manner as the other models. 
 
 The direction of the teeth in a normal jaw are nearly perpen- 
 dicular, while those in the V-shaped vault are at an angle of 
 45 degrees. This is due to the forward movement of the incisor 
 teeth. Just back of the incisor teeth there is a prominent ridge 
 of alveolar process (noticed in the normal jaw), is due to con- 
 traction of the vault in the anterior portion, producing thicken- 
 ing of the alveolar process. In other respects the vault does 
 
288 ' IRREGULARITIES OF THE TEETH. 
 
 PLATE D. 
 
DKVKt.OPMKNl'AI. NEUROSES OK THE VAULT. 289 
 
 not differ from the normal palates. The same general rule holds 
 good in the semi-V vault, except that the teeth do not stand 
 at such an angle. This is due to the fact that frequently but 
 one incisor protrudes, hence, one incisor only extends, while 
 the other is perpendicular. The position of the normal tooth 
 may be on the side of the model reproduced in this illustra- 
 tion. In the illustrations showing a cross section of the vault, 
 the vaults are usually much narrower than in the normal. The 
 two sides of the vault are not in harmony. These illustrations 
 were very accurately made, so that by placing a rule at the center 
 of the upper and lower arches, and drawing a line from one to 
 the other, the two sides of the vault can be easily studied. The 
 more contracted the jaw, the higher the vault and more irregular 
 the sides. In the saddle and semi-saddle antero-posterior illus- 
 trations the teeth stand perpendicularly, hence, do not protrude. 
 The ridge, posterior to the incisors is not so thick or prominent. 
 The lateral illustrations do not show the pinched condition at 
 the upper part of the vault that is noticed in the V-shaped 
 vaults. This is due to the fact that the contr-action is not in the 
 anterior part of the mouth, but at the bicuspid region, while 
 the bicuspids are carried in. The top of the vault is rarely ever 
 affected. Occasionally alveolar process hypertrophy is so exten- 
 sive that the teeth are carried laterally toward the median line, 
 the vault is very much narrower and sometimes almost closed. 
 Local irregularities of the teeth may affect only the margins 
 of the vaults and not the vault proper, since but few teeth are 
 ever involved. The remainder of the dental arch, being, as a 
 rule, normal, the vault proper is retained in its natural shape. 
 
 20 
 
CHAPTER XXIV. 
 
 DEVELOPMENTAL NEUROSES OF THE PALATE. 
 
 As soon as the external nares are separated from the mouth 
 a partition forms between the nasal pits and the mouth. This 
 partition in which the intermaxillary bone is differentiated later 
 is supplemented by another partition (the true palate), which 
 shuts off the upper part of the oral cavity from the lower, thus 
 adding the upper part to the nasal chambers. The palate is a 
 secondary structure which divides the mouth into an upper 
 respiratory passage and a lower lingual or digestive passage. 
 The palate arises as two shelf-like growths on the inner side of 
 each maxillary process. It is completed by union of the two 
 shelves in the median line. The shelves arch so as to descend 
 a certain distance into the pharynx, but in the pharynx their 
 growth is arrested, though they may be still recognized in the 
 adult. In the region of the tongue which includes more than 
 the primitive oral cavity, the palate shelves continue growing. 
 
 At first they project obliquely downward toward the floor 
 of the mouth and the tongue rises high between them and appears 
 in sections which pass through the internal nares to be about to 
 join the internasal septum. As the lower jaw grows the floor 
 of the mouth is lowered and the tongue is thereby brought 
 further away from the internasal septum. At the same time 
 the palate shelves take a more horizontal position and pass 
 toward one another above the tongue and below the nasal sep- 
 tum and meet in the middle line where they unite. From their 
 original position the shelves necessarily meet in front (toward 
 the lips) first and then unite behind (toward the pharynx) later. 
 In the human embryo the union begins at eight weeks and at 
 nine weeks is completed for the region of the future hard palate, 
 and by eleven weeks is usually completed for the soft palate 
 also. The palate shelves extend back across the second and third 
 branchial arches ; by the migration of the first gill pouch or in 
 other words of the Eustachian tube, the Eustachian opening 
 
 290 
 
DEVELOPMENTAL NEUROSES OF THE PALATE. 201 
 
 comes to lie above the palate (uvula), while the second cleft 
 remains lower down and lies below the palate as the anlage of 
 the tonsil. The uvula appears during the latter half of the third 
 month as a projection of the border of the soft palate. Soon 
 after the two palatal shelves have united with one another the 
 nasal septum unites with the palate also, and thereby the per- 
 manent or adult relations of the cavities are estabHshed.^ 
 
 According to Bcaunis and Bouchard the related development 
 of the surrounding parts occurs as follows : "Beginning of third 
 week — first pharyngeal arch ; buccal depression. End of third 
 week, coalescence of the inferior maxillary protuberances ; form- 
 ation of the three last pharyngeal arches. Fourth week — olfactory 
 fossae. Fifth week — ossification of lower jaw. Sixth \veek — 
 the pharyngeal clefts disappear; the tongue, the larynx and 
 germs of teeth. Seventh week — points of ossification of inter- 
 maxillary bone ; palate and upper jaw (its first four points). 
 Eighth week — the two halves of the bony palate unite. Ninth 
 week — osseous nuclei of vomer and malar bone ; the union of the 
 hard palate is completed. Third month — points of ossification 
 for the sphenoid and nasal bones ; squamous portion of temporal ; 
 orbital center of superior maxillary bone; commencement of 
 formation of maxillary sinus ; epiglottis. Fifth month — osseous 
 points of lateral masses of ethmoid; ossification of germs of 
 teeth ; appearance of germs of permanent teeth." 
 
 It will be obvious that any maternal factor (whether arising 
 during a particular pregnancy or hereditary) may so check the 
 development of the palate as to produce the various types of 
 deficiency which are observed by surgeons.^ Cleft palates are 
 comparatively rare in proportion to other forms of nutritive 
 degeneracy. As just pointed out palatal embryology casts a 
 certain hght on the etiology. Since most cases of cleft palate 
 occur in defective individuals, and since cleft palate predisposes 
 to death by infectious diseases whose local manifestations are 
 in the mouth and throat, defectives in whom cleft palate most 
 occurs are liable to die before the completion of their fifth year. 
 
 Cleft palate was much discussed by early writers. Early in 
 
 1 Minot Embryology. 
 
 2 Keen's American System of Surgery, page 639. 
 
292 IRREGULARITIES OF THE TEETH. 
 
 the nineteenth century Tiedemanir noticed in certain cases of cleft 
 palate that the olfactory nerve was absent or abnormal. He con- 
 cluded therefrom the deformity was resultant upon atrophy of 
 nervous origin of the olfactory organ. This theory, however, 
 failed to meet much acceptance. M. J. Weber, after a careful 
 analysis of all accessible cases, failed to find one in which the 
 olfactor}^ nerve was absent. The coincidence of cleft palate 
 and olfactory nerve atrophy discovered by Tiedemann probably 
 resulted from the same central nerv^ous maldevelopment. They 
 bore no casual relation to each other. 
 
 The failure from various causes of the ultimate coalescence 
 of the structures described by Minot leads to certain deformities 
 the chief of which are cleft palate and harelip. Cleft palate, accord- 
 ing to Bland Sutton,'* has been known to affect several members 
 of the same family and to occur in the offspring of the affected 
 members. There are instances of the transmission of this 
 deformity from an affected pug-bitch to her offspring. If it were 
 possible to practice selective breeding in man as in dogs, a race 
 of men with hare-lips and cleft palates could be produced. 
 
 Engle refers cleft palate to excessive development of the 
 anterior portion of the brain and skull, such as produces hernia 
 cerebri, ventricular atrophy or excessive anterior cerebral lobe 
 development. This mixed patho-teratologic theory is not war- 
 ranted by either embryology or clinical observation. The narrow 
 and broad foreheads are alike affected. 
 
 Langdon Down, who has found a constant relation between 
 brain deformity, cleft palate and deformed vaults, states : "The 
 cause of the frequent excessive vaulting of the palate is not quite 
 clear. It may possibly arise, as has been suggested, from sphen- 
 oid arrest of development or vomer defects in development." 
 It has been plausibly shown that contracted high vault is not 
 due to these conditions, and there can be no relation between 
 contracted vaults and cleft palates. The cleft occurs before the 
 tenth week of foetal life, while the contracted vault does not 
 appear until after the sixth year. The claim was made by Wal- 
 
 3 Zeitschrift f. Phys., Band i, Heft i, 1844, p. 71- 
 * Evolution and Disease, page 189. 
 
DEVELOPMENTAL NEUROSES OF THE PALATE. 293 
 
 ther'^ and Langenbuch^ that cleft palate was becoming more 
 frequent during the present century. This opinion was sup- 
 ported by Oakley Coles'^ on the ground that palatal vault 
 deformities are more frequent and that a relationship existed 
 between these and cleft palate. That the relation between a high 
 state of civilization and a high proportion of palatal deformities 
 is something more than a mere matter of coincidence. Coles, 
 in dealing with the influences of civilization, ignores all but its 
 supposed degenerative influence. Under civilization the defec- 
 tive classes are preserved. Furthermore, this preservation 
 extends particularly to those under five years of age who would 
 be destroyed under primitive conditions. 
 
 Early literature on this subject is admittedly meager. Early 
 teratologists discussed the gross rather than the minute details, 
 and registration of cleft palates was neglected in common with 
 brain, renal, hepatic and cardiac teratology. 
 
 Cleft palate may divided into two classes — congenital and 
 acquired. Congenital cleft palate is meant existing at birth. 
 Acquired cleft palate is the result of disease, inherited or 
 acquired, but affecting the part after birth. Better acquaintance 
 with disease etiology and its effects upon the hard palate 
 shows causes of congenital lesions and effects of acquired disease 
 upon the tissues to be at least allied. 
 
 Congenital cleft palate is divisible into two kinds — complete 
 and partial ; complete, when the fissure extends the entire length 
 from the uvula to and including the anterior alveolar process 
 and even the lips ; partial, when only a small part of the structure 
 is involved. Thus the cleft may extend through the anterior 
 alveolar process involving only the incisive bones, which is very 
 rare ; when present, single or double harelip almost invariably 
 co-exists. Cases occur where a small portion of the anterior 
 alveolar process and jaw was involved with one or two teeth. 
 The hard palate only may be involved to the extent of a small 
 fissure, or the whole palate may be wanting. The soft palate 
 only may contain the cleft or simply the uvula. Cases are on 
 
 5 Graefe and Walther's Zeitschrift, Band 21, Heft 2, 1834, page 175. 
 « Neue Bibliothek f. die Chir., Band 4, Heft 3, page 492. 
 ^ Coles : Deformities of the Mouth. 
 
294 IRREGULARITIES OF THE TEETH. 
 
 record in which the non-development of the intermaxillary 
 bones produces fissures in the lip. 
 
 A priori cleft palate would seem to be a direct expression of 
 heredity. This view is taken by Bland Sutton^ from actual 
 observation. According to Oakley Coles,'' "the antecedent 
 which strikes one a priori, as being likely to play the most 
 important part in the production of congenital deformities, is 
 that of hereditary influence. But though it will be evident from 
 the facts which I shall presently adduce that the direct influence 
 of heredity in the production of cleft palate is marked and unde- 
 niable, no sufficient statistics have as yet been brought forward to 
 show that the actual presence of the deformity in the parent has 
 any direct predisposing influence in the child. In other words, 
 though the defective conditions which precede and accompany 
 the phenomenon of cleft palate are almost certainly to be referred 
 to parental influence it is extremely doubtful whether cleft 
 palate is in itself transmissible." Demarquay, Roux, Trelat, 
 FolHn and Duplay are inclined to an opposite belief and their 
 conclusion is supported by the evidence in connection with the 
 analogous deformity of harelip. Still, unless accurate records 
 of ancestry could be obtained for three or four degrees of 
 removal, it would be premature to make any positive assertion 
 on the point. However, it may be confidently stated the deform- 
 ity is not usually produced from impressions received by the 
 mother during pregnancy. In most of the cases which have 
 come immediately under my notice, where one of the parents 
 had a cleft palate, all the children have been born perfectly 
 developed, even though dread of transmitting the deformity was 
 always present in the mind of the mother. In one case, curiously 
 enough, there are three members of one family with cleft palate, 
 one seventeen years of age, the other thirty and the third thirty- 
 five ; the first and last are ladies, the other a gentleman who is 
 married and has -a family without any trace of the father's 
 deformity. In these cases no instance of cleft palate could be 
 found either among the ancestors or the collateral branches of 
 the family. 
 
 8 Op. Cit. 
 
 ° Deformities of the Mouth. 
 
DEVELOPMENTAL NEUROSES OF THE PALATE. 295 
 
 In another family, I have obtained the following remarkable 
 history: G. H. C, born 1853 ; perfect. L. C, born 1855 ; single 
 harelip and cleft palate. J. F. C, born 1856; perfect. F. W. C, 
 born i860; double harelip and cleft palate. H. E. C, born 1863 ; 
 perfect. The paternal grandmother also had cleft palate. 
 
 Knecht^^ found five per cent of 1,200 criminals examined to 
 have cleft palates and fourteen per cent of the prostitutes exam- 
 ined by Pauline Tarnovi^skyi^had cleft palates. Langdon Down, 
 among congenital idiots, found only a half per ceat of cleft 
 palates. Grenser only found nine cases in 14,466 children, or one 
 in 1,607. I examined 1,977 feeble-minded children without 
 finding a single case. In 207 blind, but one case was observed. 
 In 1,935 deaf mutes two cases, or about one in 1,000. The 
 percentage among the defective classes is undoubtedly much 
 larger than among normal individuals, but early deaths explain 
 the small numbers. 
 
 Bland Sutton's experiments with dogs indicate not only the 
 presence of this deformity among animals, but the fact that 
 it is transmitted. The influence of heredity is shown by the 
 statistics of zoologic gardens. A keeper of the Zoologic Gar- 
 dens in Philadelphia observed cleft palates in the mouths of 
 lion cubs born in the gardens. Cleft palates were also observed 
 in a number of pups born in Buffalo. 
 
 Ogle found that ninety-nine per cent of the lion cubs born 
 in the London Zoologic Gardens had cleft palates. This he 
 ascribes to the artificial diet as the result of enforced captivity. 
 Similar results in other gardens in Europe w^ere charged to feed- 
 ing the mother with meat wathout bone, since feeding with the 
 whole carcass of small animals greatly diminished these deform- 
 ities. If cleft palate were sometimes attributable to this cause, 
 other bony structures should likewise be involved. It is, hence, 
 not astonishing to find many lions born in captivity were rickety. 
 Cleft palate has been observed among dogs, sheep, goats, etc. 
 The question, however, whether domesticity does not play in 
 them the alleged part of civilization in man, can be solved only 
 by knowledge of the frequency of the condition among wild 
 
 1° Cited by Lombroso, Criminal Man. 
 11 Etudes Anthropometriques, Op. Cit. 
 
296 IRREGULARITIES OF THE TEETH. 
 
 animals of the same family. In dealing with etiology the influ- 
 ence of shock on the mother's nervous system cannot be 
 excluded in the cases charged to feeding. 
 
 The palate, it will be remembered, is partly of bone and 
 partly of flesh. The fleshy part ends in what is called the uvula, 
 which is very subject to abnormalities. As has been pointed out 
 by C. L. Dana, uvula abnormality is very frequent in degener- 
 ates. Charles Dickens long ago noticed a uvular tone of voice 
 in vounsf thieves. 
 
CHAPTER XXV. 
 
 DEVELOPMENTAL NEUROSES IN TEETH POSITION. 
 
 Arrest of developntcnt is confined mostly to the upper jaw ; 
 hence V and saddle-shaped arches are more numerous than 
 irregularities of the lower jaw. Local conditions, such as pre- 
 mature extraction of the temporary teeth, causing the first per- 
 manent molars to move forward, thus diminishing the size of the 
 jaw, are causes of irregularities. 
 
 The manner of these formations is as varied as the pecul- 
 iarities themselves. 
 
 Fig. i-;>i. 
 
 The only structures involved in the formation of these 
 deformities are the jaws and alveolar process on the one hand 
 and the teeth upon the other. The alveolar process is soft and 
 yielding, while the teeth and jaws are composed of hard, unyield- 
 ing substances. The process adapts itself to the conformation 
 of the teeth. The teeth of the superior and inferior maxilla 
 constitute a dental arch and the first permanent molars perform 
 the function of keys to the arch. The jaws and teeth, like the 
 lateral halves of the body, develop independently of each other, 
 each possessing peculiar characteristics as regards irregularities 
 
 2y7 
 
298 
 
 IRREGULARITIES OF THE TEETH, 
 
 of the teeth. To simplify classification of irregularities of the 
 teeth the lateral halves of the jaws, which are separated by 
 the median line, will be denominated the right and left inferior 
 and the right and left superior dental arches. While these terms, 
 as applied to the lateral halves of the maxillary bones, are not 
 strictly correct from an architectural point of view, still (as will be 
 seen) they answer the purpose for which they are employed. 
 
 The manner of the formation of the V-shaped arch and kin- 
 dred deformities may be compared to the construction of an arch. 
 The changes which take place in the movement of the teeth 
 are very similar to those which may occur in an arch of faulty 
 
 Fig. 1^. 
 
 construction. Figs. 121, 122 and 123 represent one normal arch 
 and five varieties of irregularities of the teeth. Each lateral arch 
 is viewed as containing stones corresponding in number and 
 size with the teeth of a normal upper denture. Fig. 121 repre- 
 sents two arches. The left superior arch is perfect. The first 
 stone is marked "posterior base" and corresponds to the first 
 permanent molar. The second stone is the "anterior base;" it 
 corresponds to the central incisor. The next stone is located 
 upon the anterior base and corresponds to the lateral incisor. 
 The succeeding stones are laid upon the posterior base and 
 represent the first and second bicuspids. The stone correspond- 
 ing to the first bicuspid is usually in position first, but some- 
 
DEVELOPMENTAL NEUROSES IN TEETH POSITION, 
 
 299 
 
 times the stone corrcsponcHn£^ to the second bicuspid is placed 
 first. To complete the arch it is necessary to place the "key- 
 stone" in position — the cuspid tooth. If the stones have proper 
 proportions and measurements be correct, the key-stone will fit 
 into place and the arch will be complete. On examining the 
 foundations, two more stones arc found, which correspond with 
 the second and third molars ; these stones with the base and 
 the stones above the base making a strong abutment. 
 
 In order that aberrations from the normal may be under- 
 stood a normal arch must first be adopted as a standard. 
 
 There are three characteristics of the normal arch. Inde- 
 
 Fio-. 123. 
 
 pendent of temperamental peculiarities, the line extending from 
 one cuspid to another should be an arc of a circle, not an angle 
 or straight line ; the lines from the cuspids to the third molar 
 should be straight, curving neither in nor out, the sides not 
 approximating parallel lines. Absolute bilateral uniformity is 
 not implied in this since the two sides of the human jaw are 
 rarely if ever wholly alike. A uniform arch necessitates uni- 
 formity of development between the arch of the maxilla and 
 the arch of the teeth and a correct relation of the individual 
 teeth to each other. When there is inharmony of development 
 between the jaw and the teeth, as may happen when one parent 
 has a small maxilla with correspondingly small teeth and the 
 
300 
 
 IRREGULARITIES OF THE TEETH. 
 
 Other a large one with correspondingly large teeth, if the child 
 inherit the jaw of one and the teeth of the other, irregularities 
 must occur. Such difference in diameter between the arch of 
 the maxilla and that of the crowns of the teeth is a constitutional 
 cause of irregularity. 
 
 Whenever there is a difference between these diameters, the 
 line formed by the teeth must either fall outside or within the 
 arch of the maxilla and irregularities of arrangement must result. 
 
 In Fig. 121, in the right superior arch, the diameter of the 
 stones is either too small for the curve of the arch or the bases 
 are set too far apart. This results in a greater space for the 
 key-stone than is required; not finding support, it drops through 
 toward the center line. 
 
 Fig. 134. 
 
 In Fig. 122, in the right superior arch, the posterior base and 
 the foundation stones have been brought forward to such an 
 extent that when the other stones are placed in position, the 
 space intended for the key-stone is closed and the key-stone 
 remains outside. The key-stone appears too heavy for the left 
 superior arch and its weight has carried the smaller stones with 
 it. The posterior base with its foundation stones being the 
 strongest, resists the force ; the anterior base being weak and 
 without support, bulges out and in this way a semi- V-shaped 
 arch is produced. 
 
 In Fig. 123 the key-stone has gradually carried the right 
 superior arch inward ; the posterior base is in its proper position, 
 the anterior base has been carried forward and all the stones 
 are in line. The key-stone in the left superior arch has produced 
 the same result as upon the opposite side, excepting that the 
 posterior base and the foundation stones were placed too far 
 
DEVELOPMENTAL NEUROSES IN TEETH POSITION. 301 
 
 forward, leaving insufficient space for the key-stone. The teeth, 
 however, do not bear the same relation to each other upon 
 their approximal surfaces that the stones of the arches do. The 
 stones of an arch have broad flat surfaces, while the teeth merely 
 touch upon the points of rounded surfaces. 
 
 The ten anterior teeth, which are involved in the construc- 
 tion of the V-shaped and kindred irregularities, are ilkistrated 
 in Fig. 124, in which the positions of the roots and crowns and 
 their mutual relations are approximately shown. As will be 
 observed, the teeth are all wedge-shaped, the bases being located 
 near the cutting and grinding-edges and the apices at the ends 
 of the roots. These are nearly round and conical, the points 
 of antagonism being near or quite at the cutting edge or grind- 
 
 Fig. 125. 
 
 ing edges. Fig. 125 shows a section of the teeth at their points 
 of contact. These points must be kept in mind, as they consti- 
 tute the fulcra of the levers, which, when force is applied to the 
 teeth, cause them to rotate and move out of position, thus pro- 
 ducing more varieties of deformities than it is possible to dem- 
 onstrate upon the stone arch. 
 
 These irregularities are not observed until after the eruption 
 of the second set of teeth. The first permanent molars are 
 largest, -strongest and possess largest roots of any teeth. They 
 are located posteriorly to the temporary set. Owing to their 
 position and to their long, large roots, their apices are directed 
 backward. In a majority of cases, the distance from the apex 
 of one root to that of another is greater than at the neck, which 
 indicates that they are firmly fixed in their alveoH. The alveolar 
 
302 
 
 IRREGULARITIES OF THE TEETH. 
 
 process is wide at those points, hence these teeth may be desig- 
 nated as the posterior basis of the lateral arches. 
 
 The next teeth which make their appearance are the central 
 incisors. These are situated in the extreme anterior alveolar 
 process on either side of the median line. The process is quite 
 thin at these points. These teeth will be called the anterior 
 bases of the lateral arches. The next to make their appearance 
 are the lateral incisors, which take positions at the distal surfaces 
 of the central incisors. The roots of these teeth are not so large 
 nor so long as the roots of the centrals, hence they are not 
 as firmly fixed in the alveoli. Each lateral tooth, however, is 
 supported by the central and represents the second stone upon 
 
 Fig. 126. 
 
 Fi^ 127. 
 
 the anterior base. The teeth which appear are the first bicuspids. 
 Immediately following are the second bicuspids, which repre- 
 sent the second and third stones upon the posterior bases. The 
 arches are then complete, except the key-stones — the cuspid 
 teeth. These cannot be omitted, for they bind and hold the teeth 
 together and give beauty and shape to the arches. The follicles 
 of these teeth are originally situated outside of and above the 
 crown and roots of the teeth already in the arch, which results 
 in a larger circle, and because these teeth have long, powerful 
 roots, unusual power and leverage is given them. For this 
 reason they are directed downward and inward, their crowns 
 being so located that the lips assist greatly in aiding the down- 
 
DEVELOPMKNTAL NEUROSES IN TEETH POSITION. 
 
 303 
 
 ward movement of these teeth. The downward and inward 
 movement of the cuspids is similar to the lowering of the key- 
 stone in an arch. It continues to move downward until it 
 meets with an obstruction, which may be confined to the upper 
 jaw and include the teeth anterior and posterior to the cuspid. 
 If the teeth in position be in harmony with the jaw, the cuspids 
 will descend into their proper places and, touching the teeth 
 on each side, lock the arches and hold the teeth in proper 
 position. 
 
 In the posterior parts of the mouth the alveolar process is 
 very thick and the base — the first permanent molar — is large, 
 having three roots in the upper and two in the lower jaw, 
 
 Fig. 128. 
 
 curved and so arranged in the alveolar process as to preclude 
 its going backward. Other teeth of nearly equal strength are 
 found posterior to the first permanent molars. Anterior to the 
 base — the first permanent molar — the first and second bicuspids 
 are found. These teeth are all firmly imbedded and situated 
 in the long axis of the alveolar process, forming together a very 
 firm base. The anterior column of the arch consists of but two 
 teeth, while the posterior column has five. The anterior teeth 
 possess single roots and are situated crosswise in a very thin 
 alveolar process, hence the comparative weakness of the anterior 
 arch. In some intances the space may be too large in the 
 superior arch and the key-stone or cuspid tooth may continue in 
 its downward course till it engages with the teeth in the lower 
 jaw. 
 
304 
 
 IRREGULARITIES OF THE TEETH. 
 
 The V-shaped arch presents a triangular outhne (Fig. 126), 
 the apex of the triangle being formed by the central incisors, 
 where the process is usually bent so that the incisors form 
 an angle instead of being in line. From this apex the lateral 
 halves are in a straight line, terminating at the first molars ; a 
 line connecting them forms the base of the triangle. The cause 
 of this peculiar outline is a want of correspondence between 
 the size of the jaw and teeth or the premature extraction of the 
 temporary molar or both causes combined, thus allowing the 
 first permanent molars to move forward. When the rest of the 
 permanent teeth come in, they are crowded together. The 
 process must give way in order to adapt the greater arch formed 
 by the crowns of the teeth to the lesser arch of the maxilla. The 
 
 Fig: 129 
 
 point of fracture is in or near the median line, since the process 
 is thinnest at this point. The illustrations given here show 
 varieties of this type. By comparing each one with the diagram 
 it will be seen that they all are triangular in outline, Fig. 129 
 being the best representation of this form of irregularities. A 
 line passing from the median line of the central incisors through 
 the cutting edges and crowns is straight. Study of the cases 
 here given will reveal the result of the forward movement of the 
 first molar. The subsequent loss of teeth, the peculiarity of 
 articulation and the thinness of the process at certain points 
 determine the modifications. In Fig. 127 the laterals are gone ; 
 for the reason the centrals are still in line, space having been 
 made by the absence of the laterals. In Fig. 128 it is evident 
 
DEVELOl'MENTAL NKUROSKS IN TEKTH POSITION. 305 
 
 from its ovcrla]>ping; centrals that tlierc was want of sj^ace at the 
 time of their eruption ; tlie loss of the second bicuspids suhse- 
 ijuently haw, together with peculiarities of articulation, ])er- 
 mitted the lateral halves to assume some curvature. In Im_<(. 
 127 there is an arch too small for the teeth and is destitute of 
 the right fust molar and the left first bicuspid. These were 
 evidently lost after the central incisors were erupted. The rest 
 of the teeth have migrated more or less because not kej)! in 
 place by close articulation. Thus the cuspids are kept out of place 
 and by their pressure inward tend still more to narrow the arch 
 anteriorly. In Fig. 130 the central is spread, though the 
 process is evidently bent. This spreading is accounted for by 
 the absence of right lateral, which has allowed the central 
 
 Fig-. ]::!(i. 
 
 to move backward and the cuspid to move in. On the left side 
 the cuspid has erupted inside of the arch. 
 
 Modifications of the V-shaped arch result from modifications 
 of the above named conditions. A difference in the time of 
 eruption of the cuspids, everything else being equal, effects a 
 difference in the space left for their accommodation and thus 
 partial \'-shaped arches are found. The key-stone (the cuspid) 
 is not entirely outside nor inside of the arch in the partial 
 V-shaped form, but may appear partially crowded out of place. 
 Hence the arch is neither a normal curve nor w^holly angular, 
 but unites the characteristics of both. Its lateral diameter is 
 less than that of the normal arch, giving it a contracted appear- 
 ance (Fig. 131). Thus a number of varieties of the funda- 
 
 21 
 
306 
 
 IRREGULARITIES OF THE TEETH. 
 
 mental forms of the V-shaped arch are formed, differing in 
 degrees of anterior contraction. All of these result from the 
 comparative thinness of the anterior portion of the process offer- 
 ing but little resistance, an abnormal pressure from behind and 
 the greater strength of the cuspids, which causes them to seek 
 room irrespective of the space left for them. By drawing a 
 perpendicular line from the median line of the central incisors 
 to the base and comparing the halves thus obtained with the 
 diagram, the right half in Fig. 132 is seen to be partially V-shaped 
 while the left is normal. Near the apex is the crowded condition 
 of the incisor, overlapping the lateral; from thence back the 
 curve of the arch is lost. The absence of the first bicuspid, 
 
 Fig. 131. 
 
 Fig. 132. 
 
 together wdth the want of proper articulation, has allowed the 
 cuspid to press nearer the center of the palate than is normal. 
 
 In Fig. 133, the V-shape is not so apparent, but the central 
 incisors are crowded, which shows that there is not perfect har- 
 mony betwen size of teeth and jaw. This contracts the anterior 
 arch. 
 
 When one side of the process near the symphysis is the 
 stronger, thus affording greater resistance or the pressure of 
 the cuspid is less, that side may maintain its normal relations, 
 while the other may give way to conditions resulting in a 
 V-shaped contraction. The curve will then be broken, not at 
 the apex of the triangle, but near it ; the incisors will overlap 
 
DEVELOPMENTAL NEUROSES IN TEETH POSITION. 
 
 307 
 
 and when pressure from the cuspid acts on the weaker column 
 it must give way. This results in the semi-V-shaped form. 
 (Fig. 134.) 
 
 In Fig. 135 is a semi-V-shaped arch. The teeth in the left 
 dental arch are nearly on a straight line. The teeth in the right 
 dental arch arc situated upon a slight curve. In this arch the 
 cuspid is in position, while ui)()n the left arch it is missing. 
 The posterior teeth have moved forward and filled the space 
 intended for the cuspid. It is still located in the alveolar jirocess, 
 but the force produced by the inward pressure of the cuspid is so 
 Sfreat that the central and lateral incisors have been carried 
 
 Fig. m. 
 
 forward and the teeth and alveolar process have produced the 
 straight line. The lateral pressure of the teeth prevents their 
 being carried farther inward. The lack of proper antagonism 
 of the central incisors has allowed the cuspid to force the incisor 
 and alveolar process forward until the basilar ridge of the right 
 central antagonizes with the mesial surface of the left central. 
 This, in a measure, checks the progress of the cuspid inward 
 and holds the arch on a slight curve. A perpendicular line 
 drawn from the mesial surface of the right central incisor (Fig. 
 136) to the base shows the left side to be V-shaped, while the 
 right is normal. In Fig. 137 the outline does not clearly point 
 to a V-shaped arch. By comparing the curvature of the two 
 halves and noting the position of the right cuspid, it is more 
 
308 
 
 IRREGULARITIES OF THE TEETH. 
 
 apparent. The bending of the process at the mesial line is evi- 
 dent from the position of the right central. This has turned 
 upon its axis from want of lateral antagonism and proper occlu- 
 sion. This partial rotation has allowed the lateral to move back, 
 occupying in part the space of the cuspid, which has forced the 
 cuspid out of its normal position, causing it to erupt outside of 
 the arch. 
 
 Fig. 138 shows a combination of semi-V and partial V-shaped 
 arches. The cuspid, being outside of the left arch, contracts it 
 and gives it the characteristics of the V-shaped. On the right 
 side the cuspid is partially crowded out of place and the arch 
 is somewhat contracted. 
 
 Fig. 134. 
 
 Fig. 135. 
 
 The lower jaw never assumes the V-shape when the teeth 
 articulate normally, because the anterior inferior teeth normally 
 close inside of the upper teeth, and, while the force from im- 
 proper occlusion of the jaws and the forward movement of the 
 posterior lower teeth is as great or greater than the like force 
 exerted upon the upper jaw, the forward movement of the cen- 
 tral incisors is prevented bystrikingtheir anterior surfaces against 
 the posterior surfaces of the superior incisors. There are many 
 irregularities of the anterior inferior teeth caused by the for- 
 ward pressure of the posterior teeth. These are quite difficult 
 to regulate, owing to their intimate relations with the superior 
 incisors. The inferior dental arch should be divided into the 
 right and left lateral arches, corresponding to those of the 
 
DEVELOPMENTAL NEUROSES IN TEETH POSITION. 
 
 309 
 
 superior arch. The pressure produced by improper articulation 
 and the forward movement of the posterior columns (the bicus- 
 pids and molars) is exerted on each lateral half independently, 
 like that in the lateral arches of the upper jaw. Each lateral 
 
 KK 
 
 K 
 
 Fig. 136. 
 
 arch on the lower jaw has its posterior base (the first permanent 
 molar), an anterior base (the central incisor) and the same num- 
 ber of stones in position upon the bases — the same key-stone — 
 
 Fig. 137. 
 
 all representing the same number of teeth as are contained in 
 the superior lateral arches. The development of each inferior 
 lateral arch is independent of the other, as is the case with 
 the superior lateral arches. The irregularities of the teeth in 
 
310 
 
 IRREGULARITIES OF THE TEETH. 
 
 each lateral arch are independent of the others. When the pos- 
 terior column moves forward, if the key-stone (the cuspid tooth) 
 is retarded or slow in coming into place, the space is filled by 
 the first bicuspid and the cuspid remains outside, precisely as 
 in the superior lateral arches. If the pressure of the posterior 
 
 Fig. 138. 
 
 columns and the key-stone be uniform, the force will be exerted 
 against the anterior base and the first stone upon the base (the 
 central and lateral incisor). In this case a different condition 
 exists. The anterior base and first stone of the superior lateral 
 arch and the anterior inferior column, resist the force. Occa- 
 
 Fig. 139. 
 
 Fig. 140. 
 
 sionally, this is so great that the anterior columns of both 
 superior and inferior dental arches are carried forward. When 
 this occurs, the incisors upon the upper jaw protrude. When 
 the forward movement of the posterior column occurs, the 
 incisor (or anterior column) will crowd past one another like 
 
DEVELOPMENTAL NEUROSES IN TEETH POSITION. 311 
 
 the Sticks of a fan, provided the pressure be uniform in both 
 lateral arches. The six teeth which are instrumental in the con- 
 struction of these deformities are illustrated in Fig. 139. These 
 teeth, as will be observed, are wedge-shaped ; their points of 
 
 FiK- 141. 
 
 contact are at their cutting edges ; slight oblique pressure will 
 cause these teeth to lap over each other. If the pressure is 
 upon one side only, the irregularity will be located on that side. 
 One of the common irregularities is seen when the key-stone 
 
 Fig. 142. 
 
 or cuspid tooth is slow in erupting. The posterior column 
 moves forward and the resistance of the anterior column forces 
 the key-stone outside the arch. It sometimes happens that the 
 key-stone moves into place and is held in position by the anterior 
 
312 
 
 IRREGULARITIES OF THE TEETH. 
 
 column and the second stone upon the posterior column (the 
 first bicuspid) is carried forward outside the arch. This can be 
 better understood by examining cases of this kind, which will be 
 illustrated later. In V\g. 140 is seen in position a section of the 
 
 Fig. n;i 
 teeth made on the line of lateral antat^onism. The mesial and 
 distal surfaces are convex and the points of contact are situated 
 at the extreme lateral surfaces. If the teeth at eruption should 
 not touch at these particular i)()inls, or if the force exerted 
 
 Fig. 144. 
 
 should not be in direct line with these points of contact, the 
 teeth would be situated upon an incline and the force thus 
 applied would readily carry the teeth one way or the other. Such 
 deformities occur more frequently with the incisor and cuspid 
 
DKVKI.OI'MKN lAI, NKTROSKS IN Tl'-KI H POSITION. 
 
 313 
 
 than with the posterior teeth. The posterior teeth are held in 
 position by their contact with the occhiding teeth of the oppo- 
 site jaw, while the incisors do not occlude. One marked feature 
 of these irregularities is that in most cases the lateral incisor 
 is carried inward and the centrals outward to remain in position 
 in one or both lateral arches. These conditions are fully illus- 
 trated in the chapter on local causes. In Fig. 141 the right 
 dental arch is normal. In the left dental arch the anterior col- 
 unm w'ith the cuspid (the key-stone) has moved forward and 
 the lateral incisor is carried inward. This is explained when 
 the relation between the mesial surface of the cuspid and the 
 distal surface of the lateral is understood. In the forward move- 
 
 Fi.if. H.-i 
 
 miMiiiffiiiiii iiimiiiiiiiiii i i 
 
 I u 14(i 
 
 ment of the cuspid the lateral impinges upon a markedly incHned 
 plane upon the mesial surface of the cuspid and the forward 
 pressure carries the lateral inward. In Fig. 142 is the same 
 irregularity in both right and left lateral arches, the pressure 
 being uniform upon each arch. The centrals are also slightly 
 rotated in their sockets. This is produced by the flat lateral 
 surfaces of the roots meeting and the pressure of the crowns 
 against the basilar ridges of the superior centrals. 
 
 The saddle-shaped arch is not so common a deformity as the 
 V-shaped. It has many peculiarities, however, that are seen in 
 the V-shaped, It may include one or both lateral arches. It may 
 
314 
 
 IRREGULARITIES OF THE TEETH. 
 
 be partial on one side and marked on the other. It may involve 
 the bicuspids and first permanent molars upon one side or but a 
 single tooth on the other. Each lateral arch produces its own 
 deformity independently of the other. The roof of the mouth 
 may be high or low. The deformity, like the A'-shaped, is 
 
 Fig. 147. 
 
 favored by the high arch. In Fig. 143 is seen the manner of pro- 
 duction of this deformity. Here is a right and left superior 
 lateral arch of stone, each stone corresponding in size and loca- 
 tion to the natural teeth. The left lateral stone arch, corre- 
 
 sponding to the left superior dental arch, shows the formation 
 of the saddle-shaped arch and order of laying the stones and 
 changing the base. The first stone laid in the arch corresponds 
 to the first permanent molar, and, like the stone in the V-shaped 
 arch, is denominated the posterior base. The next stone laid 
 
DEVELOPMENTAL NEUROSES IN TEETH POSITION. 
 
 315 
 
 corresponds to the central incisor, then the stone which stands 
 for the lateral incisor. The natural order then changes and the 
 next stone laid corresponds to the key-stone of the V-shaped 
 arch (the cuspid). It becomes the anterior base forming a fixed 
 point in the anterior part of the mouth. The next stone laid 
 corresponds to the first bicuspid, followed by those representing 
 the second bicuspid and the second and third molars. The 
 stones being in position, the anterior and posterior columns 
 are nearly equal in strength and resisting power. The anterior 
 column is made up of the anterior base (the cuspid) with its 
 long root, backed up by two foundation stones representing the 
 central and lateral incisors. The posterior column is made up 
 
 of its base, the first permanent molar backed by two foundation- 
 stones representing the second and third molars. The forward 
 movement of the posterior column takes place in the arch from 
 the same causes which produce the forward movement in the 
 V-shaped arch. The stone representing the cuspid is not the 
 stone involved ; it is always fixed in its proper place. The 
 weaker stones are those which correspond to the bicuspids and 
 they are the stones which are always displaced when the forward 
 movement of the posterior column occurs. The change in the 
 order of the laying of the stones — i. e., the stones corresponding 
 to the cuspid instead of the bicuspid (it being irregular) — accounts 
 for there being fewer saddle than V-shaped arches. The change 
 of the anterior base will also explain why the anterior column 
 
31G IRREGULARITIES OF THE TEETH. 
 
 and alveolar process do not project, as in the case of the V-shaped 
 arch. The right superior lateral arch illustrates another com- 
 mon variety of the saddle-shaped arch. It does not differ 
 materially from the left lateral arch as regards the order of 
 laying the stones. The anterior base is transferred one stone 
 back, the stone corresponding to the first bicuspid. The posterior 
 base remains the same. The posterior column moves forward 
 and carries the stone representing the second bicuspid inward. 
 On comparing the shapes of the natural teeth with the stones 
 in the arch just described, it is found that the approximate sur- 
 faces are convex instead of flat like those of the stone arch just 
 
 I 
 
 Fig. 151. 
 
 described. The peculiar incline of the anterior surface of the 
 first permanent molar and the posterior surface of the cuspid 
 tooth, together with the oval shapes of the bicuspids, are singu- 
 larly well adapted to cause these irregularities upon the applica- 
 tion of force. The first permanent molars are situated farther 
 outside in the arch than any teeth posterior to them. The cus- 
 pids occupying such a prominent position in the arch in the 
 anterior part of the mouth, the least deviation inward of the 
 bicuspids would give the pinched appearance of the jaw at that 
 locality. In neurotics and degenerates the jaws will in some 
 cases develop in length and not in width. In such cases the 
 jaws at the sixth and seventh year remain permanent. The 
 
DEVELOPMENTAL NEUROSES IN TEETH POSITION. 
 
 317 
 
 temporary molars hold the permanent bicuspids in the unde- 
 veloped position and the cuspids erupt outside the arch. In this 
 way a full saddle is formed. This deformity is caused also by 
 the too early extraction oi the temporary molars, which allows 
 the first permanent molars to work forward and force the bicus- 
 pids inward, or by the retention of the temporary molars or their 
 roots, thus deflecting the crowns of the bicuspids. The question 
 arises, why are not the bicuspids forced outward as well as 
 inward? They do occur frequently cnitside the arch. The 
 inward movement, however, is the natural one, because the 
 crowns when in the jaw are situated between the roots of the 
 
 Fig. 152. 
 
 Fig. 153. 
 
 temporary molars. The temporary molars are situated upon 
 a smaller circle than the permanent molars and cuspids (Fig. 
 144). When the temporary molars are extracted, the crowns 
 of the bicuspids are in the radius of a smaller circle, while their 
 roots have been carried outward by the development of the jaw 
 and alveolar process. 
 
 The molars in the saddle and semi-saddle-shaped arches of 
 the upper jaw frequently diverge laterally. If the case shows 
 a semi-saddle-shaped arch, the divergence is on the side of the 
 deformity. If both lateral arches are involved, both sides diverge. 
 Cases having the deformity most prominently have the most 
 marked divergence. When a slight change exists only at the 
 bicuspid region, the divergence in the molar region is slight. 
 
318 
 
 IRREGULARITIES OF THE TEETH. 
 
 This peculiar arrangement of the molar teeth may be due to 
 two causes : First, the teeth upon the lower jaw diverge on 
 account of the shape of the inferior maxilla ; the farther removed 
 from the incisors, the greater the distance between the molars 
 of the opposite side. The molars upon the upper jaw usually 
 articulate with those upon the lower jaw. The disparity in the 
 appearance of the normal position of the teeth and those above 
 described is due to the pinched condition in the bicuspid and 
 first molar region rather than to the position of the molars. 
 Second, when the arch is contracted at the bicuspid region the 
 tongue goes to the roof of the mouth and is then forced back- 
 ward for lack of room, thus shortening and consequently broad- 
 
 Fig. 154. 
 
 Fig. 155. 
 
 ening its surface. The result of the lateral expansion would 
 naturally be to force the teeth and alveolar process outward. 
 
 The position of the temporary molars determines the position 
 of the bicuspids. This position shows the diameter of the jaw 
 early in life. From that time until the eruption of the third 
 molar, i. e., from the third to the twentieth year, the jaw has 
 no opportunity to develop, which naturally carries the alveolar 
 process and teeth out laterally, causing the crowns of the third 
 molar to face the cheek sometimes. 
 
 When there is harmony between the size of the teeth and 
 that of the arch and the permanent bicuspids erupt under favor- 
 able conditions, so that their greatest diameter is in a line with 
 the greatest diameter of both first cuspid and molar, they will 
 
DEVELOI'MENTAL NEUROSES IN TEETH POSITION. 319 
 
 be held firmly in place, since the greatest pressure is on this 
 very line. On the other hand, when the bicuspids are erupted 
 after their proper time, while the cuspids progress duly, the cus- 
 pids, meeting with no resistance, fall into their natural position, 
 while the bicuspids erupt inside of the arch, forming an angle. 
 This angle results from two causes — thinness of the process at 
 this point and diminution of resistance which must follow. 
 
 In Figs. 145 and 146 is seen a decidedly saddle-shaped arch. 
 The maxillary bone is too narrow at its anterior extremity for 
 the teeth, which are suited to a more expanded jaw. The consti- 
 tutional tendency to this deformity is quite apparent in this case. 
 The vault is high and narrow. The first molars are pushed 
 
 ■J 
 
 % '':fm;^yj 
 
 Fig. 156. 
 
 forward, leaving only sufficient space on each side for one bicus- 
 pid. These are, therefore, turned inward toward the palate, 
 making the vault at this point still narrower than it natur- 
 ally is. 
 
 When the unfavorable conditions that result in the saddle- 
 shaped arch are not so pronounced we have the partial saddle- 
 shaped arch (P^ig. 147). Thus, because of the greater uniformity 
 of the maxilla and of the crowns there may be more space and 
 the bicuspids may be forced but little out of place, or the molar 
 may move forward but slightly, interfering less with the bicus- 
 pids. Sometimes it happens that in trying to adjust themselves 
 to the Hmited space one bicuspid may be crowded outward and 
 another inward. Sometimes the first bicuspid is in, more fre- 
 quently the second (Fig. 148). 
 
320 IRREGULARITIES OF THE TEETH. 
 
 In Figs. 149 and 150 are found a normal arch on the left 
 side and a saddle-shaped arch on the right. The vault is normal 
 in this case ; hence there is more room for the erupting bicus- 
 pids and less curvature results than is found in Fig. 148. Fig. 
 151 shows a similar condition of the left side. 
 
 How the V and saddle-shaped arch niav he combined on 
 one side remains to be ex])lained. Given lliinness of process in 
 the anterior part of the mouth, premature or tardy extraction of 
 the first molar and there will be a forward movement of the 
 incisors. The development of the cuspid will press the alveolar 
 process inward, thereby contracting the arch and the tardily 
 
 Fig. 157. 
 
 erupted bicuspids will adjust themselves to the limited curve 
 as before stated. In this way the features of the two forms are 
 combined ; that is a contracted or angular anterior arch and a 
 posterior arch more or less concave. The opposite side may 
 be V-shaped, saddle-shaped or normal (Figs. 152 and 154). 
 
 In Fig. 153 occurs a combination of V and saddle-shaped 
 arch on the left side and \"-shaped on the right. In Figs. 154 
 and 155 is seen a case of semi-V and semi-saddle-shaped arches 
 combined. 
 
 In Fig. 156 appears a semi-saddle-shape in the right lateral 
 arch ; the second biscuspid has been forced inside the arch. 
 The opposite side shows a condition exactly reversed. The 
 points of lateral antagonism of the second bicuspid are outside 
 
DKVKl.dl'.MKNTAL NEUROSES IN TKETII I'OSITION, 
 
 321 
 
 the long diameter of tli€ dental arch. The anterior movement 
 of the posterior base forced the tooth outward. The tendency of 
 this irregularity was to form the V-shaped variety. The irregu- 
 larity of the left lateral arch (Fig. 157) is a common one. The 
 teeth develop normally, but the second bicuspid is either retarded 
 in development or deflected inward by a local cause. The 
 anterior base is, in this case, transferred to the first bicuspid. 
 The posterior and anterior bases come together, and the second 
 bicuspid is crowded inward. The irregularity corresponds to 
 the right lateral stone arch of Fig. 143. 
 
 The saddle-shaped arch on the lower jaw is generally due to 
 
 Fig. 158. 
 
 local causes, the retention of the temporary molars being one. 
 The one illustrated is the result of both local and constitutional 
 causes. This deformity is also due to an arrest of development 
 of the lower jaw. 
 
 In Fig. 158 a saddle-shaped irregularity upon the lower jaw 
 is observable. The impression is from the jaw of a man fifty-six 
 vears of age. The second molars were extracted at the age of 
 twenty-two. The irregularity was produced at the time of devel- 
 opment of the teeth. The teeth are large and firmly set in the 
 powerful jaws. Asymmetry of the jaws exists. If they had 
 developed in unison, this deformity would have been prevented. 
 The forward movements of the posterior columns have carried 
 the cuspids forward and the lateral incisors inward, so that the 
 
 22 
 
322 IRREGULARITIES OF THE TEETH. 
 
 cuspids and centrals stand on a line. The second bicuspids and 
 first permanent molars have been forced inward by the inclined 
 plane formed by the posterior surfaces of the first bicuspids 
 and also by the articulation of the superior teeth, which form 
 a smaller arch than the lower teeth. As will be seen, the third 
 molars have moved forward and nearly filled the spaces made 
 vacant by the extraction of the second molars. This forward 
 movement was no doubt due to improper articulation with the 
 upper teeth. 
 
CHAPTER XXVI. 
 
 LOCAL CAUSES OF TEETH IRREGULARITIES- 
 UPPER JAW. 
 
 Local irregularities are found in malposition and malocclu- 
 sion of individual teeth, as a result of an accident (such as pre- 
 mature or tardy extraction of temporary teeth) or malposition 
 and malocclusion resultant on constitutional causes. 
 
 Foremost in influence on the relative position of permanent 
 teeth is the first molar. If the temporary molar be extracted 
 prematurely, the forward movement of the posterior column fol- 
 lows it, the expanse of the anterior column producing more or 
 less vicious position, relation and occlusion. The anterior move- 
 
 Fig. 159. 
 
 ment of the temporary molars and cuspids as well as the perma- 
 nent bicuspids and cuspids from the great force exerted by the 
 first permanent molar occurs the same. To this even the cuspid, 
 though most influential in the anterior colunm, must yield. Next 
 to the first permanent molar in importance is the cuspid. It 
 asserts itself above the rest because of its vital force, length 
 of root, pecuHar shape and location in the jaw. The length 
 of its roots allows it to be deviated most of any tooth from its 
 original position, since with the same degree of pressure brought 
 to bear on or near the apex of its root a tooth may diverge in 
 proportion to the length of its roots. Though the angle be 
 the same the divergence grows greater the farther the cusp is 
 from the apex. 
 
 The central incisor comes next in importance and then the 
 lateral. The central incisor finds a support in its fellow on the 
 opposite side, while the lateral is the most passive of teeth. It, 
 
 323 
 
324 
 
 IRREGULARITIES OF THE TEETH. 
 
 however, plays the part of a co-ordinating force. Without this 
 wedge the teeth would not be retained in their position and 
 occlusion would be disturbed. Becaus'e of its weakness and 
 short root it is very easily displaced. 
 
 In the chapter on general causes of irregularities the fact 
 was emphasized that the forward movement of the posterior 
 column, i. e., the bicuspids and molars, due to premature or 
 tardy extraction, will force the weaker anterior column and 
 
 Fii? Ibl 
 
 alveolar process forward. The pressure brought to bear upon it 
 from both sides makes the arch of the upper maxilla greater than 
 that of the lower. As a consequence occlusion will be want- 
 ing or defective and flexion must take place according to posi- 
 tion assumed in the eruption of each individual tooth. This 
 condition is greatly promoted by the pressure of the cuspids, 
 which, in coming down, assert themselves at the expense of the 
 
 Fig. 162. 
 
 weaker incisors. But this is not all. Much depends on the size 
 and the development of the germs of the permanent incisors. 
 When there is strong vitality and they join in the struggle for 
 existence between the organs, their growth may be out of pro- 
 portion to that of the alveolar process. Owing to healthy nutri- 
 tion or the nature of the food that is taken into the system during 
 the time of their development the centrals may become very 
 vigorous. This extraordinary development shows itself not so 
 much in relative position of the axes as in irregularities of the 
 
LOCAL TEETH IRREGULARITIES UPPER JAW. 325 
 
 cuttings edges. These, from their excessive diameters, overlap 
 slightly. When a temporary incisor persists too long in its 
 socket, the germ of the permanent tooth is embarrassed in its 
 eruption. The germ seeks its way out as best it can and as 
 projecting in a straight line is out of the question, it slips around 
 the temporary teeth and is forced partially out of position. The 
 process in this case is not unlike that of the germ of a plant that 
 forces its wav out from under a stone. 
 
 Fig. 163. 
 
 Having considered the cause of the irregularities of this 
 division, the varieties must next attract attention. A form fre- 
 (|uently met with is found in \'-shaped arches. The central incis- 
 ors are crowded together so that their cutting edges are not in a 
 line, but form an angle that points forward (Fig. 159). This is 
 the most natural form for the flexion to assunije. The arch 
 is simply broken in front, fi iIImw in;^- the general direction of the 
 
 Fig. IfU. 
 
 pressure. The mesial surfaces are parallel ; the anterior angle 
 points forward, following the general law of the incisors. The 
 force is uniform. Had the anterior column not been forced 
 forward by the posterior one, these teeth would be normal in 
 every respect. Sometimes they overlap slightly. Occasionally 
 general axes of the teeth do not converge, but diverge. This 
 is due to faulty occlusion, the lower incisors acting as a wedge, 
 driving the upper incisors apart or from want of occlusion, they 
 follow their course without guidance and support. 
 
326 
 
 IRREGULARITIES OF THE TEETH. 
 
 Ill tlie second class, where the cutting edges form an angle, 
 which is directed backward (Fig. i6o), the pressure from behind 
 by the posterior column has met with an obstruction in front. 
 This obstruction exists in the center of the alveolar process and 
 is strong enough to resist in a measure the pressure from 
 behind. Hence the force spreads itself on the lateral divisions 
 of the anterior process. The result is that the mesial line is 
 formed behind the distal line and an angle is formed. Here, 
 as in the former case, occlusion is an important factor in deter- 
 mining the position of the axis. A want of proper occlusion 
 may force the anterior teeth apart. The laterals also, in seeking 
 their natural position, may help to force the distal surfaces of the 
 central incisors still more out of place. Being wedged in between 
 centrals and the cuspid teeth, the latter, by their great force, 
 cause the centrals to vield to the laterals that are wedged between 
 
 / \ 
 
 them. The mesial angle of the laterals infringes upon the innei 
 surface of the distal angle of the centrals. These continue to 
 rotate until the entire mesial surface of the laterals rests against 
 the palatine surface of the centrals. Then the rotation natur- 
 ally ceases, the laterals forming an abutment. Pressure being 
 exerted on both centrals, in this way the angle is formed and 
 the pressure on both sides being equal, they are not thrown 
 out any farther. The direction of the cutting edges depends on 
 the shape of the teeth. 
 
 If the diameters of the cutting edges much exceed those of 
 the necks they necessarily overlap to a greater extent. 
 
 When the two centrals do not erupt harmoniously, one over- 
 laps (Fig. i6i). If, in addition to this condition, the force that 
 is brought to bear on the anterior alveolar arch be very unequal, 
 certain modifications occur. An unequal pressure exerted by the 
 cuspids in their eruption will force one side of the arch farther 
 
LOCAL TKF.TH IRREGULARITIES UPPER JAW. 327 
 
 forward than the other. When the first molar on one side has 
 been extracted, while that on the other remains, the forward 
 movement is necessarily one-sided and a corresponding irregu- 
 larity follows. The tardy extraction of temporary teeth goes 
 far in forcing the germs of the permanent teeth out of place. 
 Irregularity in the lower incisors, through faulty occlusion, modi- 
 fies greatly the direction of the upper teeth. 
 
 Fig. 167. 
 
 Sometimes centrals projecting in a line in front of the later- 
 als are found (Fig. 162). In this case the centrals erupted prop- 
 erly. The arch being undeveloped, there was not room for the 
 laterals. These were carried forward by the posterior column 
 and in by the cuspids and possibly driven in by the lower incisors, 
 which strike without, exaggerating the difficulty. When this is 
 not the case and the laterals strike outside of the lower teeth, 
 the upper arch is too large for the lower, and the upper centrals 
 
 Fig, 168. 
 
 not finding the proper support below, are forced out in a similar 
 manner. 
 
 A similar condition is that in which the central incisors strike 
 within the laterals (Fig. 163). The cause is the same; but the 
 laterals, in erupting, fail to find the proper support and project 
 outward, while the centrals occlude properly. In this case the 
 upper maxillary arch is not necessarily too large for the lower, 
 but the teeth are crowded. 
 
 One form of irregularity occasionally met with gives rise to 
 
328 
 
 IRREGULARITIES OF THE TEETH. 
 
 a right angle in the region of the cuspids, the incisors being in 
 a straight Hne (Fig. 164). There are, of course, cases where the 
 upper and lower arches resemble each other and where the occlu- 
 sion is fair, which hence cannot be classed under irregularities. 
 When this rectangular appearance is found in the upper jaw 
 only, it is evidently due to a flexion in the region of the cuspids 
 caused by the forward movement of the posterior column. The 
 anterior alveolar column will be found thick, and therefore 
 capable of resisting the pressure of the posterior column, and 
 the pressure is spent on the weakest point, i. e., the region of 
 tlie cuspid. Hence the flexion at this point. There is always 
 excessive development of the upper jaw and alveolar process. 
 This causes the teeth to erupt too far forward for occlusion with 
 the lower arch and the lip draws them in until they strike the 
 lower arch and the long axes of the teeth point inward instead 
 
 Fig. 170. 
 
 of outward. Thus the vault is brought forward, leaving the 
 lower incisors without support. 
 
 The usual course of eruption of the teeth and harmonization 
 of their development is occasionally disturbed. The germs that 
 should be directly over the temporary incisors may be displaced. 
 These should be situated above and anterior to the temporary 
 teeth ; but occasionally the germ is situated above and deflected 
 posteriorly and thus it is liable to be erupted on the palatine 
 surface. Displacement of the germs generally results in vicious 
 eruption; for, however, slight as the tooth progresses, the line 
 of its axes must diverge more and more from that of its normal 
 position. The central incisors spring from a point farther back 
 than it should be. If the elevation of the gum be followed, it will 
 be seen that these two diverge more and more toward their 
 cutting edges. Thus tlie relation of their axes is changed entirely 
 and a partial rotation is produced (Fig. 165). 
 
 Again, if the roots of the temporary teeth persist, instead of 
 
LOCAL TEETH IRREG U L ARITIES— Ul'PKK |A\V. 
 
 329 
 
 hi'ing absorbed as the pennanent teeth advance, tlicy materially 
 interfere with the eruption of these and arc apt to turn them out 
 of their course. When one of the conical roots of the incisors 
 infringes upon another not in the same line, as the teeth develop 
 a tendency to rotation is estal)lished on the principle of the 
 screw. This partial rotation upon its axis is more apparent the 
 greater the diameter of the tooth, since the cutting edge, usually 
 in line with the other teeth, now partakes of the revolution of the 
 axis and so forms an angle with the arch. 
 
 In these cases when the tfjoth is fully erupted it finds a proper 
 resting place on the opposing tooth. Its malposition may be 
 corrected by the exercise of its proper function, but it often fails 
 to find this and projects out, being without support. 
 
 Adventitious germs appear occasionally in the alveolar proc- 
 ess. When these are found in the arch, they necessarily disar- 
 
 Fig. 1,1 
 
 Fig. r, 
 
 range the occlusion and throw the teeth out of their proper 
 position. Supernumerary teeth usually appear at the median 
 line, and then necessarily crowd all the teeth laterally. Fre- 
 quently one supernumerary tooth is found exactly in the median 
 line and centrals coming down to the right and left in the 
 arch. 
 
 Occasionally two are found in the position where the centrals 
 should be. In such cases the central incisors are generally 
 located outside and anterior to the lateral incisors. When a 
 supernumerary is found outside of the arch in the median line 
 one central may be in position ; the other may be thrown out or 
 in and may be rotated 45 degrees upon its axis (Fig. 166). 
 
 The irregularities produced by the malposition of laterals are 
 
 1. Mesial surface of lateral overlapping distal surface of cen- 
 tral, while distal surface is in a line with cuspid. 
 
 2. Mesial surface of lateral overlapping distal surface of 
 central, while distal surface is behind the cuspid. 
 
330 IRREGULARITIES OF THE TEETH. 
 
 3. Mesial surface of lateral behind the distal surface of the 
 central, while the distal surface is in a line with the cuspid. 
 
 4. Lateral in a line anterior to that of central and cuspid. 
 
 5. Lateral in a line posterior to central and cuspid. 
 
 6. Lateral at right angles with the line of the incisor and 
 cuspid. 
 
 7. Lateral wholly inside the arch. 
 
 The lateral is found more frequently out of position than 
 any other tooth because it is the weakest tooth in the arch and 
 has the shortest root and is therefore more easily displaced. 
 
 The position of the central incisor is the combined result 
 of the relative strength of the alveolar process, the force brought 
 to bear upon it by the posterior column and the cuspid and the 
 peculiarities of occlusion. The lateral, on the other hand, 
 depends for its position on the combined force of central and 
 
 f^^ '^y^-^ *x,/' \|j 
 
 Fig. 174. 
 
 cuspid. Like other teeth, each lateral depends upon the environ- 
 ments of its own side of the arch, independent of the other. 
 Besides its weakness, two other conditions are productive of its 
 change of position: (i) the shortness and conical shape of its 
 root ; (2) its wedge-shaped crown. The shortness of its root, 
 together with its conical outline, causes it to be more easily 
 impinged upon by the root of the incisor, which will produce 
 partial rotation. The wedge-shape of its crown facilitates rota- 
 tion. The greater the diameter of the cutting-edge in proportion 
 to that of the root the greater the degree of rotation must be 
 before the lateral finds a resting place. If the diameter were 
 equal to the space left and there were no impinging on the root, 
 there would be no displacements. But when the space is not 
 sufficient for the lateral and a pressure is brought to bear on 
 one side of either cutting-edge or root, there must be a partial 
 rotation which is proportioned to the diameter of the cutting- 
 
LOCAL TEETH IRREGULARITIES UPPER JAW. 
 
 331 
 
 edge. The wedge-shaped character of the crown assists in rota- 
 tion, as the roimded angle of the anterior cusp offers less 
 resistance than a line or surface. This gives rise to the com- 
 monest form of irregularity (Nos. i and 2, Figs. 167 and 168), 
 in which the mesial surface of the lateral overlaps the distal 
 surface of the central, while the distal surface of the lateral is 
 either in a line with the cuspid or just back of it. 
 
 3. In those cases where the lateral is in a line with the 
 cuspid (Fig. 169), but its mesial surface is behind the central, 
 the cuspid having a much broader mesial surface, affords a firm 
 abutment to the movement of the lateral, while the mesial surface 
 of the latter easily glides over the narrow rounded distal sur- 
 face of the central incisor. In this case the relative diameter of 
 the upper and lower maxillse determines the occlusion and posi- 
 tion in a measure. If the lower maxilla and the upper be prop- 
 
 Fig. 1T5. 
 
 Fig. 17 
 
 erly proportioned, the lower incisor may strike in front of the 
 upper. 
 
 4 and 5. Laterals not finding room in the anterior column 
 are met with in a line in front of that formed by the central and 
 cuspid (Fig. 170), or behind it (Fig. 171). In both cases rota- 
 tion is not produced by a one-sided pressure either upon the 
 root or cutting edge. Whether the lateral is found without or 
 within the line depends upon the relative diameter of the upper 
 and lower maxillae and occlusion. If the proper relation exist 
 and the lower incisor strike within the upper, the upper laterals 
 will be found outside the arch. When the diameter of the 
 upper arch is greater than that of the lower, its laterals may be 
 found within the line of the centrals and cuspids. In this case 
 the lower incisors must either strike over the upper, which occurs 
 
332 
 
 IRREGULARITIES OF THE TEETH. 
 
 when there is a proper relation of diameters of upper and lower 
 maxillae or else behind the upper laterals. This can occur only 
 when the upper arch has a greater diameter than the lower. 
 
 6. A rotation of 90 degrees so that the lateral is at right 
 angles with a line passing through centrals and cuspids, can 
 occur only when there is no obstruction to the movement of 
 either root or cutting edge and where there is no proper occlu- 
 sion (Fig. 172). 
 
 7. Occasionally a lateral is found wholly inside the arch. 
 The cause is twofold. Sometimes the lateral is erupted so 
 tardily that the cuspid pushes it out of its place. Then, even 
 though erupted, the greater relative (Fig. 173) size and strength 
 of the cuspid may in due time crowd it toward the palate. 
 
 '1 he cuspid is the most important tooth in the anterior part 
 
 Fig. ITT. 
 
 Fig. 1T8. 
 
 of the mouth in regard to durability and influence on expression. 
 It owes its durability to the hardness of its tissue, slowness of 
 its development and simplicity of shape. The absence of sulci 
 lays it less open to the inroads of caries. The pyramidal shape 
 of its cusp gives it great power of resistance. Its strength 
 depends on these conditions and the length of its root, which 
 exceeds that of any other tooth. Owing to the length of its root 
 its cusp may move farther from its normal axis without really 
 forming a greater angle with it. It is placed at the angle between 
 the anterior and posterior columns, forming the key-stone ; 
 hence it is of the greatest importance in expression. The shape 
 of the crown may vary from the agreeably rounded outline of 
 beauty to the prominence of the tusk of a wild beast. The 
 limits of variation of form and position thus being greater than 
 
LOCAL TKETH IRRKC UL A K ITIES Ul'PKR JAW. 
 
 333 
 
 those of any other tooth, it attracts attention and helps to make 
 or mar beauty. Deviations from its normal position may be due 
 to malposition of the germ or crowding out of place. 
 
 When no source of pressure upon the erupting tooth can be 
 recognized, such as is the case when the cuspid erupts in the 
 vault, it is safe to assume the former. 
 
 iig 1^' 
 
 In both deciduous and permanent sets as compared with 
 other teeth, the cuspids are late in erupting. In both it nmst 
 seek its way between two teeth already erupted, hence its lia- 
 bility to be forced out of place. 
 
 The permanent cuspid rarely erupts before the twelfth year 
 after the centrals, laterals and bicuspids are in position. It is 
 crowded and therefore meets with obstacles in its descent. Its 
 
 Fig. 180. 
 
 crypt is placed above and in front of those of the lateral and 
 bicuspid. As at the age of nine the roots of the incisors and 
 bicuspids are pretty well calcified, the cuspid may be materially 
 hindered in its eruption by these when there is a lack of space. Its 
 conical root makes it yield easily to pressure and its cusp glides 
 readily over the roots of the adjoining teeth. If its calcification 
 and the decalcification of the temporary teeth do not occur 
 
334 
 
 IRREGULARITIES OF THE TEETH. 
 
 simultaneously a new factor of disturbance arises, for, by the 
 pressure of an additional obstacle in the shape of a remaining 
 portion of the root of a deciduous tooth, the cuspid may be 
 thrown out of its course, while a too rapid absorption of a decid- 
 uous root leaves the column of resistance broken, thus opening 
 a new channel for the erupting tooth. 
 
 The position of its crypt above and in front of those of the 
 lateral and bicuspid accounts for the most common form of 
 irregularity, i. e., being outside of the arch and above the other 
 teeth. The tendency of the cusp is necessarily forward, because 
 the combined force of the bicuspids and the first permanent 
 molar from behind is greater than that of the lateral in front ; 
 
 Fig. 181. 
 
 hence the lateral is easily pushed out of place. Besides, the 
 roots of all teeth pointing backward naturally give it this ten- 
 dency. 
 
 When in its normal position the cuspid pushes its way 
 between the roots of the lateral and bicuspid, thereby spreads 
 the arch, giving it a parabolic outline and forming a key-stone. 
 When it remains outside of the arch, the expanded contour 
 is lost and a pinched condition results in the shape of a V-shaped 
 arch. The additional pressure of the cuspid upon the region 
 of the lateral only increases this tendency. The cuspid, when out 
 of place, is usually found above and outside of the lateral and 
 bicuspid, this tendency being given by the position of its germ 
 and its calcification being late as compared with other teeth. 
 (Fig. 174.) 
 
LOCAL TEETH IRREGULARITIES UPPER JAW. 
 
 335 
 
 One or two cuspids may be found erupted in the palatal 
 vault when there is a malposition of the germs (Fig. 175). Occa- 
 sionally the cuspid is found outside of the first bicuspid or 
 between the first and second bicuspid, sometirnes in front or 
 anterior to the lateral (Figs. 176 and 177). Frequently it takes 
 the place of the lateral (Fig. 178). Sometimes one cuspid is 
 found in the palate, while the other is on a line pointing inward 
 (Fig. 179). When it comes through in this position the decidu- 
 ous cuspid may still be in position, the first bicuspid having 
 crowded forward to the lateral (Fig. 180). Occasionally when 
 the cuspid is missing, the lateral will drop backward (Fig. 181). 
 Its usual position when in the palate is inside the lateral incisor, 
 but sometimes it is embedded in the hard palate. A pinched 
 condition in the bicuspid region necessarily results from such 
 malposition, due in part to want of prominence of this tooth 
 when in normal position and in part to the inward pressure of 
 the cuspid upon the bone-cells (Figs. 182 and 183). When the 
 
 cuspid moves out of position it does so at the expense of the 
 first bicuspid and lateral incisor. The force may be so great as to 
 push the lateral forward and through the alveolar process. 
 When the cuspid is found in the roof of the mouth, or out 
 of its normal position, the posterior column moves forward, 
 filling the space usually occupied by the cuspid (Fig. 178) and 
 the half of the arch of which this tooth is a member remains 
 undeveloped (Fig. 182). If the cuspid erupt simultaneously 
 the pressure exerted is uniform and there is less liability to 
 irregularity. One may erupt normally, while the other may be 
 abnormal in position. 
 
 The shape of the crown of the bicuspid renders it particularly 
 liable to irregularities of position. The antero-posterior diameter 
 of its outer cusp is greater in proportion than that of the inner. 
 
336 
 
 IRREGULARITIES OF THE TEETH. 
 
 having a wedge-shaped space on the palatal side. This causes 
 it to touch at one point the tooth in front and back of it and 
 makes rotation upon its axis easy. Irregularities are chiefly lim- 
 ited to the second bicuspid for reasons that become apparent 
 when their causes are considered. 
 
 Like irregularities of other teeth, irregularities of bicuspids 
 may arise from constitutional causes, i. e., (from a lack of accord 
 between the size of the jaw and that of the teeth) or from local 
 causes. The latter are frequent. They are (i) tardy eruption; 
 (2) deflection due to the retention of temporary roots ; (3) for- 
 ward movement of the molars, and (4) rotation from want of 
 occlusion. 
 
 Fig^. 184. 
 
 1. Tardy eruption. The natural order of eruption is: first 
 bicuspid, second bicuspid, cuspid. But this is sometimes dis- 
 turbed, so that the first bicuspid is followed by the cuspid, thus 
 pushing it backward. When there is a lack of space the second 
 bicuspid must seek its way between the first bicuspid and the' 
 first permanent molar and if there is a lack of room it is crowded 
 outside or within the arch (Fig. 184). 
 
 2. Deflection. When a temporary molar is retained too 
 long or its root is not absorbed as fast as the bicuspid is erupted, 
 this obstacle may deflect the bicuspid or cause it to rotate more 
 or less upon its axis, being favored by the spongy character of 
 the alveolar process (Fig. 185). 
 
LOCAL TEETH IRREGULARITIES UPPER JAW. 337 
 
 3. The forward movement of the molars necessarily dimin- 
 ishes the space left for the bicuspids and cuspids and when the 
 first bicuspid and cuspid erupt before the second bicuspid, this 
 may be crowded out of its proper place. 
 
 4. A rotation of a bicuspid from a want of proper occlusion 
 is not rare. An examination of the grinding surface of the bicus- 
 pid shows that it is designed to articulate with an opposing 
 tooth. When its two cusps fail to find an opposing cusp to keep 
 them in place its function is lost and its fixedness of position 
 endangered. 
 
 Frequently more than one of these causes are at work or 
 one implies another. Thus, if there is accord between the size 
 of the jaw and that of the teeth, some of the local causes cannot 
 
 Fig. 185 
 
 arise ; the cuspid may erupt before the second bicuspid with- 
 out disarranging the arch and a bicuspid may be deflected by a 
 deciduous root and ultimately move into place unless crowded 
 upon by a six-year molar. Rotation may be the result of a 
 crowded condition, throwing the tooth out of the arch when 
 proper occlusion is out of the question. 
 
 As the first bicuspid erupts before the second it has the 
 advantage of such space as there is. It may be crowded out of 
 place by the forward movement of the six-year molar together 
 with the premature eruption of the cuspid. Permanent deflec- 
 tion due to the retention of a deciduous root is out of the ques- 
 tion vvhen^ there is sufficient space, but rotation upon its axis from 
 want of proper occlusion may occur here as elsewhere. 
 
 23 
 
338 IRREGULARITIES OF THE TEETH. 
 
 The posterior surface of the bicuspid touches the first cuspid 
 only at one point, being an angle and not a surface, and this is 
 a fruitful source of irregularity. 
 
 Irregularities first attracted attention by the deformity they 
 produced, not by their interference with function. Overcrowded 
 anterior portions of the arch and displacement of individual 
 teeth were noticed. It was long ere the results of injudicious 
 extraction were observed. The first permanent molar was ruth- 
 lessly destroyed until comparatively recent times, producing a 
 large proportion of irregularities in the form of malocclusion. 
 This loss of function was produced so gradually that the patient 
 was not aware of it. He might notice inconvenience in mastica- 
 tion, but did not attribute it to the cause, since even persons 
 of great intelligence know but little about occlusion of their 
 teeth. 
 
 This tooth has hitherto been sacrificed for two reasons: 
 (i) Its early decay, brought about by the tax upon the system 
 of the growing child and the neglect from which the teeth sufifer, 
 particularly during the period of its development. The parent 
 usually did not know of its existence until the child complained 
 of toothache. (2) It has been extracted to correct an over- 
 crowded arch. 
 
 When removed to stop pain, the pain is indeed relieved by 
 extraction, but leaves in its train many evils. When removed 
 to correct a crowded arch, twice as much space is gained as 
 desirable. The crowded arch is not relieved, as the cuspid, 
 because of the length and strength of its root, remains station- 
 ary, while the bicuspids move back singly or in pairs, leaving 
 the position of the incisors unchanged. The disastrous effects of 
 extracting the first molar become apparent when its function is 
 understood. 
 
 As Dr. J. E. Cravens,^ of Indianapolis, has remarked, "The 
 first permanent molar has four distinct functions : (i) To sup- 
 ply additional surface for mastication when development has 
 progressed so that the deciduous molars, unaided, are no longer 
 competent to meet the requirements of nature. (2) To support 
 the crowns of the deciduous molars when they have become 
 
 1 Annual Universal Medical Science, 1888. 
 
LOCAL TEETH IRREGULARITIES UPPER JAW. 
 
 339 
 
 unstable, because of absorption of their roots to accommodate 
 the advance of their immediate successors — the bicuspids — 
 which are usually erupted between the ninth and the eleventh 
 years. The deciduous molars begin to loosen six to twelve 
 months before their final displacement. Should a permanent 
 first molar be extracted early — say between the seventh and 
 eighth years — the "deciduous molars supported by it would loosen 
 prematurely so as to be unserviceable for mastication and per- 
 haps be lost six to twelve months before the eruption of the 
 succeeding bicuspids. (3) To guide the second bicuspid into 
 position in event of a loss of this molar previous to eruption 
 of the second bicuspid, the latter is liable to erupt back of its 
 true position, or after erupting normally to float backward along 
 the ridge of the gum, inclining posteriorly in such a manner as 
 
 ijifliijllliiiliiiiiiiiiiiliiiililliiiilliiiiiiiiijii lllljiiililiiiiljiiliillil lH^ 
 
 Fig. 186. 
 
 seriously to impair its efifectiveness as a masticating organ. This 
 is particularly the case in the inferior maxilla. (4) To induce 
 additional development of the horizontal portion of the lower 
 jaw, immediately anterior to the ramus, in order to make easier 
 the eruption of the permanent second molar and to prevent the 
 well-known tendency of the latter to tip forward, thus weakening 
 the support of its roots and impairing its value as a grinder. 
 
 The first permanent molar is supposed by many observers to 
 exercise an important influence in establishing a proper angle to 
 the inferior maxilla. If such idea is correct (and several condi- 
 tions indicate that it is) it adds possibly another to the already 
 long and important list of the functions pertaining to this 
 tooth." 
 
340 ^ IRREGULARITIES OF THE TEETH. 
 
 The wholesale extraction of the first permanent molar in the 
 past, no doubt arrested development of the alveolar process as 
 well as of the maxillary bones, since development of the process 
 and jaws depends largely on the function of the teeth, their artic- 
 ulation and their motion stimulating nutrition and enlarging the 
 arch. 
 
 Some dentists with a skill the result of routine rather 
 than knowledge, are still extracting four sound molars without 
 the least thought of the consequences. Such a one, who was 
 practicing in a southern parish not many years ago, was in the 
 habit of taking out the first permanent molar in every instance. 
 The result was, he claimed, "that all the people in that part 
 of the country possessed good, regular teeth and that an irregu- 
 larity was the exception." I have after observed the want of 
 development of the alveolar process and sometimes the jaws 
 from the extraction of those teeth. This also occurs in cases 
 where the germ has not developed and the tooth is missing. 
 More marked instances are those where three or four germs 
 are wanting. The loss of a tooth performing such a work as 
 the first permanent molar impairs mastication and produces 
 vicious occlusion and is detrimental to the contour of the face. 
 
 When extracted before the second molars erupt, one-half 
 or more of the grinding surface of the teeth is lost. The nutri- 
 tion of the patient suffers in proportion and health may be 
 seriously impaired because of inability to masticate food prop- 
 erly. The horizontal portion of the lower jaw is but imperfectly 
 developed because function, one of the most important means 
 of development, is lost and insufficient room is left for the second 
 and third molars. 
 
 When the jaw with deciduous teeth is compared with one 
 having permanent teeth, there is noticeable a difference in the 
 length of the rami and bodies, and a still greater difference in 
 the angles. This difference results from the gradual separation 
 near the angle and is due to the growth of the molars. The 
 arches of the permanent set are separated posteriorly by the 
 eruption of the first permanent molar. When these molars are 
 lost before the second molars are in place, the characteristic 
 angle of the jaw becomes less marked. The loss of this molar on 
 
LOCAL TEETH IRREGULARITIES UPPER JAW. 341 
 
 one side only will produce asymmetry of the two sides of the 
 face, noticeable to the trained eye the parallelism of the two 
 arches having been disturbed. If the two be lost early the jaws 
 approach each other more than normally near the angle, throw- 
 ing the force of mastication forward. As the first and second 
 bicuspids do not erupt until the tenth or eleventh year, and the 
 deciduous molars loosen six to twelve months before they are 
 displaced, the child is forced to masticate its food for several 
 years on a portion of the arch designed for other purposes, com- 
 pelling these teeth to perform the unnatural function of grinding. 
 This confusion of functions has imperfect results and changes 
 the facial outline of the face. 
 
 ^— *G--s!£\ .^_i^ : Fig. 187. 
 
 As the first permanent molar erupts it acts as a fixed point 
 separating and holding the jaws somewhat throughout their 
 entire extent in front, as well so as to make room for the grow- 
 ing incisors. The deciduous incisors being very much shorter 
 than the permanent ones, necessarily have a shorter bite. When 
 the first permanent molar is lost the natural bite is shortened, 
 for this molar acts as a force which lengthens the arches back- 
 ward and also separates them verticallv. 
 
 When this tooth is lost the lower permanent incisors as they 
 develop strike with greater force against the upper and are 
 carried forward. The change at first is imperceptible, but in the 
 course of time these teeth will be found spreading more or less 
 like a fan. Though the organic relation of the upper and lower 
 jaw is not apparent at first as that of other organs and the twq 
 
342 
 
 IRREGULARITIES OF THE TEETH. 
 
 jaws seem to enjoy greater independence, proper occlusion is 
 indispensable to their health and the teeth in the lower arch are 
 forced out of their sockets by a deposit of osseous material not 
 consumed through proper function. 
 
 Naturally bicuspids tend to move forward because of the 
 inclination of the root and the angle formed by the two jaws, 
 which makes the teeth strike at an angle as well. This tendency 
 usually prevents them from moving back, even if the first molar 
 is extracted. When the cusps are long they usually retain their 
 natural articulation, but sometimes, as has been pointed out, 
 they move backward. They may move back separately or 
 may drop back together (Fig. i86). This dropping back destioys 
 the articulation, causing the opposing teeth to strike only at 
 
 Fig. 188. 
 
 certain points, instead of bringing surfaces in contact and fre- 
 quently partial rotation upon their axes results. 
 
 The most ordinary result of the extraction of this tooth, as 
 Dr. Davenport^ has shown, is the forward movement of the 
 second and third molars (Fig. 187), causing these to tip forward 
 and resulting in vicious articulation. Externally the articula- 
 tion may appear not to have sufifered, but when it is examined 
 inside of the arch, it is found that the opposing teeth meet only 
 at certain points, becoming thereby partially useless. Fig. 188 
 shows the forward movement of the first permanent molar. The 
 temporary molars on the right side are in place, thus holding 
 
 2 Dental Cosmos, July, 1887. 
 
LOCAL TEETH IRREGULARITIES — UPPER JAW. 343 
 
 the first permanent molar in place; while on the left side the 
 temporary molars have been extracted and the first molar has 
 moved forward one-fourth of an inch. The force of mastication 
 and the direction of the roots, together with the eruption of the 
 second molar, increases this tendency. 
 
 Length of the rami body, depth of sulci of masticating sur- 
 face and local irregularities of the teeth in front, may so modify 
 the occlusion as to result in bilateral asymmetry and the degree 
 of tipping forward may be quite unlike. 
 
CHAPTER XXVII. 
 
 LOCAL CAUSES OF TEETH IRREGULARITTES— 
 LOWER JAW. 
 
 The upper and lower jaw are, as already pointed out, distinct 
 in character, function and course of development. 
 
 The upper jaw, when normal, describes a portion of a lareei 
 circle, the teeth overlapping those of the lower. It is fixed nnd 
 depends for its function on the activity of the lower. Owing 
 to this immobility, irregularities are more markedly constitu- 
 tional in type. Thus, the various abnormal arches not seen in 
 the lower, the high and narrow vault and the inward curvature 
 
 1 
 
 Fig. 189. 
 
 iig. i!JU. 
 
 of the alveolar processes occur. The upper jaw has a greater 
 sweep of development and consequently greater possibility of 
 irregularity in its anterior columns as these are unrestricted. 
 The lower is restrained by the overlapping of the upper teeth. 
 The lower jaw is hung loosely, but firmly by its condyles, permit- 
 ting motion in three directions — antero-posterior, vertical and 
 lateral. 
 
 In Fig. 189, the six anterior inferior incisors are shown. The 
 points of contact are at their cutting edges, the mesial and distal 
 surfaces being rounded which enables them to crowd easily past 
 each other when force is applied. The roots are flattened at 
 their sides, so that when pressure is brought to bear upon them 
 they move with readiness over a considerable distance. That 
 pressure cannot well be exerted in a straight line through the 
 posterior column and from thence extend in a curve through the 
 
 344 
 
LOCAL TEETH IRREGULARITIES — LOWER JAW. 
 
 345 
 
 anterior teeth, from the law of simple forces, which act in straight 
 lines only. The cuspid, finding no resistance in front, but being 
 resisted by the incisors slightly at the side, necessarily pass for- 
 ward. The lateral is too weak to afTord resistance. Even if the 
 centrals could be acted upon by the pressure from behind, they 
 would not be prevented from assuming a V-shape by the over- 
 lapping incisors above, since the more the upper arch is com- 
 pressed laterally and the mesial angle of the central is turned out- 
 ward, the more will the distal angle be turned inward, and thus 
 confine the lower incisors. 
 
 The narrowness of the lower incisors as compared with the 
 upper favors this tendency. These conditions are necessarily 
 modified by the local peculiarities of the upper arch, relative 
 
 i'lK. I'.tl. 
 
 tig. 11« 
 
 str?!-!gth of teeth and nature of occlusion being all important 
 factors in determining final results. 
 
 In Fig. 190 is a normal lower maxilla. The line a b, passing 
 through the cuspids, bicu?''Ids and molars, shows the direction 
 of the force exerted by t'he posterior column upon the anterior. 
 For growth the lower jaw depends far more upon function than 
 the upper. Tl e growth of the lower jaw is limited to the pos- 
 terior coluiiMi. This is accomplished by absorption of the 
 aniero-posterior border. The freedom of motion is retarded 
 by the arch of the upper, for which reason irregularities are 
 much rarer in the lower than the upper jaw, since overlapping 
 of the upper teeth tends to correct predisposition to mal arrange- 
 ment. 
 
 Irregularities of the lower jaw result more from local causes 
 than those of the upper except such as are found in the under- 
 hung jaw. Its development depends largely on mastication. 
 
346 
 
 IRREGULARITIES OF THE TEETH. 
 
 Owing to its movements there are fewer irregularities in this 
 maxilla and the jaw is more apt to be normal. Irregularities 
 back of the cuspids are very rare. Occasional contractions of 
 the lower arch occur, dipping in, is due to peculiarities of occlu- 
 sion. When cases of irregularity exist, they are generally found 
 in mouths, the lower arch of which exceeds the upper in diam- 
 eter, thus permitting less firm interlocking and greater freedom 
 of individual teeth. 
 
 When the diameter of the -circle of the teeth of the lower jaw 
 exceeds that of the upper, its lateral movement causes an 
 enlargement of the upper circle by opening the median suture, 
 this condition being indicated by the spreading of the superior 
 central incisors. As has been shown in the chapter on migration 
 of teeth, twisted bicuspids often result from entire want of occlu- 
 
 Fig. 193. Fig. 194. 
 
 sion, or the touching of two opposing teeth at only one point. 
 The most frequent form of irregularity is a crowding of the 
 incisors. This is generally the case where the size of the teeth , 
 and the jaw are not in harmony. It is due to two causes : (i) 
 The teeth of the lower jaw are forced inward by occlusion, the 
 diameter of the circle of the upper teeth being usually the 
 smaller ; (2) The forward movement of the posterior column. 
 
 The two halves of tlie lower arch, like those of the upper 
 for obvious reasons do not present the same forms of irregu- 
 larity. Like the upper jaw, the lower is subject to forward 
 movement of the posterior column. A want of harmony in the 
 development of upper and lower maxillae produces a crowded 
 condition of the lower arch, resulting in pressure upon the 
 anterior column. 
 
LOCAL TKETH IRREGULARITIKS LOWER JAW. 
 
 347 
 
 The direction of the roots of the lower molars greatly 
 increases this tendency. When the crowns of the second and 
 third molars are erupted, the first molar is pushed forward. The 
 pressure is exerted principally through the posterior column 
 upon the cuspid and is in a straight line. This tooth, by virtue of 
 its rounded cusp, slips by the lateral and is projected forward 
 often beyond the central incisors, leaving the lateral behind. 
 
 Like the upper maxillae the two halves of the alveolar arch 
 are separate and are modified independently. An irregularity 
 on one side by no means indicates a similar irregularity on the 
 other, owing to the difference of pressure that may be exerted. 
 
 In Fig. 191 the left dental arch is seen to be normal, but the 
 
 Fig. 195. 
 
 forward movement of the posterior column has caused the right 
 lateral to fall behind. As the two columns converge anteriorly 
 they exert their pressure in this direction, in consequence irregu- 
 larities of the lower jaw are confined for the most part to the 
 region of the incisors. 
 
 Though the laterals are generally pressed within, while the 
 centrals occupy their usual position, these teeth may stand at 
 various angles determined by local peculiarities of the teeth of 
 the upper maxilla. Thus it may happen that a cuspid or a lateral 
 may strike outside of its antagonist of the opposite jaw. 
 
 In Fig. 192 a common form of irregularity, in which both 
 posterior columns have moved forward. The laterals are 
 crowded backward and inward. The lines of force are also 
 directed inward, but a V-shaped arch is prevented by the lower 
 
348 IRREGULARITIES OF THE TEETH. 
 
 centrals striking against the palatal surfaces of the upper cen- 
 trals. If the cause of this form of irregularity be borne in mind 
 it will be understood why extraction of a lower lateral or central 
 renders this irregularity worse, inasmuch as it disarranges ccclu- 
 sion of the cuspids. 
 
 In Fig. 193 the right dental arch is normal. The left posterior 
 column has pushed against the lateral and, meeting with sufficient 
 resistance, the central is carried backward. While erupting, 
 the central was carried inward, owing to a want of harmony of 
 development. Two centrals have been found directed inward, 
 though this form of irregularity is rare. 
 
 In Fig. 194 the left dental arch is normal. The forward 
 movement of the posterior column on the right side has caused 
 the cuspid to advance beyond the line of the incisors. The 
 rotation of the cuspid upon its axis caused it to pass by the 
 
 Fig. 196. 
 
 lateral, leaving it in position. This is a common form of irregu- 
 larity. Occasionally the cuspid is carried forward in the direction 
 of the pressure. Such a case is illustrated in Fig. 195. The left 
 lateral has been carried inward in the manner already described. 
 The posterior column has pushed the cuspid on the right side 
 laterally so that it occupies the position of the right lateral and 
 the bicuspid is carried forward and outside of the arch. 
 
 The cuspid erupts in line with the other anterior teeth unlike 
 the upper, the crypt of which is above and outside of the lateral 
 incisor and bicuspids. For this reason and the fact that the 
 upper cuspid tends to keep it in position by occlusion, irregu- 
 larities of the cuspid of the lower jaw are not so common as 
 those of the upper. When the tooth is found out of line, it is 
 anterior to its normal position — rarely, if ever, posterior. Its 
 eruption may be tardy, giving the advantage ot time to the upper 
 cuspid and directing the lower cuspid outward. In a crowded 
 jaw, disarrangement pf the incisors ma^ follow, leaving th^ 
 
LOCAL TEETH IRREGULARITIES — LOWER JAW. 
 
 349 
 
 lateral almost directly behind the cuspid, as in Fig. 195. When 
 there is malposition of the cuspid on one side of the maxilla, 
 the cuspid of the opposite is usually pushed forward, as seen 
 in the same illustration. 
 
 Owing to malposition of the germ, the cuspid may be 
 found outside of the incisors in the median line (Fig. 196), or 
 even inside of the arch (Fig. 197). Rarely it is found on the 
 median line between the incisors, as shown in this illustration. 
 
 Like the cuspid, the position of the bicuspid is most fre- 
 quently afifected by the forward movement of the posterior col- 
 umns. Irregularity in a lateral direction is rare, since density 
 of the lower maxilla is unfavorable. 
 
 If a bicuspid be found without or within the arch, its position 
 is due to undue retention of the temporary teeth. In Fig. 198 
 
 Fig. 197. 
 
 the second bicuspid is situated inside the arch, while in Fig. 199 
 the first bicuspid is inside and the second bicuspid outside of 
 the arch. Twisted bicuspids occur frequently from want of 
 proper occlusion, when the space yielded by the lower jaw is 
 larger than that of the upper, or when the first molar is extracted. 
 
 When the second temporary molar is retained too long, the 
 first permanent molar may be pushed forward, thus confining 
 the bicuspid and preventing it from erupting. 
 
 That teeth move when acted upon by external force is well- 
 known, and the fact is utilized in operations for producing tem- 
 porary separations in regulating and the like. Why they should 
 move from their normal positions without any apparent cause 
 is not very easy to explain. When the arch of the alveolar process 
 is greater than that of the combined diameters of the teeth, 
 there must be space or spaces somewhere. This space is usually 
 equally distributed among the anterior teeth. Sometimes, how- 
 
350 IRREGULARITIES OF THE TEETH.l 
 
 ever, spaces are found that disfigure the mouth and besides one 
 or more teeth appear to have rotated upon their axes. 
 
 These motions are best considered under two heads : (A) 
 Perfect occlusion ; (B) proper relation between waste and repair. 
 
 (A) If the occlusion of the teeth be perfect, so that each 
 tooth is kept in place by its adjoining neighbors and the opposing 
 tooth, dislodgment is impossible. Each tooth should touch 
 that adjoining them at the extremities of their greatest diameters. 
 This allows a slight lateral motion. 
 
 Good occlusion differs according to the function of different 
 teeth. The upper and lower incisors overlap each other, pro- 
 ducing what is termed the overbite. In the normal relation 
 they strike in a straight line, which passes through their roots. 
 
 Fig. 108. 
 
 The curved lingual surface of the upper incisors allows for their 
 sliding into this position. The force being thus exerted in 
 straight lines there is constant tendency to keep them in position 
 and as the pressure is upward and downward vertical spread- 
 ing of the upper incisors is impossible. The relation of cuspids 
 is similar. Quite otherwise with bicuspids and molars. Begin- 
 ning with the bicuspids the cusps of the first superior bicuspid 
 are found striking not over that of the first lower bicuspid alone, 
 but over the angles formed by the distal side of the first lower 
 and mesial side of the second. Each tooth beginning at this 
 point is not only in relation to one below, but to two. When 
 one of these teeth is extracted the order of the mouth is dis- 
 turbed and r' arrangement of some kind usually follows. What 
 this will be diipends on a variety of circumstances. 
 
LOCAL TEETH IRREGULARITIES — LOWER JAW. 
 
 351 
 
 A typical example is furnished by the extraction of the first 
 molar. The forward movement of the second molar follows 
 as a consequence. A tilting forward of this tooth results. The 
 reason for this is obvious. The posterior cusp of the first upper 
 molar strikes the anterior cusp of the second lower and exerts 
 its whole force, which was meant to be distributed on both cusps. 
 
 (B) The position of the teeth alone does not determine the 
 relative size of the maxillae and the occlusion of the teeth. Nutri- 
 tion and absorption, waste and repair play an important part. 
 On perfect harmony of these, beauty and health of the teeth 
 depend. Changes in the position and removal of bone-cells con- 
 stantly vary with age and other physical conditions of the patient. 
 
 Fig. I'.iO. 
 
 This disposition and removal of bone-cells is seen in the changes 
 that the lower maxillse undergo during the different periods of 
 life. When the deciduous teeth are replaced by the permanent 
 ones, the arch of the jaw becomes more pronounced and there 
 is a lengthening of the alveolar ridge backward to accommodate 
 the molars. When the senile changes take place the angle of the 
 jaw becomes more obtuse. That there is a similar adjustment 
 to circumstances going on constantly is proven by circumstances. 
 Correction of irregularities depends on this. The position of 
 the teeth in the alveoli is determined solely by the tissues around 
 it. By producing a pressure in a given direction bone-cells may 
 be removed on one side and others deposited on the other, and 
 the position of the tooth changed. The change in the deposit 
 
352 
 
 IRREGULARITIES OF THE TEETH. 
 
 and removal of osseous matter is not unlike that of the deposit 
 of particles of earth in the bed of a river, where stakes have been 
 placed for the purpose of locating the bed of the river. By 
 successive deposit and removal of these particles the position of 
 these may be changed and even the current of the river. Similar 
 changes in the contour and density of the alveolar processes 
 occur, depending on the changes of blood supply and absorption. 
 Irritation may thus stimulate the activity of the capillaries to a 
 more than ordinary degree of repair. 
 
 Every tooth exerts a pressure of its own in different direc- 
 tions. Were this not so it would be dilificult to account for the 
 elongation of a tooth when its opponent is extracted. This pres- 
 
 sure is healthy and implies the antagonism of opposing teeth. 
 If this occlusion is wanting, the relation of waste and repair is 
 disturbed. Excess of bone-cells is often deposited as a result. 
 
 When these two fundamental laws of good occlusion and 
 balanced waste and repair are violated, one of the three following 
 conditions follows: i. Movement of individual teeth in straight 
 lines. 2. Rotation of individual teeth upon their axes. 3. For- 
 ward movement of groups of teeth and the alveolar processes 
 supporting them. 
 
 When alveolar processes and teeth correspond in size and 
 the occlusion is good, as already stated, spaces between the teeth 
 are out of the question. Sometimes a space is found between 
 the central incisors. If the occlusion be good otherwise, this 
 space is due to continuance of growth at the margin of the 
 
LOCAL TEETH IRREGL^LARITIES — LOWER JAW. 
 
 353 
 
 suture. There is a greater deposit of osseous material than is 
 needed, producing a larger diameter of the jaw than the teeth. 
 This begins, usually, at an early period in life and continues till 
 the growth of the osseous system has ceased. As the jaw devel- 
 ops in the child while the temporary teeth remain, it is but 
 natural that spaces should be formed in time until the permanent 
 teeth take their place. 
 
 Spaces may be artificially created gradually by forcible separ- 
 ation by wedges. In former years, when more force was applied 
 by dentists, irritation was created and absorption on one side 
 induced. In this way several teeth were sometimes crowded in 
 one direction. When the anterior incisors do not strike on a 
 line, but at an angle so that the cutting-edges of the lower 
 incisors strike against the inclined plane of the lingual surface of 
 
 Fig. 201. 
 
 the upper incisors, outward pressure is exerted and the incisors 
 separate. The spaces so frequently seen in the permanent 
 incisors in children are produced by tardy eruption of the 
 cuspids. When the cuspids come down into place these spaces 
 disappear. Spaces are rarely, if ever, observed between molars. 
 Again, the lower jaw, if too large for the upper jaw, may act 
 as a wedge and by striking against it may spread the central 
 suture. The spaces between these teeth are usually found to be 
 healthy. It is not reasonable to suppose that either salivary 
 or germinal calculus or inflamed gums could produce this 
 motion. Were the pressure exerted on one side only there 
 might appear to be some ground for this supposition, providing 
 the calculus exerted a pressure too great for the rest of the 
 teeth to resist. But when calculus is deposited on both sides 
 the pressure exerted would be counter-balanced and lateral 
 motion could not take place. Those who hold this opinion are 
 
 24 
 
354 IRREGULARITIES OF THE TEETH. 
 
 probably misled by the fact that a tooth may be dislodged by 
 calculus from its socket vertically. In this case the calculus 
 diminishes the diameter of the socket and the wedge-shaped root 
 is forced out. 
 
 When a tooth touches its opposites only at one point, or the 
 opposing tooth was extracted as it frequently happens with 
 bicuspids, instead of articulating with surfaces, rotation may 
 result. In this case bone-cells are deposited on one side, while 
 those at an angle with these are removed. This produces a 
 slight rotation which twists the tooth. That this process is physi- 
 ologic is proven by the healthy state of the gums and alveolus, 
 which is found in most of these cases. In Fig. 200 is seen not 
 only the rotary motion to the bicuspids, but also spontaneous 
 motion in direct lines — a condition frequently observed. 
 
 In young persons when the blood supply is rich with nutri- 
 
 tious material and when waste and repair go on rapidly, four 
 and sometimes six anterior teeth and alveolar processes are car- 
 ried forward. This proper occlusion with the inferior incisors 
 becomes impossible. These become elongated, and, failing to 
 find support in the upper incisors, strike against the roof of the 
 mouth. Irritation is produced and an excessive flow of blood 
 to the parts follows. 
 
 One of the most interesting forms of irregularity thus result- 
 ing, is that in which the inferior incisors impinge upon the 
 mucous membrane of the mouth and the superior centrals, 
 laterals, cuspids and bicuspids, having moved forward, project 
 to such an extent that the upper lip cannot close over them. 
 
 These cases, while found in normal individuals, occur also 
 among idiots, deaf-mvites, the blind and insane. The deformity, 
 not seen in temporary teeth, is confined to the permanent set, 
 beginning at the seventh or eighth year and increasing with age. 
 
LOCAL TEETH IRREGULARITIES — LOWER JAW. 
 
 355 
 
 When not corrected the teeth will finally project at an obtuse 
 angle. In a woman fifty-five or sixty years of age the teeth will 
 project almost horizontally. The vault connected with this 
 irregularity, usually low, is sometimes high. In this case it is 
 more pronounced; just as V and saddle-shaped arches are more 
 pronounced when associated with a high vault. Irregularity 
 begins at the central incisors, extending backward. Generally 
 later in life tartar collects around the roots and interstitial gingi- 
 vitis sets in, exaggerating the condition. 
 
 In the majority of cases the superior maxilla is arrested. The 
 teeth project at an angle of 20 degrees, carrying the alveolar 
 process wnth them so that they strike over the lower incisors. 
 
 Dr. Kingsley (who first described this form of irregularity) 
 correctly claimed that this condition is neither inherited nor the 
 
 Fig. 303. 
 
 result of thumb-sucking. The conditions under which this 
 irregularity is brought about are both constitutional and local. 
 Excessive proliferation of bone-cells does not begin before the 
 sixth or seventh year, hence, not until the permanent teeth are 
 erupted. A want of balance of nervous function, resulting from 
 neurotic conditions or a transmitted tendency to disease, may 
 interfere with the centers of ossification. This interference, as has 
 been shown, frequently finds expression in the anterior part of 
 the mouth, sometimes producing a high vault, contracted arches, 
 excessive or deficient deposition of bone-cells. The conditions 
 are mostlv confined to neurotics and degenerates. Excessive 
 proliferation of bone-cells near the median line of the superior 
 alveolar process tilts the axes of the erupting centrals slightly 
 outward. This direction once being given to them, when the 
 
356 
 
 IRREGULARITIES OF THE TEETH. 
 
 lower incisors strike against them they do not find resistance of 
 correct occlusion, but act as upon an inclined plane, throwing 
 them out more and more during the process of eruption. This 
 must necessarily terminate in striking the process itself ; the 
 increased activity of nutrition which irritation sets up results in 
 excessive development, which in itself is an evidence of degen- 
 eracy. The tilting forward of the upper incisors increases the 
 distance between them, and the lower incisors do not find the 
 resistance belonging to natural function. The consequence is 
 the elongation of the lower anterior alveolar arch. Eruption of 
 the first permanent molars determines the relation of the jaws to 
 each other. Occasionally, however, they do not develop their 
 
 Fig. 204. 
 
 full length. In either case the lower incisors strike against the 
 mucous membrane of the roof of the mouth, which constant 
 irritation stimulates deposition of the bone-cells in the process. 
 Were occlusion correct, constant pressure on the roots of the 
 teeth would, in part, conterbalance excessive deposit by waste. 
 As it is, the roots of the upper incisors form an angle with the 
 cutting-edge of the lower teeth and as the mouth opens and 
 closes, the force of the lower incisors is not only spent on the 
 superior process, but also through it on the roots of the upper 
 teeth, forcing them out more and more. In Fig. 201 is seen 
 the starting-point. The central incisors have just commenced 
 to move forward, in the mouth of a girl eleven years of age. 
 
LOCAL TEETH IRREGULARITIES — LOWER JAW. 357 
 
 The trouble is extended to the neighboring teeth from the nature 
 of the occhision. In Fig. 202 the incisors and alveolar process 
 are seen carried forward by excessive deposition of bone-cells. 
 By action of the lower lip, which cannot close over the cutting- 
 edges of the upper teeth, but soon gets between the superior and 
 inferior incisors, the former are pressed out still more. Fig. 203 
 shows a side view of this irregularity. In Fig. 204 is seen a 
 remarkable migration of the molars. 
 
 Want of fimction encourages deposit of lime salts around the 
 roots of the teeth, inducing interstitial gingivitis later in life 
 and loosening the teeth. 
 
 A common dental irregularity resultant on extraction is elon- 
 gation of the teeth on the opposite jaw (Fig. 203). To remain 
 in position and to retain a healthy alveolar process, teeth must 
 have resistance power. If two teeth be extracted upon one jaw, 
 in tooth or teeth on the opposite there is no occlusion when 
 the jaws are closed. In a sense these teeth become foreign 
 bodies. In reality they come under the suppressive economy 
 of growth (loss of the function of mastication). Owing to tran- 
 sitory nature of the alveolar process, interstitial gingivitis sets 
 in and about the roots of the teeth. 
 
 Deposition and absorption of bone results from both normal 
 processes (as in development of the skeleton) and from irrita- 
 tions (the deposition and absorption of bone about a fracture). 
 Inflammation in the alveolar process about the root or roots of 
 the teeth under favorable conditions likewise build up or absorb 
 the alveolar process. Bone building produces lengthening of the 
 teeth. Interstitial gingivitis frequently becomes permanent. 
 Pyorrhoea ensues with deposits upon the roots as a result of 
 bone absorption. 
 
CHAPTER XXVIII. 
 
 LOCAL CAUSES OF TEETH IRREGULARITIES— 
 FINGER-SUCKING. 
 
 Elsewhere reasons have been given why the high vault and 
 the V and saddle-shaped arches cannot be ascribed indiscrimin- 
 ately to thumb-sucking, as has been the custom. 
 
 The greatest confusion of ideas has been current among 
 practitioners as to the etiologic differentiation of these cases. 
 The conditions due to thumb-sucking should be so described 
 that the student is aided in making a diagnosis. In cases of 
 irregularities, due to thumb-sucking, several teeth and the alveo- 
 lar process are often brought forward. Frequently spaces are 
 found between them so that they stand out more and more fan- 
 shaped. The vault, while it may be high, is usually low. The 
 
 Fig. 205. 
 
 teeth are frequently aflfected only on one side, the shape and 
 extent depending upon the direction of the force and the hand 
 employed in sucking. In the V-shaped arch the teeth are crowded 
 and point toward the center, owing to a force applied by the 
 posterior column and spent on both halves toward the median 
 line. The vault may or may not be arched. In the saddle- 
 shaped arch the teeth are crowded, except in cases due to hyper- 
 trophy, and they stand perpendicular. The vault may be high 
 or low. In cases of thumb-sucking, the teeth of the inferior 
 maxilla do not articulate properly with the upper and are often 
 turned inward, which is caused by the pressure of the thumb 
 upon the cutting-edges. The distinguishing feature of a case of 
 thumb-sucking, therefore, is the spreading of all or a part of 
 the anterior teeth and the lower teeth usually turned inwards. 
 
 358 
 
LOCAL CAUSES OV TEETH IRREGULARITIES. 
 
 359 
 
 \\'hen the vault is high it may be quite marked in the anterior 
 portion of the roof of the mouth. This is by no means a char- 
 acteristic feature. As the habit of thumb-sucking usually ter- 
 minates before eruption of the permanent teeth, cases of irregu- 
 larities resulting in children over ten years of age are rare. 
 
 Infants usually commence to suck their fingers within a few 
 hours after birth — in the majority of cases not later than the 
 first week. The habit is therefore well fixed before the tem- 
 porary teeth begin to erupt. This being the case, the teeth and 
 the alveolar process are naturally afifected in their development 
 if the pressure is continuous. The extent, shape and location 
 of the irregularity depends upon the hand employed and the 
 position of the thumb and finger used. The right or left side are 
 
 afifected according to the hand used, though occasionally it is 
 found in the median line. 
 
 As the child usually discontinues the habit before the time 
 of the eruption of the permanent teeth, deformities produced by 
 thumb-sucking are usually confined to the temporary set. 
 
 In Fig. 205 is shown the forward movement of the right 
 central and lateral incisor. The model was taken from an impres- 
 sion of the teeth of a little girl two and a half years of age. While 
 in the act of sucking, the right arm rested upon the breast and 
 the ball of the thumb was directed against the palatine surfaces 
 of the incisors which were carried forward. The child discontin- 
 ued the habit at four. \Miile the cutting-edges of the teeth have 
 been slightly pressed forward and a very slight impression has 
 been made on the alveolar process, none was made on the roots 
 
360 
 
 IRREGULARITIES OF THE TEETH. 
 
 of the teeth and consequently no deformity exists where the 
 germs of the permanent teeth are located. After the child dis- 
 continued the habit, the teeth soon returned to their natural 
 position, aided by the pressure from the lip. At this age absorp- 
 tion and deposition of bone-cells is so active that very marked 
 deformities are frequently corrected before the temporary teeth 
 are lost, providing the habit ceases in infancy. 
 
 In Fig. 206 is seen quite a different deformity. Here the 
 teeth are fully developed, but a marked deformity existing at 
 the median line. This case is that of a child six years of age. 
 The thumb was held in the mouth so that the teeth came in 
 contact with the thumb at right angles, preventing the develop- 
 
 ment of the alveolar process. The teeth of the inferior maxilla 
 do not articulate properly with those of the superior. This lack 
 of proper articulation is caused by the thumb having rotated 
 upon the lower teeth after the upper had closed upon them. 
 The hard palate was flat and normal, hence the pressure was 
 direct upon the teeth and the thumb did not come in contact 
 with the tissues of the mouth. When the habit continues dur- 
 ing the development of the permanent set, the deformity is more 
 marked because there is more leverage, as is shown in Fig. 207. 
 In the case illustrated the palate is flat and normal, showing the 
 pressure was direct upon the teeth and the thumb did not come 
 in contact with the tissues of the mouth. The superior jaw and 
 
I.OCAT, CAUSES OF TEETH IRREGULARITIES. 
 
 361 
 
 teeth are brought forward by absorption and deposition of bone- 
 cells, and the lower teeth and jaw are carried inward. 
 
 These cases arc so unlike those of any other form of irregu- 
 larity of the permanent set it would seem impossible to over- 
 look the cause. The alveolar process and teeth assume the shape 
 of the object or thing sucked. 
 
 In Fig. 208 is shown the front view of a case of thumb- 
 sucking. The teeth have developed their normal length. Arrest 
 
 Fig ii 
 
 of development of the superior alveolar process has taken place 
 similarly to Fig. 206. 
 
 In Fig. 208 is shown quite a protrusion and forward move- 
 ment of the superior incisors and alveolar process, the teeth 
 standing fan-shaped. The lower incisors are pressed inward and 
 crowded together. The space is greater on the right side than 
 on the left showing the right hand was used. Irregularities of 
 the permanent teeth, due to thumb-sucking, are rare. 
 
CHAPTER XXIX. 
 
 THE DEGENERATE TEETH. 
 
 The evolution of the primitive tooth from the lower verte- 
 brates and their dermal appendages illustrates physiologic p'^o- 
 cesses much ignored by practitioners. 
 
 Fig. 309. 
 
 The teeth, as noted elsewhere/ were primitiveU organs of 
 the skin which developed over the surface of the body. They 
 became dermal bones like those which went to furT.i part of the 
 skull elsewhere. 
 
 The placoid scales, which were dermal teeth n the shark, 
 
 Fig. 210. 
 
 helped out the deficiencies of the brain case. In vertebrate 
 evolution the cartilaginous scales were hardly suflficient to cover 
 the developing brain, etc. The teeth of sharks depart from the 
 primitive method, since they do not develop upon the surface, 
 but deep down in the tissue. This method of tooth formation, 
 
 1 Chapter on Development of the Teeth. 
 
 362 
 
THE DEGENERATE TEETH. 
 
 363 
 
 converting- epithelial cells without vascular supply into enamel 
 rods, is a degeneration in itself. A papilla forms in the dermis 
 which eventually becomes the dentine of the tooth. The epi- 
 dermis dips into the tissue below, enlarges and adds the enamel. 
 The debris resulting therefrom, observed in animals as well as 
 
 Fig. 211. 
 
 man. is a degeneration or are "abortive rudiments" of tooth 
 succession, as observed in sharks, some whales and reptiles. 
 Degeneration of structure in tooth formation, however, is more 
 worthy of attention than tooth evolution. The pulp of the 
 tooth obtains its shape and size to form the dentine. Calcifica- 
 
 FiR. 212. 
 
 tion of dentine proceeds from the periphery, while the blood ves- 
 sels and connecting tissue recede until finally when the root is 
 completely formed a minute opening is left for the passage of an 
 artery, vein and nerve. These not only supply nourishment to 
 the pulp of the tooth but also to the structure of the tooth. 
 The method of tooth formation, as compared with the original 
 
364 
 
 IRREGULARITIES OF THE TEETH. 
 
 placoid scales, is evidently a degeneration. Diseases which 
 ajffect the human body necessarily affect markedly, structures so 
 poorly nourished. Change in shape of the alveolar process and 
 neglect to keep the alveolar process healthy causes interstitial 
 gingivitis and endarteritis obliterans (thus preventing circula- 
 
 Fig:. 2n. 
 
 tion and nourishment of the teeth), removes the resistance, thus 
 furnishing a suitable medium for micro-organisms. 
 
 Interglobular spaces and defective enamel formation mark 
 tooth degeneration. 
 
 Tooth degeneration, or decay, at one period of stress (close 
 of the first dentition) or at a period of involution (normal senil- 
 ity) is a normal process, for the carrying out of which osteo- 
 
 Fig. 214. 
 
 Fig:. 215. 
 
 malaciary methods are provided. In polyphyodont animals this 
 condition of tooth degeneration is normally a continuous one, 
 since the teeth in these do not follow periods of stress. 
 
 Man at his present stage of evolution generally has twenty 
 teeth in his temporary and thirty-two in his permanent set. Any 
 deviation in number is the result of embr\^onic change occurring 
 between the sixth and fifteenth week for the temporary teeth 
 
THE DEGENERATE TEETH. 
 
 365 
 
 and the fifteenth week and birth for the permanent. The germs 
 of teeth which erupt late in Hfe and are (properly) called third 
 sets, of necessity appear ere birth, and are completely formed 
 at the beginning of the second year, although they remain pro- 
 tected in the jaw until late in life. 
 
 More than twenty teeth in the temporary or than thirty-two 
 in the permanent is hence an atavistic abnormality. 
 
 From a maxillary and dental standpoint man reached his 
 highest development when well-developed jaws held twenty 
 temporary and thirty-two permanent teeth. Decrease in the 
 numbers meant, from the dental standpoint, degeneracy, albeit it 
 
 Fig. 216. 
 
 might mark advance in the man's evolution as a complete being. 
 Marsh- points out that in the New Mexican lower eocene occur a 
 few representatives of the lowest primates, such as the lemu- 
 rarius and limnotherium, each the type of a distinct family. The 
 lemurarius, most nearly alHed to the lemurs, is the most gener- 
 alized primate yet found. It had forty-four teeth in continuous 
 series above and below. The limnotherium, while related to 
 the lemurs, had some affinities with the American marmosets. 
 A. H. Thompson,^ in discussing the "missing teeth" of 
 
 2 Vertebrate Life ( Proceedings American Association for Advance- 
 ment of Science, 1877). 
 • Dental Cosmos, 1894. 
 
366 
 
 IRREGULARITIES OF THE TEETH. 
 
 man, remarks that these researches of Marsh suggested and 
 subsequent studies aided the solution of the problem of the 
 origin of the extra teeth (known as supernumeraries) that some- 
 times occur in man. These, usually regarded as pure freaks, 
 like polydactylism, are, however, beautiful illustrations of ata- 
 vism, and demonstrate that man during his evolution from the 
 lowest primate has lost twelve teeth. These supernumerary 
 teeth assume two forms, — either they resemble the adjoining 
 teeth or are cone-shaped. While they rarely are exactly coun- 
 terparts, every tooth can be and is duplicated, as the following 
 illustrations show. Fig. 209 illustrates fairly well-formed dupli- 
 
 Fig, 21 
 
 cate central incisors, the normal incisors being outside the dental 
 arch. They are crowded laterally by the large roots of the 
 supernumerary incisors. Fig. 210 shows an extra right lateral 
 in a temporary set in the upper jaw; Fig-. 211, an extra right 
 lateral in the permanent set. Fig. 212 illustrates normally devel- 
 oped supernumerary cuspids, which are all grouped together 
 upon the right side, the bicuspids being also, duplicated on each 
 side; indeed, all but the molars are duplicated. Fig. 213 shows 
 supernumerary third molars easily demarcated from the 
 normal molars. The teeth, which fail to approximate their nor- 
 mal neighbors, assume the cone shape of the primitive tooth. 
 
THE DEGENKRATE TEETH. 
 
 367 
 
 The fact that the cone-shaped tooth, as a rule, is perfect in 
 construction, is found everywhere in the jaw, but especially in 
 the anterior and posterior part of the mouth, is of much value 
 in outlining tooth and jaw evolution, especially from degener- 
 
 Fig. 218. 
 Smale and Colyer. 
 
 acy aspects. The upper jaw being an integral part of the skull 
 and fixed, is of necessity influenced by brain and skull growth, 
 hence degeneracy is more detectable in it than in the lower. 
 
 The evolution of the jaw is towards shortening in both direc- 
 tions. This shortening will continue so long as the jaw must be 
 
 Fig. 219. 
 
 adjusted to a varying environment. The jaw of man having 
 originally contained more teeth than at present, lack of adjust- 
 ment to environment produces from the shortening, degeneracy 
 of the jaw and atavism of the teeth. While this may coincide 
 
368 
 
 IRREGULARITIES OF THE TEETH. 
 
 with general advances of the individual, it indicates that he is 
 not yet adjusted to his new environment. The shortening of the 
 upper jaw causes supernumerary cone-shaped teeth to erupt in 
 mass at the extreme ends of the jaw, as shown in the following 
 
 Fig. 220. 
 
 figures. Fig. 214 illustrates a cone-shaped tooth between the 
 two central incisors, forcing them out of position. Fig. 215 
 shows three supernumerary teeth ; a cone-shaped tooth between 
 the central, lateral, and cuspids out of position. The left per- 
 
 Fig 221 
 
 manent lateral is at the median line, another cone-shaped tooth 
 remains in the vault, while the supernumerary left lateral is in 
 place. As many as eight are at times to be observed in the 
 anterior vault. Posteriorly these teeth are most often noticed 
 
THK DEGKNERATE TEETH. 
 
 369 
 
 in connection with third molars, usually on a line with other 
 teeth, posterior to the last molar. Fig. 216 shows two super- 
 numerary cus])i(ls in the anterior and two in the posterior part 
 of the left ari-h ; the molars have been extracted Super- 
 
 ;yA. 
 
 A 
 
 Fig. 232. 
 
 numerary teeth are not confined to these localities, but may be 
 observed at any point in the dental arch. (Figs. 217 and 218.) 
 The primitive cone-shaped tooth is rarely observed in the lower 
 
 Fig. 223. 
 
 jaw. The mobility of the lower jaw prevents that maladjustment 
 to environment present in the upper. 
 
 The continual shortening in both directions of the jaw causes 
 the third molars frequently so to wedge in between the angle 
 of the jaw and the second molar that eruption, if possible, is 
 
 25 
 
370 
 
 IRREGULARITIES OF THE TEETH. 
 
 difficult. The third molar is often absent in the Caucasian races. 
 In forty-six per cent of six hundred and seventy patients it was 
 missing. Frequently its development is abortive. This tooth 
 in the struggle for existence seems destined to disappear. It is 
 
 Fig. 224. 
 American System of Dentistry. 
 
 more often absent from the upper than the lower jaw. When 
 absent or badly developed the jaw is smaller, and frequently 
 teeth irregularities, nasal stenosis, nasal bone and mucous mem- 
 brane hypertrophy, adenoids, and eye disorders coexist. Fig. 
 
 Fig. 225. 
 
 219 shows absence of the left third molar, with irregularities 
 of that side of the arch. In Fig. 220 both third molars are seen 
 to be missing, coincident with irregularities on both sides of 
 the arch. Anteriorly the lateral incisors are most often wanting; 
 fourteen per cent of the laterals were wanting in six hundred 
 
THE DEGENERATE TEETH. 
 
 371 
 
 and seventy patients. In the progress of evolution man has lost 
 one lateral upon each side of the mouth, and the second lateral 
 seems also destined to disappear. In Fig. 221 the left lateral 
 incisor has disappeared, and in Fig. 222 both lateral incisors 
 are absent. Not infrequently does it occur that centrals, cuspids, 
 bicuspids, and even molars are absent ; even their germs are not 
 detectable. Fig. 223 illustrates a cast showing three supernumer- 
 aries in the anterior part of the mouth and but two molars. The 
 
 Plfir. 226. 
 
 American System of Dentistry. 
 
 absence of teeth indicates lack of development of germs, due 
 either to heredity or defective maternal nutrition at the time of 
 conception or during early pregnancy. 
 
 Crescent-shaped, bitubercular, tritubercular, as well as all 
 deformed teeth tend to the cone shape. The malformation of 
 these teeth results from precongenital trophic change in dentine 
 development. It consists in dwarfing and notching the cutting 
 
 FiK. 22: 
 
 Fig. 229. 
 
 Fig. 228. 
 
 and grinding edges of the second set of teeth, a familiar example 
 of which is seen in the so-called Hutchinson teeth, usually 
 referred to a syphilitic etiology. Hutchinson's position has, 
 however, been more strongly stated than his words justify, since 
 he admits that in at least one-tenth the cases luetic etiology could 
 be excluded.'* 
 
 Lues only plays the part of a diathetic state profoundly affect- 
 ing the maternal constitution at the time of dentine development. 
 
 * American System of Dentistry. 
 
S72 IRREGULARITIES OF THE TEETrt. 
 
 While these teeth may be due to secondary result of lues, they 
 do not demonstrate luetic heredity. 
 
 In Fig. 224 are seen the teeth of an individual affected with 
 very marked constitutional disease. The degree of pitting will 
 depend, as a rule, upon the severity of the constitutional dis- 
 order. In the case just cited, however, although nutrition was 
 but slightly disordered, each tooth shows a tendency to conate. 
 Not infrequently are cavities extended completely through the 
 tooth. The cusps of the (permanent) first molars calcifying at 
 the first year are usually attacked also and arrested in devel- 
 opment, producing the cone shape. These data, together with 
 dates of eruption of the temporary and permanent teeth, furnish 
 an absolute basis for calculation as to excessive or arrested 
 
 
 Fig. 231. 
 
 development of tissue. Fig. 225 shows a very degenerate jaw 
 with cone-shaped malformed bicuspids. The right lateral is 
 missing, the cuspids are erupting in the vault, and the dental 
 arch is assuming a V-shape. The jaw as a whole shows marked 
 arrest in development. Fig. 226 shows "Hutchinson" teeth. 
 Were the first molars visible they would present marked con- 
 traction of the outer surface with a malformed center. 
 
 Figs. 227, 228, 229, 230, and the molars in Fig. 223 exhibit 
 malformations, assume the cone shape, and the center frequetuly 
 associated with this type of teeth. The coincidence in form 
 between "Hutchinson" and malformed teeth and those of the 
 chameleon demonstrates that tropho-neurotic change produces 
 atavistic teeth. Fig. 231 illustrates the tendency of human bicus- 
 
THE DEGENERATE TEETH. 373 
 
 pids (when there is no antagonism) to rotate one-fourth round, 
 thus again demonstrating the atavistic tendency towards the 
 teeth of the chameleon. Fig. 232 exhibits extreme atavism; 
 all teeth anterior to the molars are cone-shaped. The third 
 molars are missing and would probably never erupt. In Fig. 233 
 appears more marked atavism. The upper and lower anterior 
 are both cone-shaped and the superior first bicuspid exhibits 
 a tendency thereto. The right superior second bicuspid, second 
 
 Fig Zii 
 Smale and Colyer. 
 
 and third molars, the right inferior first and. second bicuspids, 
 second and third molars are missing. The same condition prob- 
 ably exists on the left side. The space in the upper jaw is due 
 to the insufficient width of the teeth. Alternation of teeth in 
 the upper and lower jaws is a reptilian feature. Fig. 223 fur- 
 nishes an excellent ilkistration of the principles hereinbefore 
 advanced. 
 
 In degenerate jaws the influence of the factors of the differ- 
 
 Fig- 233. 
 Smale and Colyer. 
 
 entiation theory are also demonstrated. Every tooth in the jaw 
 at one point or another may display rudimentary cusps. On 
 the incisors they are always to be found on the lingual surface. 
 
 Fig. 234 illustrates the centrals with two rudimentary cusps, 
 the laterals with one and the cuspids with one also. Fig. 235 
 represents cusps upon the lingual surfaces of the molars. The 
 cuspids are not unlike the lower bicuspids with a rudimentary 
 lingual cusp. 
 
 Thompson remarks that there is a gradation from central 
 
374 IRREGULARITIES OF THE TEETH. 
 
 incisors towards the bicuspids in evolution. This grading of 
 form is not observed in the passage from the cuspid to the 
 bicuspid in man. But it should be remembered that the cuspid 
 often presents a cingulum on the lingual face that inclines it 
 towards the bicuspid forms in lower mammals, like the mole, 
 and that the first premolar or bicuspid is then more caniniform, 
 the inner tubercle being much reduced. This inner tubercle is 
 very variable and erratic as to its position. It appears as far 
 front as the centrals and is often present on the lingual face of 
 the laterals of man. The lingual tubercle is very constant on 
 the first bicuspid of man and is well developed as the buccal. 
 But in some lower forms, as in the lemurs, it is quite deficient. 
 
 Fig. 2.34. 
 
 It attains the highest development only in the anthropoids and 
 man. Considering these stages of development, the grading 
 from the cuspid to the bicuspid forms was more gradual in the 
 earlier species than in the later, where the individual teeth have 
 taken on special development.^ 
 
 The skull of a degenerate girl, who died from tuberculosis 
 at thirteen years, has, among other stigmata, a cusp on the 
 external surface of a right inferior cuspid. This is a decidedly 
 strong point in favor of the differentiation theory. Another 
 strong point in favor of this theory occurs in Fig. 236, where 
 
 •> Dental Cosmos, May, 1894. 
 
THE DEGENERATE TEETH. 
 
 375 
 
 every tooth is present and a most remarkable display of cusps 
 occurs. The cusps upon the cutting and grinding edges are not 
 obliterated. Commencing with the left superior central incisor 
 three cusps are present with a rudimentary palatine cusp. The 
 laterals also show three cusps, while the cuspid has two very 
 distinct. The first and second bicuspids have tubercular cusps, 
 they being in line. The buccal cusps upon the molars two to 
 three and are still in position. The palatine cusps are worn 
 away. The same is the case upon the opposite side except that 
 
 Fig. 235. 
 
 the cuspid has cusps that have fused together, leaving a small 
 projection upon the mesial side and a rudimentary palatine cusp. 
 The cusp upon the third molar is lost. In another case (Fig. 218) 
 the primitive cone teeth are seen trying to shape themselves 
 into incisors. The lateral incisors, cuspids, and bicuspids are still 
 cone-shaped. The first permanent molar is fairly formed, while 
 the second molars are still in a primitive condition. The points 
 made by Osborn are fully demonstrated in the two last illustra- 
 tions, — namely, the triangular-shaped crowns and the levelling of 
 cusps. 
 
376 
 
 IRREGULARITIES OF THE TEETH. 
 
 There is abundant evidence to show that degenerate teeth 
 unite in twos, threes, fours, and fives, as indicated in the con- 
 crescent theory. These single cone-shaped teeth grow together 
 and form bicuspids and molars. The germs of any two normal 
 teeth may intermingle and unite ; not only are the crowns found 
 united with separate roots, but crowns and roots are united 
 throughout. 
 
 Figs. 237 and 238 show two superior central and lateral 
 incisors joined together throughout the entire length of crown 
 and root ; Fig. 239, two lower incisors are united throughout ; 
 
 Fig. 2.^(;. 
 
 Smale and Colyer. 
 
 Fig. 240 shows a cuspid with two roots ; George T. Carpenter, 
 of Chicago, has a right superior second bicuspid with three 
 well-formed roots ; Fig. 241 illustrates two bicuspids united at 
 the crowns ; Fig. 242 shows two molars perfectly united ; Fig. 
 243 illustrates central and lateral incisors of the permanent set 
 perfectly united; Fig. 244 shows two molars united; Fig. 245 
 a molar and supernumerary united, the supernumerary taking 
 the cone shape with deformed center. Fig. 246 shows three mal- 
 formed teeth, each conated and completely united. 
 
 It is not uncommon to find three molars united together, as 
 for instance the second, third, and supernumerary molar. C. V. 
 
THE DEGENERATE TEETH. 
 
 s?*; 
 
 Rosser, Atlanta, Georgia, has two small molars and a super- 
 numerary cuspid perfectly united from crown to root, and these 
 three further united to the roots of a well-formed molar. Thus 
 we see the concrescence theory is fully established. 
 
 A condition of molar tooth occasionally observed in America, 
 but more often in England, Scotland and Ireland, is that where 
 the crown is flattened from side to side (Fig. 247) and the roots 
 nearly or quite on a line. Instead of being normal like Fig. 248, 
 they stand like Fig. 249. These teeth are generally observed 
 in jaws of arrested deveIo])nient. The third or last molar, be it 
 second or first, is usually affected. 
 
 Dr. S. H. Guilford was the first to call attention to this par- 
 ticular anomaly in the American System of Dentistry, page 416, 
 under the heading, "Com])ressed or Flattened Crowns." He 
 savs, "among; the anomalies of tooth structure or formation this 
 
 Fig. 237. 
 
 Fig. 2.98. Fig. 239. 
 
 Smale and Colyer. 
 
 Fig. 240. 
 
 one is quite rare. The crowns of this character are flattened 
 in an antero-posterior direction, so that their diameter trans- 
 versely of the jaw is by far the greater one. The fissures or 
 culci, instead of presenting the usual form, are distorted and 
 sigmoid in shape, corresponding with the long diameter, while 
 the cusps resolve themselves into narrow ridges somewhat after 
 the manner of the molars of the Ruminantia. The third molars 
 of the superior arch are the ones usually affected, although the 
 writer has seen one case in which the superior first molar pre- 
 sented the same condition." 
 
 William Booth Pearsoll,*' of Dublin, Ireland, called the atten- 
 tion to this abnormality at the 1888 meeting of the Royal College 
 of Surgeons, Ireland. The question arose in connection with 
 extraction, since there was dif^culty in seizing the tooth with 
 the forceps because of the shape of the crown and roots. These 
 
 6 Dental Review, Jan. 15, 1899, 
 
378 IRREGULARITIES OF THE TEETH. 
 
 teeth are usually found in degenerate jaws. Like most dental 
 abnormalities observed in degenerate jaws these teeth are ata- 
 vistic, reverting in crown and roots to the original "tricono- 
 dont" type with cusps and roots in line. The roots are some- 
 times separated, containing two or three, or there may be only 
 one flattened upon the sides. 
 
 In degeneracy are peculiarly well illustrated the operation 
 of the law of economy of growth producing arrested and exces- 
 sive development as seen in edentulousness and excessive denti- 
 tion. 
 
 As Darwin points out, hairless dogs have imperfect teeth. 
 Here the dermic defects affected the animal as a whole ; other 
 organs profiting by the deficiencies of the hair and teeth. In 
 most cases of hairy men. there is, as Magitot remarks, defective 
 or irregular dentition. Here the struggle for existence, (which 
 
 Fig. 241. Fig. -^42. 
 
 Smale and Colyer. 
 
 has been between the teeth, which are derived, as elsewhere 
 shown, originally from the skin,) is now between the teeth and 
 the hair. In the case reported by Thurman, a man fifty-eight 
 years of age, who was almost devoid of hair all his life, possessed 
 only four teeth. His skin was very delicate. There was absence 
 of sensible perspiration and tears. The skin was peculiar in 
 thinness, softness and absence of pigmentation. The hair on the 
 crown of the head and back was very fine, short and soft and 
 in quantity about that of a three-months infant. A similar 
 condition existed in his cousin-german. In a case reported by 
 Williams, a fifteen-year-old girl had scarcely any hair on the 
 eyebrows or head and was destitute of eyelashes. She was 
 endentulous and had never sensibly perspired. "Jo-Jo," the 
 famous "Dog-man," had very defective teeth. Borelius found 
 atrophy of all the dental follicles in a woman of sixty who had 
 never possessed any teeth. Fanton-Touvet saw a boy of nine 
 
THE DF.GKNF.RATE TEETH. 379 
 
 who had never had teeth. Fox reports a woman who had but 
 four in both jaws. Tomes cites several similar instances. Hutch- 
 inson reports a child who was perfectly endentulous as to tem- 
 porary teeth but whose permanent teeth duly and fully erupted. 
 Guilford describes a man of forty-eight congenitally and per- 
 manently edentulous, who had no sense of smell and almost 
 without taste. The surface of his body was covered with fine 
 hairs. He had never had visible perspiration. Otto observed 
 two edentulous brothers.''' 
 
 Excessive dentition shows itself in many varieties. Those 
 which constitute return to the polyphyodontia of the lower verte- 
 brates. O. Hildebrand. of Gottingen.^ Germany, in 1889 
 reported the case of a child of twelve which, after various oper- 
 
 Fi?. 243. 
 
 ations, had been relieved of about two hundred teeth of various 
 sizes. Tw^o years later (July, 1891) the patient came under obser- 
 vation^ at the Gottingen Surgical Clinic. Both sides of the lower 
 jaw were much thickened, as also was the right upper jaw. 
 There were found seventeen teeth, part of them normally devel- 
 oped, others in an undeveloped condition. Their position was 
 deviated and irregular. From the upper and lower jaw there 
 were again some masses of teeth removed (which had the same 
 conformation as those described in 1889). which represented 
 about 150 teeth. There were also found two round, glassy 
 bodies about the size of two peas, which upon microscopical 
 
 7 Gould's Anomalies. 
 
 8 Medical and Surgical Reporter, July 15, 1890. 
 ^ Centralblatt f. Chirurgie, 1892. 
 
380 
 
 IRREGULARITIES OF THE TEETH. 
 
 investigation showed tooth structure. This is a return to poly- 
 phyodontia from arrest of development very early in foetal life. 
 Beside the supernumerary teeth elsewhere described, arrests 
 of development producing excessive dentition may evince them- 
 selves in double rows and in anomalous position. In the Paris 
 Dental School Museum are several milk teeth both of the 
 superior and inferior maxilla fused together. Bloch cites a case 
 where there were two rows of teeth in the superior maxilla. 
 Hellwig has observed three rows of teeth. The Ephemerides 
 contain an account of a similar anomaly. Teeth have been 
 found, as Gould points out, in the nose, orbit, palate and excep- 
 tionally, as in a case reported by Carver, they may grow from 
 the lower eyelid. In Carver's case the number of deciduous 
 teeth was perfect. Although the supernumerary tooth was 
 canine it had a somewhat bulbous fang. Arrest of development 
 
 Fig. 2U. 
 
 Fir. •.'45. 
 
 Fig. 846. 
 
 proceeding from checked development at the senile period of 
 foetal life may evince itself in senility of the alveolar process, as 
 in a case reported by Bronzet, where a child of twelve had but 
 half its teeth, the alveolar process having receded as in age. 
 
 Such arrest of development may also produce polyphyodont 
 conditions in the human being. Catching^*^ reports the case of 
 a girl v,'ho had all her teeth at six months and shed these at 
 nine. At fifteen months she had a full set once more. In six 
 weeks thereafter these were shed. At thirty months she had a 
 full set again, which remained until her fourth year, when came 
 another set. These remained until another set began to erupt 
 at eleven and became the permanent set complete at fifteen. 
 
 The homology of the dental tissues with the tissues of the 
 derm, already .pointed out, and the special identity of the enamel 
 with the extra vascular appendages, render it certain, as A. H. 
 
 ^° Boston Medical and Surgical Journal, July loth, 1887. 
 
THE DEGENERATE TEETH. 381 
 
 Thompson,^^ of Topeka, Kansas, points out, tlic) are i^^ovcrned 
 by the same laws, subject to the same inllucnces, and possess 
 the same phenomena of character as the allied tissues. Com- 
 munity of origin and similarity of structure and nature neces- 
 sarily establish identity of the manner of life, of the methods 
 of maintaining life with its varied phenomena of similarity of 
 
 '- Fig. 247. 
 
 service rendered to the economy and of the process of dissolution 
 and expulsion from the system. The relationship and homology 
 of the teeth with the derm and its varied appendicular produc- 
 tions are established by demonstration. These can well be and 
 yet preserA^e the unity of character, which they do not fail to do. 
 Teeth, spines, scales, dermal plates, feathers, nails, hair, bristles, 
 
 Fig. a48. Fig. 5249. 
 
 Dental Review. 
 
 horn, hoof, etc., varied in form and apparent purpose as tissues 
 can well attain, are yet closely related in structure and function, 
 with variations, of course, within certain limits. 
 
 The enamel consists of calcified epithelial cells elaborated 
 for the endurance of an appointed work and service in the econ- 
 omy. Enamel, like epithelium and all corneous structures, 
 
 11 Dental Cosmos, Vol. ig, page 22,"]. 
 
382 "'irregularities of the teeth. 
 
 yields, as A. H. Thompson remarks, keratin. In such unstable 
 structures in evolution as the teeth, arrest of development would 
 tend to produce for this reason, in place of enamel, horny 
 structures. Indeed, this occurs physiologically in certain verte- 
 brates. In that oviparous mammal, the duck-bill (ornithorhyn- 
 cus), true teeth appear in the embryonic state to give way later 
 by what Thompson calls suppressive economy or the degener- 
 ative results of the struggle for existence between the organs, 
 to horny structures. The same condition must have appeared 
 when the toothed birds began to lose their teeth in the tertiary. 
 Arrests of development in man may, therefore, produce what is 
 seeriiingly a reversion to this condition of the duck-bill. As 
 has already been pointed out in the chapter on Developmental 
 Neuroses of the Face, neurotic cases occur in which, from arrests 
 of development, there is very little enamel upon the teeth. 
 
CHAPTER XXX. 
 
 SURGICAL DIAGNOSES. 
 
 In all branches of medicine and surgery, the patient rather 
 than the symptoms rccjuires treatment. In dealing with treat- 
 ment, the origin as well as the symptom requires examination. 
 To remove the symptom without ascertaining its cause is to fail 
 utterly in the main object, the removal or amehoration of the 
 disorder. More disrepute has fallen upon dentists from this 
 cause than upon general surgeons, since the latter make an 
 attempt to deal with the patient's disorder from the side of its 
 causation. It is equally important, therefore, for the dentist to 
 look beyond the mouth for the origin of the disorder therein 
 found. 
 
 Frequently when a case of irregularity is presented, the gen- 
 eral contour and profile of the face will show whether the case 
 be one of constitutional type, the external proportions being 
 affected by a decided V-shaped arch, excessively developed alve- 
 oli or underhung jaw. The first thing a dentist should learn 
 are what constitutes a normal face and jaw in a given individual 
 and how to observe carefully. In determining correctness or 
 incorrectness of the outline of the mouth and jaw he instinctively 
 takes it in as a whole on the same principle that when looking 
 at a portrait he decides it a likeness but reserves judgment on 
 details. 
 
 Observe each jaw. See if it have a normal outline or belongs 
 to the V or saddle-shaped variety. Notice the vault and alveolar 
 processes. Examine the occlusion, letting the patient open and 
 close his mouth slowly. No detail must go unnoticed. The 
 beginner should familiarize himself with the individuality of teeth 
 as to class, outline and occlusion. 
 
 When there is asymmetry of the upper and lower jaws, occlu- 
 sion from the cuspid back is usually wrong. In such cases it 
 generally strikes in front of the lower cuspid instead of between 
 it and the bicuspid, disarranging the articulation of every tooth 
 
 back. 
 
 383 
 
384 IRREGULARITIES OF THE TEETH. 
 
 The difficulty in local irregularities is, as a rule, readily 
 detected. It is either found in the alveolar arch or the malposi- 
 tion of the individual teeth. 
 
 The first inquiry should be into the family history. I cannot 
 agree with Kingsley "that it is useless to try to correct an irreg- 
 ularity peculiar to a family type, nature reverting to her original 
 design, notwithstanding long-continued efforts." I have shown 
 elsewhere (especially in America), owing to changes in cli- 
 mate, food and marriage with different nationalities, the shape 
 of heads, faces, and jaws will change from one extreme to the 
 other in four generations. Again evolution in face and jaw 
 forms goes on so rapidly that the tissues are too unstable to 
 present fixed forms of jaws. In a general way, it can be said 
 there is no such thing as family type in relation to jaws and 
 teeth. While it is possible (as I have elsewhere shown) for the 
 child to inherit a family type of face, still irregular teeth cannot 
 be said to be an inheritance, since order and manner of their 
 eruption and position assumed are purely mechanical. There are 
 never two irregularities alike. It is oftentimes well to wait until 
 the patient is of an age when the permanent type of jaw can 
 be determined. Tooth regulation before that period is in many 
 cases a very unsatisfactory operation. Every case can be modi- 
 fied and thus be made less unsightly. Knowledge of evolution 
 and its reverse phase degeneration, as well as heredity anci 
 atavism, are necessary factors in the skill of the operator. The 
 first examination should be supplemented by a study from the 
 model. 
 
 In prognosis, extent of deformity must be taken into consid- 
 eration. Many cases will be corrected without interference. 
 Cuspids and bicuspids not infrequently erupt out of position, but 
 gradually find their proper places. 
 
 During the second dentition deformities are common, while 
 some deciduous teeth remain in position. Difference in size of 
 the two sets of teeth and consequent mal-occlusion alarm those 
 not familiar with these deformities; here time will harmonize. 
 
 Caution should be exercised in statements as to the ease, 
 difficulty of correction or the time required. Many cases which 
 seemingly present no difficulty often give much trouble, since 
 the resistance cannot be determined. Time spent in careful 
 
SURGICAL DIAGNOSKS. 385 
 
 examination of the case is well spent. Haste here, as elsewhere, 
 makes waste. Every particular in the deformity must be studied. 
 The dentist must forecast in his mind appliances to be used, the 
 different steps to be taken and time required before prognosis 
 can be given with approximate exactness. 
 
 Approximately the best time for interference is from the 
 twelfth to the fourteenth year. At this time — the transitional 
 period between childhood and puberty — all of the teeth are 
 erupted, general nutrition is most active, the osseous system 
 is in constructive stage and formative processes are in operation. 
 Where maxillary arrest of development is present, arrest or 
 retardation in completion of the root may result. The roots 
 not fully developed are more or less loosely confined within 
 the alveoli. The apical foramina are large, which lessens liabil- 
 ity of blood supply impairment and consequent destruction of 
 the pulp. 
 
 Since the conditions existing between the twelfth and six- 
 teenth year are coincident with the completion of tooth eruption 
 the converse holds true. Hence where the teeth are fully 
 erupted, the dentist may operate, irrespective of the age of the 
 patient. 
 
 The chances for perfectly satisfactory results in regulating 
 decrease yearly after puberty and after twenty-six are very 
 meagre. At this time the entire osseous system is fully devel- 
 oped. An unusual amount of force is required to set up inflam- 
 mation and absorption. It is possible to regulate deformities 
 as late as the thirtieth year. The resulting pain is, however, 
 so severe and the mechanical force necessary to produce absorp- 
 tion of the obstructive portions of the alveoli so great that the 
 results hardly justify the procedure. When regulated so late 
 in life, retentive and corrective plates must be worn for years, 
 until ossific material has formed to retain the teeth in place. 
 
 Sometimes in late correction, especially when extensive oper- 
 ations are performed and absorption of the alveolar process is 
 not followed by compensatory ossific deposit, mechanical inter- 
 ference produces chronic inflammation of the peridental mem- 
 brane (a veritable interstitial gingivitis), and later excessive ab- 
 sorption of the gums and alveolar process. This condition is 
 noticeable in the mouths of patients who have had extended 
 
 26 
 
386 IRREGULARITIES OF THE TEETH. 
 
 and it may be said ill-advised operations. If the teeth must be 
 regulated at this period of life, the operation should be done 
 with great care. The patient should be impressed with a doubt- 
 ful prognosis. The alveolar process is a transitory structure. 
 It is present simply to hold the teeth in place. The alveolar 
 process is removed when the teeth are extracted or from irri- 
 tation, auto-intoxication or senile absorption. Hence the older 
 the patient, the less the chances are for a restoration. When the 
 patient insists upon an attempt at regulation and is willing to 
 assume responsibility of failure, dentists may, perhaps, be justi- 
 fied in operating in any case of reasonable age. 
 
 Physiologic process of regulating teeth differs from repair in 
 fractures. Repair, under favorable conditions, is possible even 
 in advanced age. In the osseous system two parts of homo- 
 geneous structure are united. This is not the case in correcting 
 an irregularity. Here the tooth root, a dense structure, is 
 enclosed in the spongy structure of the alveolus. Alveolar nutri- 
 tion is very active during the first and second dentition until 
 the roots are perfectly formed and to the twentieth year. After 
 that, blood supply being less, waste and repair do not go 
 on so rapidly when the alveolus is injured. Lowered nutrition 
 is sometimes shown in the separation of teeth and recession 
 of gums, in rapid wedging as well as in interstitial gingivitis. The 
 fact that the attachment of a tooth to the alveolus late in life 
 cannot be compared to the union of a fractured bone is evident 
 in the aptitude of teeth, where regulated, to return to their 
 original place unless kept in position for some time by an appli- 
 ance aided by proper occlusion. The new tissue is not as strong 
 as the original tissue, while the bones and cicatricial tissue are 
 practically of the same strength. 
 
 The general health and constitutional peculiarities of the 
 patients require attention. As the majority of cases for regula- 
 tion are found in youth, the state of general health is of no slight 
 importance. The most favorable period for operation is, unfor- 
 tunately, one of the most critical in the life of the patient. 
 
 From the age of twelve, the beginning of one of the most 
 important periods of stress, the rapidly-growing boy or girl is 
 subjected to many physical changes, entaihng profound disturb- 
 ances of the trophic nervous system. Prolonged and injudi- 
 
SURGICAL DIAGNOSES. 387 
 
 cious worry, over-study, over-exertion, impure air, improper 
 food, sexual irritation, auto-intoxication, as well as other dis- 
 turbing factors tend to become prominent in the life of the 
 patient. 
 
 Sexual disturbance is of especial importance on account of 
 the periods of stress. When to physiologic perturbations of this 
 important period of evolution are added influences of environ- 
 ment, perversions of nutrition, like rachitis and allied states, 
 consequent upon congenital weakness, improper dietetics, hered- 
 itary syphilis or the exanthemata, the importance of taking into 
 account the influence of the general health upon operative pro- 
 cedures is self-evident. Operation on young persons in delicate 
 health should be deferred until the constitution has improved. 
 Dentists must recognize these general conditions, so that they 
 may be properly treated. Many patients requiring correction are 
 children with unstable nervous systems, whose physical devel- 
 opment departs from the normal. The mucous membranes are 
 badly developed, digestion and assimilation are faulty. The 
 glandular system is weak. The excreta are not properly elim- 
 inated. From an undeveloped nervous system, strain at this 
 period is often attended with disastrous results. Not infre- 
 quently in such patients later in life, it is found that the alveolar 
 process has not been restored. Interstitial gingivitis sets in 
 early, the teeth loosen, separate or crowd together, elongate and 
 are finally lost. 
 
 Patients that present themselves are, unfortunately, mostly 
 neuropaths and degenerates. This increases the danger from 
 careless procedures. Here assimilation of the patient must be 
 normal. The patient should be given enough unstimulating nutri- 
 tious food suited to his particular case. It is often difficult to 
 do this, since the appHance hinders mastication. The patient 
 should have abundance of sleep in a well-ventilated room. He 
 should be in the open air as much as possible. The mind should 
 be placid and agreeably occupied so as to aid him to forget the 
 irritation during the process. Absence of pain from lack of 
 physiologic response is as great a tax on the nervous system as 
 the pain itself. Dentists should, therefore, not be satisfied with 
 the absence of complaint by the patient, who should, if reticent, 
 
388 IRREGULARITIES OF THE TEETH. 
 
 be encouraged to give expression to his feelings. This aids in 
 deciding the time required for each step. 
 
 To carry out the programme it may be necessary to take 
 the patient out of school or to diminish his tasks. Schools are 
 generally badly ventilated. Exercise during school hours is 
 almost impossible. These patients cannot be under routine dis- 
 cipline of the school room without detriment to health and 
 spirits. School-life is a heavy tax during development. The 
 strain of correcting an irregularity should not be added to the 
 other cares of puberty and adolescence. Children during 
 puberty and adolescence are morbidly conscientious, ambitious 
 and reserved. They suffer much and say little. This is partic- 
 ularly true of girls, who do not find the relief boys do in outdoor 
 play. The sights and sounds of field or wood or even the street, 
 that furnish diversion to the active boy, are denied the girl. Her 
 life, more circumscribed, is more liable to passive suffering. 
 Great care is, therefore, required in the case of the girl. 
 
 In such cases co-operation of a skillful physician is indis- 
 pensable. A delicate, puny woman has been invalided for two 
 years, solely by the shock produced upon a primarily unstable 
 nervous system from a prolonged operation in regulation. The 
 weight of the patient should be obtained at the time the appli- 
 ances are adjusted and noted and every two weeks throughout 
 the operation. 
 
 Success in dentistry as well as in medicine depends to some 
 extent on the mental attitude of the patient. Interaction of mind 
 and body may be aided greatly in accomplishing an operation or 
 may be a decided drawback. 
 
 Knowledge of human nature, quick judicious sympathy, an 
 agreeable presence and tact are among the most valuable pos- 
 sessions of the operator. If the dentist work in harmony with 
 the laws of mental and physical health, half is gained. With 
 the aid of these qualities the more likely will he gain the co-oper- 
 ation of the patient and guardian. 
 
 Desire for correction depends somewhat on the social status 
 of the patient, sex and age. The poverty stricken, even if they 
 have a decided sesthetic sense, are so hampered with pressing 
 considerations of a more urgent nature that little attention is 
 paid to irregularity. With the well-to-do, the sesthetic side of 
 
SURGICAL DIAGNOSES. 389 
 
 life assumes larger proportions Beauty is of the greatest 
 importance, especially in women. Their lot in life may be 
 materially changed by an attractive mouth. Society, taking these 
 things for granted, acts upon them. The dentist is, hence, more 
 likely to secure the co-operation of the child of the well-to-do. 
 The daughter of Dives who subjects herself cheerfully to the tor- 
 ture of waist compression will with equal readiness and more 
 logic subject herself to the irritation of correcting a deformed 
 arch. The mouth, with its ample opportunity for display in 
 repose, conversation or laughter, suffers less from the ravages 
 of time than the waist. Mothers, usually alive to these con- 
 siderations, encourage their children to endure the strain. Occa- 
 sionally parents, by their indifference or careless remarks, be- 
 com.e a great hindrance to the dentist. They do not co-operate 
 with him by enforcing wearing of appliances and regular visits. 
 The dentist should determine the attitude of patients and guard- 
 ian before his task is undertaken, since without their co-oper- 
 ation his best efforts will be thwarted and his reputation suffer. 
 
 Taking the impression of the mouth and jaws is, of necessity, 
 the first step in regulation. The position of the teeth, their rela- 
 tions to one another and the conformation of the jaws can be 
 more easily studied and accurate conclusions more readily 
 deduced. The teeth should not only be moved to their proper 
 places, but must be in harmonious relations to one another. 
 Otherwise, they tend to return to their faulty positions. Their 
 normal relations can best be determined by studying the model. 
 
 The material employed in taking impressions must depend 
 upon the shape of the jaw and position of the teeth. If the teeth 
 be but slightly irregular or if the crowns be short and quite 
 irregular, plaster of Paris should be used. 
 
 If, on the other hand, the teeth be irregular and long and 
 the arch deep, plaster of Paris will be apt to adhere to the teeth. 
 In such cases the modeling compound should be used. 
 
 Where the plaster is used the patient should occupy an ordi- 
 nary chair, as the head is lower and the operator has better con- 
 trol of the patient. The clothing should be protected by two 
 towels under the chin and a newspaper in the lap. An impression 
 cup large enough to enclose the teeth should be selected and 
 30 built up with wax that it will extend beyond the margin of the 
 
390 IRREGULARITIES OF THE TEETH. 
 
 gums. The center of the cup should be filled with soft wax 
 to conform to the palate ; and the plaster will be readily carried to 
 all parts of the mouth. The finest quality of plaster should be 
 mixed in a bowl with sufficient water to make a mixture of the 
 consistency of thick cream ; addition of a little salt will hasten 
 the process of setting. After stirring until the air bubbles have 
 disappeared and the plaster has begun to set, the cup and outer 
 edges should be filled with it. 
 
 The operator should stand to the right and just behind the 
 patient with the left arm around the left side of the head and 
 'the forefinger inserted into the mouth. The cup should be car- 
 ried to the mouth with the thumb and forefinger upon the 
 handle and the middle finger in the center to steady it. After it 
 has been inserted into the mouth it should be pressed into place 
 with a rotary motion of the right hand. At the same time the 
 lip should be raised, the cheek pressed out with the left finger. 
 When the cup is in position, it should be held firmly with the 
 middle finger in the center of the plate against the teeth. The 
 head should be inclined toward the breast to prevent the plaster 
 passing back to the fauces. Should the stomach become dis- 
 turbed and vorniting ensue, it can be evacuated without interfer- 
 ing with the impression. 
 
 Test the plaster in the bowl or in the impression cup and 
 when it will break with a clean fracture it is time to remove 
 the cup, which can be done by moving the cup backward and 
 forward with the right hand and pushing out the cheek with the 
 fingers of the left hand to admit the air. Having placed it in 
 the upper towel, held up by the assistant, carefully examine 
 the mouth and if pieces of plaster be seen, put them in the 
 towel on the proper side of the impression to save time. Set 
 the impression carefully away, afterwards arranging the pieces 
 in their right places. 
 
 The second towel is for the purpose of removing plaster that 
 may remain about the face. 
 
 The operation should be explained in part to the patient, 
 who otherwise anticipates serious experience. All these little 
 details should be strictly attended to so as to insure perfect 
 impression at the first sitting and save' the patient the annoy- 
 ance of later applications. 
 
SURGICAL DIAGNOSES. 
 
 3.1 
 
 In taking impressions of the lower jaw the patient should 
 sit higher, so that the month will be on a level with the elbow 
 of the operator, w^ho stands in front of the patient. The fingers 
 of the left hand should push out the cheeks and lips while the 
 cup is rotated into place with the right hand. The first and 
 second fingers of each hand should rest upon the cup over the 
 bicuspids and molars, the thumbs under the jaw on either side, 
 tlius holding the cup firmly in place until the plaster sets, which 
 should then be removed and placed in the towel as before. After 
 a few minutes' hardening the impression should be placed under 
 running water to remove mucous, saliva, blood or particles of 
 plaster. Should the plaster be broken, the pieces can be placed 
 
 Fig. 250. 
 
 in the position indicated by the arrangement on the towel, and, 
 when perfectly dry, fastened together by melted wax. A 
 clean separation of the model is obtained by covering it with a 
 lather of soap and washing ofT the surplus or by coating with 
 shellac and oiling to prevent sticking. 
 
 Modeling compound is employed with success if water heated 
 to the boiling point be poured into a bowd containing modeling 
 compound. The compound should be inserted as hot as it can 
 be borne. Enough should be used to cover all parts of the 
 teeth and jaws when it is forced into place. The impression 
 cup should be held firmly in place for a moment and a towel 
 saturated with cold water should be carried at all parts of the 
 
392 
 
 IRREGULARITIES OF THE TEETH. 
 
 mouth to chill the compound. Impression cups (Figs. 250 and 
 251) should be used in cases of irregularities. The compound 
 loses elasticity by boiling. The surface of the impressions 
 should be oiled, thus preventing the compound's sticking to 
 the cast. 
 
 To obtain the model, place a sufficient quantity of water in a 
 bowl and pour in plaster, allow it to settle and thus prevent 
 formation of air bubbles. Add enough plaster to make it of 
 the consistency of cream. To exclude the air put a drop of 
 water into each depression made by the teeth in the impression 
 and add a small additional quantity of plaster. On tapping the 
 cup upon the bench the plaster will fill up the depression with- 
 
 Fig. 251. 
 
 out formation of air bubbles. The surface should now be cov- 
 ered with plaster. After mixing in more dry plaster to make it 
 thicken, fill the impression full and place it upside down on a 
 glass slide. Then build out the model until even with the impres- 
 sion cup and allow it to harden. It had better stand from twelve 
 to twenty-four hours so that it may be thoroughly hardened 
 before being removed. 
 
 Having removed the impression, trim the model roughly. 
 After articulating, trim it so that the body of the model will be 
 parallel with the line of the teeth and made presentable for 
 inspection. Place the name of the patient and the date of begin- 
 ning operation on the surface of the lower model. The patient's 
 
SITRGICAT, niAGNOSES. 3fl3 
 
 initials should be put upon the Ujjpcr ukxU'I. After this the sur- 
 face should be varnished. A band of elastic rubber will hold 
 them together. An articulator of brass wire (Fig. 252) may 
 be made for holding the models in proper positions and then 
 preparing them for easy inspection. The upper arms and spiral 
 may be made of one piece of wire, No. ]8, U. S. gauge; the 
 lower arms from another piece of the same wire passed through 
 the spiral and bent to correspond to the upper arms. The 
 models may now be articulated and the wire arms bent to meet 
 the upper and lower surfaces. The surfaces, after being sat- 
 urated with water should be covered with plaster and the arms 
 united to the model. 
 
 Fig. 5i52. 
 
 In regulating teeth a model should be conveniently placed 
 so to improve spare moments by studying the physiologic con- 
 ditions of the teeth before arriving at conclusions as to the 
 pathology of the case. In determining the character and extent 
 of a deformity a criterion is necessary. In the skull, on taking 
 the two cuspids for the starting point, the arc of a circle is found. 
 On dropping a line from the cusp of the cuspid to the center 
 of the wisdom tooth, the posterior part is seen to diverge con- 
 siderably from the central line (Fig. 253). The three normal 
 lines of the dental arch are seen. 
 
 The incisors of the inferior maxilla should close inside of 
 the superior incisors. The buccal cusps of the bicuspids and 
 molars should occlude at the center line or sulci of the superior 
 
39-1 IRREGULARITIES OF THE TEETH. 
 
 bicuspids and molars. If the articulated skull be placed with 
 the buccal surface toward the observer, a gentle curve down- 
 ward will be seen from the cuspid to the second bicuspid, rising 
 then until the wisdom teeth. are reached. Fig. 254 shows the 
 relative positions of the teeth in the jaw and their relation to 
 one another.- Since mastication is done principally by the bicus- 
 pids and first molars, these teeth should articulate perfectly. 
 This is accomplished by the tooth of one jaw interlocking 
 between two teeth of the opposite jaw, thus providing support 
 and surface. The points of the cusps of the superior cuspids 
 should stand at the point of occlusion of the inferior cuspid and 
 first bicuspid. 
 
 If the arch posterior to the cuspids be uniform and these 
 teeth be regular and articulate as shown in Fig. 254, they should 
 
 not be interfered with for slight deformity in any of the six 
 anterior teeth. The cuspids may be widened laterally to make 
 all the room needed. When this is accomplished and the deform- 
 ity corrected, the teeth in the arch will adjust themselves prop- 
 erly. If the irregularity be complicated and more room be 
 required than can be obtained by extending the cuspids, it is best 
 to enlarge both arches, which will give all the space needed. 
 The changing of a well-articulated set of teeth so that the cusps 
 of the opposite teeth will strike is an unpardonable error. 
 
 The arch of the superior and inferior maxilla should have 
 a diameter of sufificient width to prevent an impression of the 
 teeth on the sides of the tongue. Any deviation of the jaws 
 or teeth from this outline is a deformity which should receive 
 the attention of the dentist. 
 
SURGICAL DIAGNOSES. 395 
 
 With this standard in mind the model will reveal certain 
 deformities. Careful consideration will show that one of two 
 conditions exist; either the teeth arc in a crowded and irregu- 
 lar condition inside of the proper line or they are isolated and 
 irregular outside. In the majority the irregularity involves the 
 teeth anterior to the first permanent molar; If space l)e want- 
 ing, the question will arise whether to enlarge the arch by force 
 or to extract one or more teeth. The age of the patient will 
 decide this question. If the temporary teeth are in the mouth, 
 causing irregularities, they must be removed. When the removal 
 of the second teeth becomes a necessity, a tooth should be 
 selected which is the least prominent or which will least afifect 
 the expression. In selecting teeth for removal, each case must 
 be taken as a law unto itself, requiring its own special treat- 
 ment. A good rule is to retain, if possible, the six anterior teeth. 
 
 Fig. 254. 
 
 As the cuspids on the upper jaw are the most prominent and 
 give expression to the face, they should not be removed. If 
 a tooth must be sacrificed, the selection lies between the first or 
 second bicuspid and the first molar. 
 
 If it be found that teeth are so decayed that the roots cannot 
 be filled and the crowns replaced with artificial ones (at the age 
 of twelve or thirteen years, the first permanent molar is often 
 decayed) those affected should be extracted. This was the case 
 in the upper teeth of a girl fourteen years of age (Fig. 255). 
 Here the bicuspids had advanced so far forward that there was 
 insufificient space for the cuspid to come down into place. Upon 
 examination it was found that the first bicuspid upon the left 
 side and the first permanent molar upon the right side were 
 badly decayed. It was easy to decide which teeth should be 
 sacrificed. Tiie cuspid upon the left side came into place with- 
 
396 
 
 IRREGULARITIES OF THE TEETH. 
 
 out assistance. The bicuspids upon the right side were carried 
 back and the right cuspid came into place. The first perma- 
 nent molar has most often been extracted without sufficient 
 cause. Since this tooth serves an important purpose in mastica- 
 tion on account of its broad surface and large long roots, it 
 should be retained if the crown be in a fair state of preserva- 
 tion. It has served for six years, which fact, in connection with 
 its solidity in the jaws and its central position, argues for keep- 
 ing it. 
 
 Upon examining tlie models, it is occasionally found that the 
 articulation posterior to the cuspids is perfect, nearly approxi- 
 mating the centrals and the laterals locked inside or outside of 
 the arch. Whether sound or decayed, it may be best in such 
 
 Fig. 255. 
 
 cases to remove one or both laterals. The general appearance 
 of the teeth will not be injured by this treatment. Dr. Guilford^ 
 describes two cases of this kind presented to him in one year for 
 the reduction of prominence in the superior front teeth. In 
 each case there was a broken or badly diseased right central 
 that was past hope of redemption. In these cases it did not hap- 
 pen particularly amiss, since extraction of the roots afforded 
 room for drawing in the remaining five teeth, thus easily reduc- 
 ing the deformity and at the same time closing the space made 
 by their loss. The appearance of the patient in each instance 
 was greatly improved. The absence of even so large a tooth as 
 the central was hardly noticeable. 
 
 1 American System of Dentistry. 
 
SURGICAL DIAGNOSES. 3U7 
 
 In another case, a girl eleven years of age had lost a right 
 superior central incisor through a fall from a swing. Two days 
 after the accident and when the tooth had been mislaid or thrown 
 away she was brought for treatment. Two methods of remedy- 
 ing the difficulty suggested themselves to Dr. Guilford. One 
 was wearing of an artificial tooth, the other drawing the teeth 
 together to close the space. The latter plan was successfully 
 carried out. Unfortunately, as there had been no protrusion 
 formerly and as there was contraction afterward, the superior 
 teeth no longer overlapped the lower ones but met them edge 
 for edge, thus giving the upper jaw a flattened appearance, in 
 itself a deformity. The patient was saved the annoyance of 
 wearing an artificial tooth, but her facial expression was injured 
 in consequence. In the large proportion of cases, where the 
 anterior teeth are crowded and the cuspids are too far forward 
 or are outside or inside of the arch, the first bicuspid should 
 be extracted on one or both sides. Removal of these teeth 
 gives sufficient room. The operation is not prolonged as would 
 be the case were the second bicuspids or first permanent molars 
 removed. In this way the anterior teeth can be brought into 
 place with little or no extra space. 
 
 Irregularities of the lower teeth-, especially of the inferior 
 incisors, are often seen. If. the articulation be normal in the 
 posterior part of the mouth, almost any of the incisors that 
 are out of position may be removed. They resemble each other 
 so closely in size and shape and are so nearly concealed by the 
 lip their loss W'ill not be observed. The operator should be 
 particularly careful in deciding the mode of treatment, since an 
 actual increase of the deformity may be produced by a hurried 
 operation. In one case, a girl of ten years of age, a central 
 incisor was removed and the muscles of the Hp together with 
 lateral pressure of the adjoining teeth pushed against the cus- 
 pids, forcing the incisors into a crowded condition, thus pro- 
 ducing a V-shaped arch. It was ascertained that the articulation 
 of the posterior teeth was not perfect. It has been advised to 
 remove a corresponding tooth on the opposite side, where want 
 of room compels the removal of a tooth in the anterior part of 
 the mouth. It is claimed that there is danger of the incisor mov- 
 ing by the median hne when a tooth from one side only is 
 
398 IRREGULARITIES OF THE TEETH. 
 
 extracted. It has been found, however, that when a tooth is 
 removed back of the cuspids the lateral pressure is seldom suffi- 
 cient materially to move the incisors. Cases occur in which the 
 cuspids on the lower jaw may be removed without injury to 
 contour or appearance. It is frequently better to do this than to 
 extract a lateral incisor or first bicuspid and try to bring the 
 cuspid into the arch. The bone is so dense that unusual pressure 
 is required to produce absorption. This can be done, if neces- 
 sary, by cutting- away the alveolar process and by the use of 
 screws. 
 
 In considering the bicuspids the one which is the most 
 decayed should be removed if, by so doing, their irregularity can 
 be corrected. Care should always be exercised in examining 
 the occlusion before a bicuspid is extracted. In one case where 
 
 the two upper second bicuspids were extracted with a view of 
 relieving the crowded condition of the anterior teeth, the artic- 
 ulation of the first bictispids was such that adjustment was impos- 
 sible. These perfectly interlocked with the lower teeth. No 
 relief followed and the only way to correct the blunder was to 
 move the first bicuspids back. The mistake had been made 
 by following blindly what was vaguely supposed to be the rule 
 without considering the requirements of occlusion. 
 
 If both bicuspids be found sound, then the first should be 
 chosen if the anterior teeth are crowded. This makes room for 
 the cuspid. In studying the model, the end to be kept in view is 
 the retention of the teeth in place after they have found their 
 new position and are so properly articulated that they will hold 
 one another in place. If this be not accomplished the action 
 
SURGICAL DIAGNOSES. 399 
 
 of the cusps will force the teeth into their original faulty posi- 
 tion. 
 
 Nowhere in medicine is diagnostic use of the Roentgen ray 
 of so much importance as in dental deformities. Delayed erup- 
 tion, early extraction, abnormal and broken roots of teeth, loca- 
 tion and position of third molars, absorption of the roots of teeth 
 and of the alveolar process around the roots can easilv be out- 
 lined. All of these lesions more or less affect occlusion and 
 impair mastication. Before the X-ray it was impossible, as is 
 now done, to outline impacted and imbedded teeth. 
 
 \Mien the permanent teeth are missing or have not erupted, 
 I usually cut down upon the locality and explore for missing 
 teeth. This is easily done and with very little pain to the patient. 
 To outline direction and contour of the tooth is difBcult, how- 
 ever. 
 
 From arrest of development of the jaw, roots become entan- 
 gled or fused together, as in the case of the cuspids and second 
 and third molars. Here it is often difftcult to determine the 
 best course. By the X-ray, lancing, probing and packing cotton 
 are avoided. By the X-ray the parts are shown in exact out- 
 line of the tooth, its root and their relations. The necessity for 
 operations upon the teeth is thus earlier seen and the operation 
 expedited. Frequently the permanent teeth are prevented from 
 erupting for want of room. In such cases the delayed tooth can 
 be assisted by extracting or otherwise making room. 
 
 While it is comparatively easy to obtain perfect skiagraph 
 of other parts of the body, it is as yet somewhat difficult to 
 obtain good skiagraphs of the jaws and teeth. The reason is 
 the difficulty of keeping the parts quiet during the process of 
 placing and retaining the plate films in proper position in the 
 mouth. In certain parts of the mouth, such as the molar and 
 bicuspid region of the lower jaw, success is greater. With the 
 anterior teeth, those of the upper jaw, success is obtained with 
 difficulty. If, however, the vault be high much better results 
 can be obtained. 
 
 The best work that has been as yet accomplished is that done 
 by Dr. C. Edmund Kells, of New Orleans, Dr. J. N. M'Dowell, 
 of Chicago, and Dr. Dwight M. Clapp, of Boston. 
 
400 IRREGULARITIES OF THE TEETH. 
 
 Dr. Kells'2 method is as follows : "A cast is made of the 
 portion of the mouth to be skiagraphed and a small piece of 
 modeling compound molded over the crowns of the teeth 
 thereon. A piece of aluminum, this metal being almost trans- 
 parent to the rays, of about 26 or 28 gauge, is cut to the desired 
 size and shape and bent to fit the cast as well as possible. This 
 is slotted along the edge toward the crowns of the teeth and 
 thereby attached to the modeling compound above referred to. 
 This forms a convenient little film holder, which when placed 
 in the mouth will allow the patient to close the teeth upon it 
 and thus hold it securely in position, without danger of its mov- 
 ing for a much longer time than is necessary to take the picture. 
 
 The next step is to cut the plate or celluloid film, whichever 
 
 is to be used, to the proper size and envelop it neatly in black 
 paper, gluing down all the edges with paste and securing it to 
 the plate holder by two or three small aluminum clamps. 
 
 This is all that is usually necessary, but if it is deemed advis- 
 able to protect this from moisture, as is sometimes the case, 
 more especially for lower teeth, then the black envelope is cov- 
 ered with thin tin foil or waterproof paper neatly pasted down, 
 care being taken not to have the foil, if that is used, doubled 
 upon the side to be exposed. While this may appear to be a long 
 process, it is quickly accomplished and the invariably satisfactory 
 results obtained w^arrant the trouble taken. 
 
 The patient is then seated in a chair with a photographer's 
 
 2 Dental Cosmos, Oct., 1899. 
 
SURGICAL DIAGNOSES. 401 
 
 head rest to hold the head, the Tesla screen, to be described 
 later, put in place, the tube brought to about ten or twelve inches 
 from the face and placed so as to throw the best shadow of the 
 parts upon the film. The length of exposure depends upon 
 the thickness of the parts to be penetrated, the working condi- 
 tion of the apparatus and the distance of the patient from 
 the tube, the time being proportional to the square of the dis- 
 tance. 
 
 From sixty to ninety seconds are necessary for ordinary cases, 
 ranging perhaps up to one hundred and twenty seconds for third 
 molars in heavy jaws, while twenty to forty seconds are suffi- 
 cient for some favorable cases in thinner bones. 
 
 Fig. 256 shows a case in practice of an unerupted bicuspid 
 
 Fig. 258. 
 M'Dowell. 
 
 taken in forty seconds. Fig. 257 shows a case of normal teeth 
 taken in twenty seconds." 
 
 Dr. J. N. M'Dowell recommends the following method : 
 'Tn taking X-rays of the teeth it was found impossible to con- 
 veniently cut glass sensitive plates to correctly fit the different 
 parts of the mouth without the spoiling of many plates. To 
 overcome this difficulty, it was necessary to have something 
 that could be easily cut and shaped to fit the mouth for each 
 occasion and at the same time transmit light as a negative in 
 making photographs. Celluloid prepared with sensitive chem- 
 icals has been found to answer this purpose best. 
 
 No special preparation of the mouth in the way of washes, 
 etc., is necessary, as the plate is protected by a covering. Cut a 
 
 27 
 
402 IRREGULARITIES OF THE TEETH. 
 
 piece of cardboard to fit the part of the mouth that is to be photo- 
 graphed. In the dark room lay the cardboard on the sensitive 
 celluloid plate and cut to the same shape. Figs. 258 and 259, 
 etc., of the X-ray pictures show the original shape of the cut 
 celluloid. This is then wrapped in black paper to protect the 
 plate from light and the moisture of the mouth. The head is 
 so placed as to be immovable and the sensitive celluloid placed 
 in the mouth directly back of the teeth to be taken. The usual 
 time of exposure is about a minute with Crookes' six-inch tube. 
 This tube should be stationed sonie six or eight inches above 
 and in front of the teeth to be taken, in order to secure the out- 
 lines of the roots. If the tube is held directly opposite the teeth 
 the roots are not taken, as the plate cannot be inserted high 
 enough, owing to the shape of the roof of the mouth. "^ 
 
 An important consideration in the regulation of teeth is the 
 pecuniary reward. The dental specialist should have so pre- 
 pared himself that he fully understands and appreciates the 
 requirements of any case which he may undertake to correct. 
 This wall take much time and anxious thought,, for which he 
 should receive just reward. A thorough understanding as to the 
 proper remuneration should be established before anything is 
 done. 
 
 The models of the jaws should be carefully examined. The 
 temperament and disposition of the patient, as well as the ossific 
 condition of the jaws, should be considered and minutely exam- 
 ined. It frequently happens that mouths exhibiting very similar 
 deformities on account of mental and physiologic idiosyncrasies 
 and dififerences in density of tissue, require different treatment 
 to accomplish favorable results. After these preliminaries have 
 been carefully arranged as correct an estimate as possible should 
 be made (and at the best it can but approximate) of the expense 
 of regulation and retention in proper position. 
 
 At this juncture before operation is begun a thorough under- 
 standing should be established between the operator and the 
 parent or guardian as to approximate cost of the work. It is 
 well not to be too definite since it frequently happens that the 
 operation requires very different appliances and consumes more 
 
 3 Dental Cosmos, March, 1900. 
 
SURGICAL DIAGNOSES. 403 
 
 time than was at first anticipated, in which case the operator 
 should be rewarded for his unexpected labor. Or, the opera- 
 tion may be completed in a much shorter time than was antici- 
 pated, in which event a proper regard for the patient's rights 
 should prompt a reduction in the fee. A medium and a maxi- 
 mum ])rice, therefore, should be agreed upon before the opera- 
 tion is undertaken. Conspicuous among the difficulties which 
 come with regulation is first to persuade the patient to submit 
 to the annoyance of wearing the appliance ; secondly, to impress 
 upon the patient the necessity of being prompt and faithful in 
 visits to the dentist's. Not appreciating the importance of these 
 operations, patients, and especially children, frequently become 
 discouraged and are anxious to abandon the treatment before it 
 is completed. The parent too often sympathizes with the child 
 
 Fig. 259. 
 M'Dowell. 
 
 and without regard for the labor or expense which the dentist 
 has assumed or the real interest of the patient abandons the 
 operation. The dentist is left without remuneration, although 
 up to this point he has carried out his part of the contract. To 
 secure the continued co-operation of the patient and parent until 
 the completion of the operations, it is justice to the dentist that 
 he should demand and receive at least one-half of the proposed 
 fee before the w^ork is begun. With this money invested in 
 the operation, the parent will be loth to allow the case to be 
 abandoned before it is finished. 
 
 The dentist with due regard to the comfort and good of his 
 patient should do all possible to expedite his operation, so that 
 suffering and expense may be as light as possible. All should 
 
404 IRREGULARITIES OF THE TEETH. 
 
 be done with an intelligent understanding of the physiologic 
 and pathologic conditions under care. The patient, by obedience 
 to the dentist's instructions, can facilitate the correction, which 
 will, of course, greatly reduce the expense of the operation. 
 Here as elsewhere in surgery it is better not to give too minute 
 details as to plans to be followed and the appliances used, since 
 it frequently happens that the most carefully-planned procedure 
 has to be varied during the operation. In this case disappoint- 
 ment and dissatisfaction may be engendered in the mind of the 
 patient with a suspicion as to the dentist's ability to accomplish 
 the results at first promised. 
 
CHAPTER XXXI. 
 
 PATHOLOGIC AND PHYSIOLOGIC CHANGES. 
 
 The chapter upon the Alveolar Process dwelt minutely upon 
 development and absorption in its relation to eruption and loss 
 of the teeth, showing that the process was solely for the purpose 
 of supporting the teeth while in place and finally, after they have 
 been removed, it is forever lost. This structure, being transitory, 
 the osteoblasts and osteoclasts are always present to build up 
 or tear down structure as may be required by the exigencies of 
 environment. The rapidity with which the cells act depends to 
 a great extent upon the age of the individual and condition of 
 the system. The osteoblasts and osteoclasts are necessarily 
 more active in periods of growth. This is due largely to the 
 vascularity and w^mt of -density of bone structure. 
 
 In the evolution of man, the face is constantly undergoing 
 change and the jaws are growing smaller. The alveolar process 
 being a transitory structure is necessarily unstable, hence here 
 the osteoblasts and the osteoclasts are quickly and readily set in 
 action. Absorption often is of slow development, but once estab- 
 lished, light, constant or intermittent pressure makes way for 
 the advancing tooth. 
 
 The teeth are constantly changing their positions in the jaw. 
 absorption and deposition of bone going on simultaneously and 
 continuously. This is particularly noticeable at the first eruption 
 of the teeth, and again from the twelfth to the sixteenth year. 
 When the first permanent molar has been removed, the second 
 and third gradually press forward and fill the space. 
 
 Teeth that are erupted out of their position will, in time, 
 often find their way back into it : when molars and bicuspids are 
 lost late in life, the anterior teeth being forced forward, causes 
 the alveolar arches to project. When the anterior teeth come 
 in irregularly they rotate their way into place. Through these 
 motions of the teeth, when assisted by mechanical devices or 
 removal of obstructions, regulation of malposition become.s, 
 
 405 
 
406 
 
 IRREGULARITIES OF THE TEETH, 
 
 simple ; furthermore, after regulation, the teeth may be firmly 
 retained in their relatively new positions in the alveolar process. 
 Application of light, constant pressure to irregular teeth, 
 aiding their motions, will greatly increase absorption and repro- 
 duction of bone. The equable reproduction and absorption will 
 depend upon the amount of pressure exerted and the condition of 
 the individual, since in cachexise disintegration is favored, while 
 
 Fig. 26o.:ii 
 
 tissue building is retarded. This notably occurs in auto-intoxi- 
 cation and senile absorption. The degree of pressure and the 
 constitutional condition of the patient must therefore be taken 
 into account in operations of regulating. When the alveolar 
 arch is widened laterally as a whole, and the force distributed 
 widely upon both sides of the jaw, the bones yield to a certain 
 extent, thus spacing the teeth equally in all directions. By 
 absorption of the old and by deposition of the new bone about 
 the teeth, they become fixed in their new position. The degree 
 
PATHOLOOU: AND PHYSIOLOGIC CHANGES. 407 
 
 of absorption and change of position is not always equal in all 
 
 parts of the tooth. They vary with the direction of the pressure. 
 
 When force is applied to the crown and the teeth have to be 
 
 1V4 inch Beck objective. MagnificationlaboutjJox. — Xoyes. 
 
 moved considerably, more absorption occurs at the margin of the 
 alveolus than at the apex. The mechanical appHance is here 
 the power and apex of the tooth is the fulcrum. The power 
 
408 
 
 IRREGULARITIES OF THE TEETH. 
 
 necessarily acts upon the margin of the cavity in which the 
 tooth is imbedded. The tooth may be said to move hke a 
 spoke in a wheel. The outer part of the crown travels relatively 
 
 Fig. 262. 
 A. A. Zeiss obj. Magnification 8C.5x. }i turn, 7 days. 
 
 more than the inner part or apex. The gradual diminution in 
 diameter frorn peck to apex must be also taken into consider- 
 fitiop. 
 
PATITOI.OmC AND PHYSIOLOGIC CHANGES. 
 
 400 
 
 If the pressure be gentle, evenly distributed and constant, 
 pain will not be experienced, when the teeth have once begun 
 
 Fis;. 263. 
 A. A. Zeiss obj. Magnification 86.5x. H turn, 7 days. 
 
 to yield in the proper direction. But when force is applied, 
 removed and re-applied, spasmodically considerable pain neces- 
 sarily results. The difference between the results of steady and 
 
410 IRREGULARITIES OF THE TEETH. 
 
 of intermittent pressure is observed every day in practice. When 
 teeth have been separated to faciHtate the filhng of proximate 
 cavities, tooth vibration due to preparing the cavity and applying 
 gold produces an intense pain, relieved by inserting a wedge to 
 distend and steady the teeth by constant and equable pressure. 
 Individual susceptibility must be taken into account since the 
 impressibility to pain and the power of endurance vary with race 
 temperament and condition of the patient. After twenty-five 
 the bones contain more earthy and less animal matter than dur- 
 ing the formative and developmental period. The constructive 
 stage having passed, the teeth are moved with more difficulty 
 than in earlier life. With increased pressure needed to effect 
 absorption, more pain and inflammation are produced. This is 
 particularly the case when alveolar process hypertrophy is pres- 
 ent. This pathologic condition is very common. The operator 
 must be on the alert to discover its location at the outset of the 
 operation, since unusual pressure is required to produce bone 
 absorption. Cutting away the alveolar process is always indi- 
 cated here. Strain upon the nervous system of the patient is 
 thus greatly diminished. 
 
 Until a few years ago, lacunar absorption was supposed to 
 be the only form of bone absorption. In a discussion of Inter- 
 stitial Gingivitis, published in 1899, I demonstrated there were 
 four forms of alveolar process absorption, lacunar or osteoclast, 
 halisteresis, perforating canal and osteomalaciary (or senile) 
 absorption. 
 
 The question had naturally arisen as to what gingivitis occur 
 from movement of teeth? To determine this, experiments were 
 made upon dogs. Impressions of the mouths were taken in 
 modeling compound. Caps of German silver were then made 
 for the cuspid teeth. A jackscrew was soldered to the caps with 
 soft solder. The dog was then securely fastened into a V-shaped 
 box, Fig. 260, with cotton bandages. When chloroformed 
 the appliances were placed upon the teeth and cemented into 
 place. A muzzle was then placed upon the head and the fore- 
 feet tied to prevent removal of the appliance. The muzzle and 
 bandage were removed twice a day for the purpose of feeding. 
 The screw was given one-fourth, one-half and one full turn 
 every evening. The screws were 60 threads to the inch. The 
 
PATHOLOGIC AND PHYSIOLOGIC CHANGES. 
 
 411 
 
 teeth of three dogs were moved 1-240, 1-120, and 1-60 of an 
 inch respectively per day, as suggested by Farrar.^ At the 
 end of three days the muzzle and leg bands could be removed, 
 
 Fig. i;64. 
 A."A. Zeiss^obj. Magnification 173x. 14 turn, 7 days. 
 
 the dogs having become accustomed to the appliances. This 
 process (whereby the screw was turned one-fourth and one- 
 
 1 Dental Cosmos, Vol. XVIII, page 23. 
 
412 IRREGULARITIES OF THE TEETH. 
 
 half turn per day) was continued for seven days. In those 
 in which the screw was turned one full turn, it was continued 
 for two weeks. The object was to set up pathologic changes in 
 the alveolar process. The dogs were killed at the end of the 
 periods mentioned. The jaws were placed in 65 per cent alcohol 
 for twelve hours, then in absolute alcohol for forty-eight hours. 
 
 Fig. 2(15. 
 D. D. Zeiss obj. Ocular No. 2. Magnification 348.8x. 'A turn, 7 days. 
 
 '^hey were then transferred to 5 per cent nitric acid and water. 
 This was changed every two days for a week or until the tissues 
 became so soft as to be easily penetrated by a pin. They were 
 then placed in running water to remove acid. This took from 
 twelve to twenty-four hours. The tissues were then placed in 
 65 per cent alcohol six hours ; then in 95 per cent six hours, 
 
PATHOLOGIC AND PHYSIOLOGIC CHANGES. 413 
 
 and then in absolute alcohol twenty-four hours. The tissues 
 were then imbedded in thin celloidin twenty-four hours, then in 
 thick celloidin twenty-four hours. They were then mounted on 
 blocks of wood and hardened in 80 per cent alcohol from six to 
 twenty-four hours. The specimens were cut, stained in haema- 
 toxylin eosin. 
 
 The second illustration (Fig. 261) shows the normal alveolar 
 process and its relation to the peridental membrane and adjoin- 
 ing teeth. 
 
 Third (Fig. 262) shows the condition of the alveolar process 
 after the screw has been turned one-fourth turn for seven days. 
 This is a longitudinal section of a cuspid tooth with the edge of 
 the alveolar process in situ. A is the alveolar process ; C the 
 cementum of the tooth ; H halisteresis ; O osteoclast or lacunar 
 absorption; P the periosteum. 
 
 The fourth (Fig. 263) is a cross section showing cuspid and 
 lateral incisor with alveolar absorption between them. A alveo- 
 lar process ; B haversian canals ; C cementum; E large medullary 
 cavities arising from absorption of the trabeculse ; H halisteresis 
 absorption ; P peridental membrane ; R round cell infiltration. 
 
 The fifth (Fig. 264), under high magnifying power, shows 
 A alveolar process ; D haversian canals with round cell inflam- 
 mation about them ; E large medullary cavities due to absorption 
 of the trabeculse ; H decalcified bone or halisteresis ; R round 
 cell infiltration. 
 
 The next sections were taken from a dog in which the screw 
 had been given one-half turn every day for seven days. Fig. 265 
 illustrates A alveolar process ; O osteoclast or lacunar absorp- 
 tion ; P peridental membrane with round cell inflammation. Fig. 
 266 shows A alveolar process ; D haversian canals ; H halister- 
 esis; P peridental membrane. Fig. 267 illustrates A alveolar 
 process ; H hahsteresis ; O osteoclast absorption-; P peridental 
 membrane ; R round cell inflammation ; V vessels of von Ebner. 
 
 The sections following show absorption of the alveolar proc- 
 ess from a dog in which the screw had been given a full turn 
 or one-sixtieth of an inch every evening for fourteen days. Fig. 
 268 illustrates A alveolar process ; B haversian canals ; E large 
 medullary cavities due to absorption of the trabeculge ; H halis- 
 teresis; VC Volkmann's perforating canals. 
 
414 
 
 IRREGULARITIES OF THE TEETH. 
 
 Fig. 269 under a higher magnification shows A alveolar pro- 
 cess ; D haversian canals ; VC Volkmann's perforating canals. 
 Fig. 270 (under a still higher magnification) shows A alveolar 
 
 Fig. 266. 
 A. A. Zeiss obj. Magnification 86.5x. % turn, 
 
 days. 
 
 process ; H hahsteresis ; O osteoclast absorption ; R round cell 
 infiltration ; VC Volkmann's perforating canal absorption. 
 
 If so many pathologic conditions occur in the alveolar process 
 
'pathologic and physiologic changes. 
 
 415 
 
 from the movement of the teeth and in interstitial gingivitis, 
 what may not be expected in tooth eruption and in healthy 
 absorption of the alveolar process after teeth have been 
 extracted ? 
 
 In the following illustration (Fig. 271), taken from the jaw 
 of a voung monkcv who died from burns, the inferior cuspid 
 
 Fig. 207. 
 D. D. Zeiss obj. Ocular No. 2. Magnification 248.8x. '.i turn, 7 c3ays. 
 
 teeth were pushing their way through the alveolar process, but 
 had not presented themselves. The temporary cuspids were still 
 in place. It shows A alveolar process; D Haversian canals; E 
 large medullary cavities due to absorption of the trabeculse; 
 F fibrous tissue resultant on halisteresis. 
 
 In moving teeth of dogs the upper jaw alone was used. Some 
 
416 
 
 IRREGULARITIES OF THE TEETH. 
 
 teeth of the lower jaw were extracted to note the change in the 
 alveolar process shown by the following illustrations. The teeth 
 
 Fig. 2<*i. 
 A. A. Zeiss obj. Magnification 86.5x. Full turn, 14 daj-s. 
 
 had been extracted for seven days. Fig. 272, under low power, 
 shows A alveolar process; D Haversian canals with round cell 
 inflammation ; O osteoclast absorption ; VC \'olkmann's perfor- 
 
Pathologic and physiologic changes. 
 
 4lt 
 
 ating canal absorption. Fig. 273, under a liigher magnification, 
 shows A alveolar process ; O osteoclast absorption ; R round 
 cell inflammation ; \"C Volkmann's perforating canal absorption. 
 
 lig. -MK 
 
 D. D. Zeiss obj. No. 2. Magnification 334.8x. Full turn, 14 days. 
 
 In Fig. 274 is seen A alveolar process; B Haversian canal: E 
 large medullary cavity due to the absorption of the trabecule; 
 
 28 
 
418 IRREGULARITIES OF THE TEETH. 
 
 O osteoclast absorption ; R round cell infiltration. In Fig. 275 
 is seen the absorption of the alveolar process. Interstitial gingi- 
 vitis is observed due to auto-intoxication. In extracting the 
 tooth, the detached bone was also removed with considerable 
 fibrous tissue which was originally alveolar process. D dentine, 
 C cementum, I inflamed fibrous tissue, J alveolar process, O 
 osteoclast absorption. 
 
 It has always been supposed that normal absorption in the 
 alveolar process under normal conditions was osteoclast or 
 lacunar absorption and that if pressure were greater than the 
 tissues could stand, inflammation set in and absorption ceased. 
 Careful study of the process of absorption revealed that different 
 results could hardly be expected in tooth movement. The sur- 
 roundings of the alveolar process are the same. Absorption is 
 the same, though the propelling forces be dififerent; interstitial 
 gingivitis irritation, the screw pressure, the eruption of the tooth 
 and the extracted tooth. Were a tooth implanted into the alveo- 
 lar process of a human being or a dog after full growth, the 
 same methods of absorption illustrated will occur under these 
 difTerent conditions. 
 
 Absorption, as already stated, occurs as osteoclast or lacunar 
 absorption, halisteresis, Volkmann's perforating canal absorp- 
 tion. As a normal senile function, osteomalacia or senile 
 ' absorption produces destruction of the alveolar process and loss 
 of the teeth. Waste and repair are so adjusted that upon the 
 slightest irritation (even tooth extraction) osteoclast absorption, 
 halisteresis and perforating canal absorption occurs. The influ- 
 ence of extraction on inflammatory conditions was carefully 
 excluded by Dr. M. Herzog, who conducted the examinations, 
 and his care is shown in the absence of inflammation in the peri- 
 dental membrane. Pressure intensifies all forms of absorption. 
 In the case in which the screw was given a full turn every day for 
 fourteen da3's the teeth were found one-half inch apart. Absorp- 
 tion of the bony process was well marked. Halisteresis and 
 perforating canal absorption was much intensified. When force 
 is apphed to the tooth the peridental membrane is compressed 
 and the blood supply is cut ofif for the time being. The osteo- 
 clasts, because of the change in the blood current, are set to 
 work. Absorption of alveolar process occurs not only adjacent 
 
PATTIOLOGIC AND lMIYSlOI,OOIC CHANGES. 
 
 419 
 
 to the root of the tooth (as shown in Fig-. 262), but also in the 
 Haversian canals throughout the entire process (Fig-.263). Inter- 
 
 Fig, aro. 
 
 D. D. Zeiss obj. Ocular No. 2. Magnification 353.48x. Full turn, 14 days. 
 
 stitial inflammation is immediately set up in the arteries running 
 through the Haversian canals, producing halisteresis. Through 
 the walls of the blood-vessels round cell infiltration occurs into 
 
420 
 
 IRREGULARITIES OF THE TEETH. 
 
 the connective tissue. Remains of decalcified bone appear in 
 Fig. 263. Frequently the irritation and inflammation has been 
 
 Pig-. 271. 
 A. A. Zeiss obj. Magnification 8G.5x. 
 
 SO severe that the fibrous matrix is likewise destroyed (Fig. 264). 
 The inflammatory process extends throughout the vessels of von 
 Ebner (Figs. 267-8-9), producing Volkmann's perforating canal 
 
PATHOLOCIC AND PHYSIOLOGIC CHANGES. 
 
 421 
 
 absorption. The same types of absorption, as are observed in 
 interstitial gingivitis occurred here under different conditions. 
 Bone building is so much slower than absorption that two weeks 
 did not suffice to show osteoclasts at work. 
 
 In cases of regulating late in life, retentive plates must often 
 be worn, for two or three years, after the malposition of the 
 teeth has been corrected until a bone deposition is sufficient to 
 hold the teeth securely. The teeth most difficult to retain are 
 those that have l)ccn rotated in the jaw, since these have a len- 
 
 FiK. 2Ta. 
 Leitz obj. No. .3. Ocular No. .3. Magnification »0x. 
 
 dency to return to their original, faulty position, through con- 
 traction of the fibrous tissue even after three years. By dis- 
 pensing with the retentive plate for a day or two and then 
 re-inserting it, any deviation in position can be readily noted. 
 When pressure is applied to a tooth, iritation extends through 
 the fibrous tissue to the periphery of the bone structure. The 
 osteoclasts begin to form in the fibrous tissue and extend into 
 the bony tissue. Fig. 262 shows the fibrous tissue and 
 
422 IRREGULARITIES OF THE TEETH. 
 
 alveolar process. Only a small portion of the peridental mem- 
 brane is seen. Absorption of the alveolar process has gone on 
 to a considerable extent. Only a small portion of bone in the 
 center being acted upon by the osteoclasts. 
 
 Fig. 263 shows the peridental membrane and the fibrous 
 tissue extending through the alveolar process. The bone is 
 entirely absorbed except a small portion in the center. Osteo- 
 clasts are seen at work producing absorption of the remaining 
 structure. 
 
 In rotation of teeth, absorption of bone rarely takes place. 
 Pressure of the peridental membrane causes the fibers to elon- 
 gate and take the direction of the tooth. In making a reasonable 
 pressure upon the teeth, the earthy substance of the bone is 
 removed, leaving the fibrous tissue intact. The fibrous tissue 
 of the bone retains the blood-vessels and osteoblasts. The pres- 
 sure upon the tooth does not detach the peridental membrane. 
 The application of force either in straight lines or rotation causes 
 the fibers to stretch. Remove the pressure and the elasticity of 
 the tissue will soon return the tooth to its original position ; when 
 the tooth or teeth have been forced to their new positions, fibrous 
 tissue is developed to reinforce that which has been injured by 
 stretching. Osteoblasts build up new bone tissue and in this way 
 the tooth is held in its new position. To accomplish this, the 
 tissues must be held perfectly still by retaining appliances upon 
 the teeth. If the alveolar process has obtained its growth and 
 the fibrous tissue (trabeculas) is destroyed the chances of restor- 
 ation are meager. In any case the normal contour will not be 
 restored. 
 
 In the light of these experiments and the ease with which 
 inflammation and absorption are produced, it is doubtful whether 
 (as some claim) the alveolar process is ever bent into a new posi- 
 tion. In any case should the process yield to pressure, absorption 
 must continue until the pressure is relieved. 
 
 Not infrequently in children whose nervous systems are 
 unstable, constant, steady pressure for any time will wholly 
 unnerve the patient. It is not good practice to cause continuous 
 pain for any length of tinie, by forcing the teeth through the 
 alveolar process, when this can be accomplished by a much more 
 rapid scientific method of cutting away the bone. 
 
PATHOLOGIC AND PHYSIOLOGIC CHANCKS. 
 
 423 
 
 From what has been said of the alveolar process in its absorp- 
 tion and its terminal structure aspects, it is evident that the teeth 
 cannot be corrected without pathologic disturbances. 
 
 While other forms of absorption must await the onset of 
 inflammatory processes, osteomalacia or senile absorption sooner 
 or later ensues in every individual. This from the unstable 
 nature of the alveolar process is a normal absorption. This 
 absorption is readily produced from shght irritation, like heat, 
 auto-intoxication, drugs, etc. Osteomalacia normally occurs 
 
 Fi.e. 273. 
 Spencer Proj. U inch. Ocular 1 inch. Magnification 200x. 
 
 after the process has obtained its growth. It may, however, 
 occur before that time when the pathologic factor is sufficient to 
 overcome cell building; such as malnutrition, drugs, etc. The 
 alveolar process is so unstable that interstitial gingivitis may be 
 found in nearly every mouth, more especially in neurotics and 
 degenerates. 
 
 Properly to correct irregularities requires a thorough under- 
 standing of the laws of degeneracy. When a practitioner prides 
 
424 
 
 IRREGULARITIES OF THE TEETH. 
 
 himself upon the rapidity with which he can correct irregulari- 
 ties, his methods demonstrate lack of knowledge of the struc- 
 tures upon which operations are done. 
 
 Extended force applied throughout the alveolar process will 
 correct the ordinary deformity. If the force be so great as to 
 destroy the trabecute, tissue building cannot restore the process. 
 If great but not steady pressure be applied and if nutrition be 
 poor, the alveolar process will not be restored. 
 
 Over three decades ago a dental professor regulated the 
 
 Fig. iU. 
 Spencer Proj. k inch. Ocular 1 inch. Magnification 200x. 
 
 teeth of a sixteen-year-old girl. This (in 1870) was considered 
 a most successful operation. So pleased was the teacher that 
 he invited the students to his office to examine the models and 
 results. Four years after the girl married. She was under my 
 observation till her death. The alveolar process was never 
 restored. Interstitial gingivitis continued as long as she lived. 
 The alveolar process absorbed from one-third to one-half the 
 length of the roots upon all the teeth and they never became 
 
I'AIHOLOGIC AND PHYSIOLOGIC CHANGES. 
 
 425 
 
 solid in tlu- jaw. They were always sore upon mastication. 
 Occasionally pus infection occurred. By free use of iodin, inter- 
 stitial gingivitis was nmch reduced as pus germs were thus 
 destroyed. Although beautiful and with beautiful teeth, irregu- 
 larity and alveolar absorption gave her an elderly appearance. 
 
 Malnutrition of the alveolar process should preclude an 
 operation, or if it must be performed slow, steady pressure should 
 be used to prevent excessive interstitial gingivitis. Patients 
 with scrofulous, syphilitic or tubercular tendencies should be 
 treated with great consideration. In such cases one or two teeth 
 should be regulated at a time. 
 
 A twelve-year-old girl in delicate health had her teeth regu- 
 
426 IRREGULARITIES OF THE TEETH. 
 
 lated in 1891. The right superior central and lateral were rotated 
 ^o that their palatine surfaces came together. The cuspids were 
 separated and the teeth rotated into place. The lower cuspids 
 were outside the arch. The arch was complete. The lower 
 teeth did not show when the mouth was open. The cuspids were 
 removed. At twenty-two health was much improved. Inter- 
 stitial gingivitis from the regulation and extraction had never 
 been diminished. An inflammatory process remained in cir- 
 cumscribed area the depth of the teeth. 
 
 The only question unsolved in regulating teeth late in life 
 is whether the results are proportionate to the strain upon the 
 system from the methods employed and from effects from the 
 ultimate success. 
 
 The tendency in such cases is toward osteomalacia, although 
 the other forms of absorption may occur. Permanent absorp- 
 tion may then ensue. Some years ago, a forty-five-year-old lady 
 wished to have a right superior lateral incisor, which occluded 
 inside the lower teeth, brought out into the arch with the other 
 teeth. Powerful pressure was applied. The tooth was brought 
 into place. Little absorption took place. The outer plate of the 
 alveolar process was split, exposing the roots of the right central 
 and cuspid teeth. The tooth was fastened securely and the bone 
 united with considerable osteomalaciary absorption. 
 
 Extended operations should not be performed. If the case 
 be successful and the teeth be retained in their position for the 
 time being this is no evidence that the alveolar process will 
 remain through life or that the next ten cases will be successful. 
 The older the patient the greater the pressure required, the 
 greater the amount of inflammation set up and the less chance 
 of success. From the transitory nature of the jaws and the 
 alveolar processes, density of bone in hypertrophy, the terminal 
 structure and the ease with which inflammation and absorption 
 ensue, the question naturally arises, when and how is regulation 
 of teeth justified. 
 
 Cutting away of the alveolar process will always relieve 
 excessive pressure, reduce the inflammation to a minimum and 
 prevent extensive absorption. Correction of the teeth at all 
 periods produces structural change in the alveolar process. The 
 extent of this ever remains a predisposing factor to interstitial 
 gingivitis. 
 
CHAPTER XXXII. 
 
 SURGICAL CORRECTIONS. 
 
 Surgical correction of deformities of the jaws and teeth in 
 its relation to dentistry resembles Orthopedic Surgery in its 
 relation to medicine. Deformity correction implies mechanical 
 operation upon the tissues in a way foreign to ordinary dentistry 
 and hence special training is needed for its practice. The oper- 
 ator should be thoroughly endowed with mechanical ingenuity, 
 familiar with mechanical movements as well as versed in path- 
 ology. 
 
 Some claim that fixed systems of appliances can be depended 
 upon for the purpose of correcting a given line of cases, that 
 these can be readily applied by the operator and the correction 
 will proceed successfully and rapidly. This is but partially true. 
 The dentist who advances such a doctrine is a victim of the 
 one-sided bias which has done such harm to science. 
 
 The opening chapter of a recent work states that "it is often 
 asserted, even by some authoritative writers upon the treatment 
 of dental irregularities (Orthodontia), that no fixed system of 
 appliances should or can be depended on: that each case so 
 differs from all others as to require some new appliance pecu- 
 liarly suited to that case, and that only. * * * The author 
 believes and has proven, that it is not only possible, but prac- 
 ticable to systematize, classify and provide ready-made regulating 
 appliances reducing them to few simple forms, to meet by their 
 combinations the requirements in all varieties of cases susceptible 
 to treatment." Centuries of experience in surgery have demon- 
 strated that appliances must be adapted to the case and not the 
 case to the appliance. This is particularly true of dentistry 
 where results must depend upon the educated touch rather than 
 the appliance. The orthopedist would scoff at the idea of 
 having routine appliances always on hand for correcting all 
 deformities. Certain parts may be kept on hand for certain 
 fixed forms, but even these must be adjusted to the special case. 
 
 427 
 
428 
 
 IRREGULARITIES OF THE TEETH. 
 
 That the same law exists as to appHances for correctmg deform- 
 ities of jaws and teeth needs no demonstration. 
 
 The victim of such teachings frequently fails in his cases by 
 relying too much upon a "system" rather than upon general 
 principles. One kind of appliance may be used to start the 
 operation, but the skilled, unbiased operator will observe that a 
 different appliance can be used to a better advantage ; especially 
 in connection with one already in use. The victim of a "system" 
 cannot be a skilled operator because of mental limitations 
 thereon resultant. "Our little systems have their day. They 
 have their day and cease to be." 
 
 Fig. 276. 
 
 Fig. 277 
 
 The constitution and health of the patient must always be 
 considered. An appliance theoretically adapted to a given case 
 may be wholly unfit because of the patient's physical condition. 
 An appliance suitable to one period of life will not be to another. 
 
 In order to work in the shortest time and with least incon- 
 venience, knowledge of the mechanical forces, the powers and 
 limitations of each, and method of application are needed. All 
 forces act either continuously like the lever, or interruptedly 
 like the screw, but in either case their action diminishes with the 
 yielding of the tooth. The mechanical powers are all modifica- 
 tions of two primary principles ; the inclined plane and the lever. 
 From these other forces are derived, thus : 
 
SURGICAL CORRECTIONS. 
 
 429 
 
 The Screw, The Inclined Plane, 
 
 The Lever, The Wedge, 
 
 The rulley, Wheel and Axle, h^lasticity. 
 
 Elasticity plays an inii)ortant ])art in the application of force 
 
 Fig. 278. 
 
 in regulating teeth. All of these forces have their places in the 
 correction of deformities of the jaws and teeth. Appliances can- 
 not be made which do not include one or more of these forces. 
 All the forces may be successfully used in regulating teeth. 
 
 Fig. 279. 
 
 Principles, rather than systems, should be taught in our schools. 
 Each may be used to a good advantage in given cases when 
 judgment has been employed in selection and adjustment of 
 appliances and in adopting the methods of using them. With 
 
430 
 
 IRREGULARITIES OF THE TEETH. 
 
 these laws and their appHcations firmly fixed in mind, the opera- 
 tor can select the one which should properly be applied, or, if 
 more than one is needed, can so combine them as to accomplish 
 the desired result. The degree and line of force required have 
 much to do with the form of appliances needed. 
 
 Fig. 280. 
 
 Every appliance for regulating the teeth aims at the object 
 to exert pressure upon the teeth to be moved. An appliance for 
 this purpose should be as small as compatible with effectiveness 
 and strength. It should be so constructed it can he applied 
 inside of the arch in such a manner it will not interfere with 
 
 Fig. 281. 
 
 speech or mastication and can be removed for cleansing. It 
 should give as little annoyance as possible and should not neces- 
 sitate frequent visits to the dentist for adjustment. Whether the 
 teeth are to be forced out or drawn in, there is always to be 
 considered a body to be moved (the tooth) and a fixed point 
 of resistance. 
 
SURGICAL CORRECTIONS. 
 
 431 
 
 Study of the model does not always determine the amount of 
 force required to move the tooth. The model should be studied 
 but not to neglect care. While usually a point opposite can be 
 chosen for the anchorage of the appliance, this does not always 
 hold good. Every case is a problem in itself. The point of 
 anchorage must, of course, afTord greater resistance than the 
 
 point to be moved. To find such a point is sometimes difficult. 
 Such is the case where a cuspid has to be moved. In such cases 
 it frequently happens the dentist finds, to his chagrin, he has 
 moved his point of resistance rather than the tooth. Constant 
 vigilance must, hence, be exercised in noting occlusion. The 
 
 W 
 
 W 
 
 li 
 
 A A A A 
 
 A 
 
 B 
 
 c 
 
 D 
 
 'A ys 
 
 E 
 
 F 
 
 I 
 
 G 
 
 fz 
 
 n 
 
 'A 
 
 Fig. -283. 
 
 I 
 
 i5< 
 
 i^^ 
 
 patient should be asked, at each sitting, in which tooth he 
 sufifers most when the nut is turned. It is often found expedient 
 in moving teeth that afford great resistance, like central incisors 
 or cuspids, to loosen them first by simple wedging with orange 
 wood, or even cotton, proceeding slowly. This causes slight 
 inflammation, then absorption of the alveolar process around 
 
432 IRREGULARITIES OF THE TEETH. 
 
 the tooth or teeth to be moved, giving these teeth a decided 
 advantage when force is appHed. Thus resistance is lessened 
 and the tooth or teeth to which the appUances are attached will 
 now afford greater resistance in proportion that at first. 
 
 Sometimes a plate can be constructed to which an appliance 
 for moving a tooth may be attached. This is desirable (i) where 
 there is not a tooth conveniently located for attachment; (2) 
 when it is expedient to avoid the additional irritation ; (3) when 
 the mechanism is such as to require it. In applying the appar- 
 atus to a tooth, its position in the jaw should be observed and 
 the inclination of the root or roots must be ascertained to decide 
 whether they stand perpendicularly in the alveolar process or on 
 an incline. All obstructions should be removed by extraction 
 or by lateral pressure. 
 
 The force should be applied to the tooth to be moved either 
 
 Fig. 284. Fig. 285. 
 
 at right angles to the long axis of the root (Fig. 276, a, b, c), or 
 at an angle of 45 degrees, d, b, c. By these means the tooth 
 is prevented from rising from the socket. The position of the 
 tooth in the jaw, the density of the alveolar process, the length 
 of the roots, their normal or abnormal condition and length of 
 crowns, all require consideration in deciding amount and direc- 
 tion of force to be used without elongating the tooth. Drilling 
 of holes in natural teeth for anchorage is practiced by some repu- 
 table dentists. There are, however, few cases that cannot be 
 treated by securing a band or cap of thin gold or platinum to 
 the teeth with zinc oxyphosphate, in which band holes may be 
 drilled or hooks or loops soldered at any required point. 
 
 If the superior maxillary bone be examined after the teeth 
 are removed, the outer plate of the alveolar process is found 
 much thinner than the inner, which is backed up by the strong, 
 thick bone of the hard palate. Upon the inferior maxilla the 
 
SURGICAL CORRECTIONS. 
 
 433 
 
 outer plate of bone is thinner as far baek as the second bicuspicls 
 and the inner phite is thinner at the parts occni)ied by the molars. 
 The inner plate is thickest between the second bicuspids upon 
 either side and is reinforced by the symphysis and gential 
 tubercles. The external i:)late is thickest in spaces occupied by 
 the molars and is backed by the external oblicpie ridge. When 
 the soft tissues have been removed from the superior maxilla, 
 it is not uncommon to find the roots of sound, healthy teeth 
 extending through the outer plate of bone. After the teeth 
 have been extracted, absorption of the outer plate takes place 
 
 Fig. 286. 
 
 much more rapidly than of the inner plate. Absorption of the 
 external and internal plates of the inferior maxilla goes on more 
 uniformly than in those of the superior, owing to a more even 
 distribution of bone. In all cases, the thick or hypertrophied 
 alveolar process should be cut away, as illustrated elsewhere. 
 
 In the application of force, most pressure is required in the 
 direction of the greatest resistance. Care must be exercised 
 in directing the force toward the weaker parts of the alveolar 
 process. 
 
 If possible the force should be uniform and steady, but this 
 while possible with certain appliances like the elastic band, liga- 
 
 29 
 
434 
 
 IRREGULARITIES OF THE TEETH. 
 
 tures and the like, is impossible with the screw. All forces act 
 either slowly and constantly like the above, diminishing in their 
 action in proportion to the yielding of the tooth, or else they act 
 by impulse like the screw. 
 
 The force exerted should be enough to produce absorption 
 of bone with slight inflammation. Too rapid movement of the 
 teeth, especially when patients are over twenty years of age, 
 should not be countenanced. The alveolar process may be 
 absorbed to such an extent that it is impossible to retain the 
 teeth in their proper places, as new material is not deposited. 
 The extensive inflammation resulting from the excessive force 
 required prevents restoration of bone. 
 
 The inconvenience and unsightly appearance of many appli- 
 
 Fig. 287. 
 
 ances required, when great pressure is needed to move certain 
 teeth (notably cuspids, upper and lower), either forward or back, 
 is another objection. Appliances adjusted to the head are so 
 unsightly and embarrassing that not infrequently the patient 
 is deterred from the operation, which would otherwise have 
 been undertaken could some method be adopted which would 
 not detract from personal appearance. 
 
 The results of attachment of appliances to the molars for the 
 purpose of moving the cuspids and incisors back frequently 
 chagrins and mortifies the operator when he discovers that, 
 instead of the molars being the fixed point and the cuspids 
 drawn back, the reverse has occurred. 
 
 One most difficult problem to solve, which always requires 
 
SURGICAL CORRECTIONS. 
 
 435 
 
 extra pressure, is that when the inferior alveolar process has 
 become excessively developed, carrying the incisors upward 
 until the cutting-edges come in contact with the mucous 
 membrane in the vault of the mouth, which causes proliferation 
 of osteoblasts that carries superior incisors forward (Fig. 12). 
 Density of bone often makes it difficult to obtain sufficient 
 force to produce the absorption of this tissue required to bring 
 the teeth back into place. Probably one of the most difficult 
 operations is to carry a cuspid, which is erupting in the vault 
 of the mouth, back into its normal position. This not only 
 requires considerable force, but time, to say nothing of the 
 difficulty in attaching a cap for a point of resistance. Rotation 
 
 Fig. 288. 
 
 of the teeth, especially the incisors and cuspids, is frequently 
 difficult, if not impossible, owing to insufficient leverage. 
 
 Alany other situations present themselves to the operator in 
 his practice other than those mentioned, but as all require treat- 
 ment in the same manner, only the most difficult cases have 
 been considered. After an appliance has been adjusted, no 
 matter of what nature and pressure applied, the long, tedious 
 method of plowing through the alveolar process (regardless of 
 the density of the bone) by absorption is pernicious and unscien- 
 tific, not to speak of the long, tedious days, weeks and months 
 of suffering. The period of life most acceptable for the correc- 
 tion of these deformities is between twelve and sixteen years. 
 
436 
 
 IRREGULARITIES OF THE TEETH 
 
 This time is to the patient the most critical and as in every case 
 they are degenerates with an unstable nervous system, the great- 
 est care should be taken not to subject them to great strain. Ner- 
 vous prostration of years' standing may result, and patients be 
 permanently injured by such nerve-strain. 
 
 To obviate excessive pressure as well as unsightly appliances 
 I have for many years proceeded in the following manner, based 
 upon modern principles of surgery : This method consists in 
 removing the alveolar process in the line of travel of the tooth 
 to be moved, leaving a small amount of process about the root 
 of the tooth, holding intact the peridental membrane. This 
 
 Fig. 289. 
 
 is accomplished with coarse-cut Revelation burs, or those that 
 will cut in all directions. They can be used as drills in certain 
 conditions, to be mentioned later on. 
 
 If the cuspidf^ require to be carried backward, make an appli- 
 ance with bands about the first and second molars, with caps 
 upon the cuspids and a bar with a screw nut upon the end, as 
 recommended by Dr. Farrar. Extract the first bicuspid and 
 adjust the appliance. Then, resting the hand against the cuspid, 
 cut out the lingual and buccal V-shaped plate, making a concave 
 surface of the alveolar process, as illustrated in Fig. o.'j'j. 
 
 If the superior incisors are to be carried back, cut semi- 
 circular spaces just posterior to the teeth to be moved (Fig. 278). 
 To carry a cuspid into place which is erupting into the vault of 
 
SURGICAL CORRECTIONS. 437 
 
 the mouth, remove the alveolar process in the direction of the 
 line of travel (Fig. 279). 
 
 In moving teeth laterally by a jack-screw, it will be found 
 that not infrequently one tooth moves faster than the other. To 
 bring both to their proper position, cut out the alveolar process 
 on the side of the slowest-moving tooth and both will come 
 into proper position (Fig. 280). To rotate a tooth, cut a cir- 
 cular groove as deep as possible around the tooth, leaving 
 enough process to hold the peridental membrane intact (Fig. 
 281). In this manner teeth may be moved very rapidly and 
 without much pain. This should always be done by means of 
 screws. Bv this method the tooth or teeth to be moved are 
 
 Fig. :."jii. 
 
 completely under control. Any of the teeth in the mouth may 
 be used for fixed points of resistance, thus doing away with all 
 unsightly appliances outside the mouth. When in place, they 
 should be anchored in the usual manner. Antiseptic washes 
 should be used from time to time. 
 
 Appliances of different forces should be discussed in order 
 of their value as adjtmcts in the correction of irregularities of 
 the teeth. Long and skilled experience has shown the screw to 
 be the most valued instrument for this purpose. When the 
 appliance is once adjusted upon the teeth, the procedure is posi- 
 tive and simple, causing less pain and producing more uniform 
 results. It is a modification of the inclined plane and always 
 
438 
 
 IRREGULARITIES OF THE TEETH. 
 
 requires a lever for the purpose of turning it. It may be used 
 for penetrating wood, like a thumb-screw, a gimlet, etc., or it 
 may be used as a moving force, as in raising buildings, or in 
 the familiar letter press. In these cases, it must work in a hollow 
 cylinder with a corresponding thread cut inside which is called 
 the female screw, or nut. When the screw is turned in the nut, 
 it will either advance or recede. With the screw, the power pro- 
 duces a pressure as riiany times greater than itself as its circum- 
 ference is greater than the distance between the threads. 
 
 It should be noticed that, unlike other mechanical powers 
 described, the screw works by impulse, each turn producing an 
 efTect at once when the motion is ended. This kind of force is 
 of peculiar importance to the dentist since it is positive and 
 when properly applied can always be depended upon. It is a 
 
 Fig. 291. 
 
 powerful agent in widening the dental arch ; obstinate cases 
 yielding readily to the pressure. Dr. Farrar, after years of careful 
 experience with dififerent appliances for regulating teeth, more 
 than three decades ago^ set forth strong reasons for using the 
 screw. The results of his experiments on tissues first with 
 elastic and afterward with the screw were decidedly in favor of 
 the latter. 
 
 He uses the screw having sixty threads to the inch. The 
 screw is turned one-half a revolution morning and evening, thus 
 advancing the nut one-half of a thread or T-120 of an inch at each 
 operation, or 1-60 of an inch per day. This rate was found to 
 produce no pain: a repetition of the sense of tightness was 
 noticed for about one hour after every advance of the screw, but 
 
 1 Dental Cosmos, Vol. XVIII, page 13. 
 
SURGICAL CORRECTIONS. 
 
 439 
 
 it easily was borne by the patient and produced no perceptible 
 pain. 
 
 His method and experience are of so much importance that 
 his conclusions deserve quotation and emphasis. "First, That 
 in regulating teeth, the traction must be intermittent and must 
 not exceed certain fixed limits. 
 
 Second. That while the system of moving teeth by elastic 
 rubber apparatus is unscientific, leads to pain and inflammation, 
 and is dangerous to the future usefulness of the teeth operated 
 upon, a properly 'constructed metallic apparatus, operated upon 
 
 Fig. 29-2. 
 
 by screws and nuts, produces happy results without pain or 
 nervous exhaustion. 
 
 Third. That if the teeth are moved through the gums and 
 alveolar process about 1-240 of an inch every morning, and the 
 same every evening, no pain or nervous exhaustion follows. 
 
 Fourth. That while these tissues will follow an advancement 
 of a tooth at this rate (1-2.40 of an inch) twice in twenty-four 
 hours, the changes being physiologic, yet, if a much greater 
 pressure be made, the tissue changes will become pathologic.^" 
 
 2 In the chapter on physiologic and pathologic changes the experi- 
 ments show that the movement of the teeth is always pathologic. 
 
440 
 
 IRREGULARITIES OF THE TEETH. 
 
 To Dr. Wm. H. Dwinell, of New York, the profession owes 
 a debt for the introduction of the jack-screw as a powerful, direct 
 force in regulating teeth. The following cuts (Fig. 282, Nos. 
 I, 2, 3) are the original jack-screws introduced by Dr. Dwinell, 
 and are very efficient when combined with rubber plates. The 
 
 Fig. -^93. 
 
 screw is just what is termed in mechanics a right hand thread 
 with a single nut. The distal end of the screw is made conical 
 that it may be directed either in the plate or band around the 
 tooth to be moved. Nos. 4, 5, 6 show Dr. A. McCullom's inven- 
 tion, and are called compound jack-screws. They are made with 
 
 Fig. 294. 
 
 right and left thread, with nuts to correspond, so that when 
 adjvisted they will expand or contract if a lever be inserted 
 in the holes drilled through the center of the bar and moved in 
 either direction. The length of the bar may differ according 
 to the convenience of the operator. 
 
 Some years of practice showed, however, these screws were 
 
SURGICAL CORRECTIONS. 
 
 in 
 
 not only ratlicr l)unj;liiig as to size, but that the threads were 
 too coarse. lM-e((ucntly shorter screws could also be used to an 
 advantage. For some years, I made my own screws. Later, at 
 my suggestion, they were made by the S. S. White Dental Manu- 
 facturing Company (Fig. 283). They are a modification of the 
 
 Fig. 295. 
 
 Dwinell-McCullom set, and in every respect have decided advan- 
 tages, one of the special features being that the nuts are hol- 
 lowed out at the ends, thus, readily adapting themselves to 
 the crowns of the teeth and preventing their slipping. These 
 screws are admirably adapted for the purpose of widening or 
 enlarging the dental arches. This may be done by banding two 
 
 Fig. 296. 
 
 or more teeth upon either side, lengthwise to the dental arch 
 and attaching the screw in a position which will give uniform 
 pressure. The location will depend upon the shape of the dental 
 arch and the location of the teeth. Another method I fre- 
 quently adopt is to make a rubber plate, similar to that of Kings- 
 ley's,3 vulcanize it only sufificiently to make it springy and locate 
 
 3 Oral Deformities. Fig. 46. 
 
442 
 
 IRREGULARITIES OF THE TEETH. 
 
 the modern jack-screw at the narrowest point or where the most 
 pressure is required. The difficuhy, however, in using plates 
 is that after the teeth have been pushed beyond the perpendicular 
 line, the plate is with difficulty kept in the mouth. I overcome 
 this difficulty by cementing bands with lugs upon them to the 
 teeth. By so doing the plate cannot slip out of the mouth. Two 
 teeth, one on either side, may be carried laterally uniformly. If 
 one is progressing faster than the others the alveolar process 
 about the one which moves the slowest may be cut away. In 
 this way uniformity of distance can be obtained. 
 
 The screw should always be used in combination with a plate 
 or with bands ; otherwise the alveolar process and gums may be 
 
 Fig. 297. 
 
 injured. When the bicuspids and molars stand inside of the 
 arch, and a uniform pressure is required on both sides of 
 the arch, the nut is prevented from working into the gum by 
 placing around the teeth to be moved platinum bands with pro- 
 jectives soldered to the edge nearest their cervical margins 
 (Fig. 284). 
 
 If the deformity be only on one side of the arch, it will be 
 necessary to obtain either a fixed point opposite, by uniting 
 three or four teeth with bands, and thus giving a strong support, 
 or by inserting a rubber plate. When the plate is finished, a 
 groove may be cut or a hole drilled to hold the screw in place. 
 The screw may be called a universal force, as it can be made 
 to force teeth in or out, or in any direction, provided a fixed 
 
SURGICAL CORRECTIONS. 
 
 443 
 
 point can be obtained from which to work the screw. Where 
 the roots are in a diagonal position in the jaw, or are in close 
 proximity to other roots, the screw is very effective. As already 
 shown, holes should never be drilled in sound teeth. 
 
 The shorter jack-screws are very efficient when a tooth is out 
 
 Fig. 298. 
 
 of line and it is possible to obtain sufficient space by forcing a 
 number of teeth in opposite directions, especially where great 
 force is reqviired, as illustrated in Fig. 285. 
 
 One of the most common and most difficult forms of deformi- 
 ties which require treatment and considerable thought need not 
 now be described in detail, since its many complications can be 
 reduced to simple forms. The pathology of this is elsewhere 
 
 Fig. 299. 
 
 discussed. There are many other deformities of the teeth in 
 which various portions of these appliances may be used with 
 success. Judgment and skill of the operator is here an absolute 
 necessity. 
 
 A rubber plate (Fig. 286) is placed in the mouth, fitting the 
 vault and of sufficient thickness in front to separate the posterior 
 
444 
 
 IRREGULARITIES OF THE TEETH. 
 
 teeth, in order to lengthen them and to force the lower incisors 
 (which alone rest upon the plate) into the jaw. This was 
 renewed once or twice to give additional space (Fig. 287). When 
 this process is completed, which requires from three to nine 
 months, it leaves a space of three-sixteenths of an inch between 
 the vault and the lower incisors when the jaws are closed. 
 
 After the models are obtained and before extraction of teeth, 
 the operator should make anchor clamps or bands and adjust 
 them to the first or second molars, or both. Caps should then 
 be made to cover the cuspids, which are to fit loosely and to 
 extend up to the gum margin all around. This is necessary 
 because of the cone-shaped crowns and the great force required 
 
 Fi>. ?00. 
 
 to move the tooth, the caps are liable to be pulled off. Tubes 
 should then be soldered upon the caps and bands to accommo- 
 date the screws and nuts. 
 
 Pending the making of appliances, wedges of wood or rubber 
 should be placed between the second bicuspids and molars and 
 first and second molars to make room for the bands. When all 
 is ready, the first bicuspids should be removed and the appliance 
 fastened into place. After the teeth have been thoroughly 
 cleaned with alcohol, the caps and the bands should be cemented 
 and the bands cemented or fastened by the screws. The nuts 
 should be turned against the caps about six hours after the bands 
 are cemented. Twenty-four hours should elapse before pressure 
 is placed upon the tooth to allow the cement to become perfectly 
 
SURGICAL CORRECTIONS. 
 
 445 
 
 hard. With a good, sharp, coarse bur, previously rendered aseptic, 
 cut out the V-shaped alveolar jjrocess on buccal and lingual sur- 
 faces (Fig. 288), up as far as the bicuspid cavity extends. This will 
 relieve the operator of anxiety as to forward movement of the 
 molars, the fixed point, and will not require the patient to wear a 
 head cap. It will at the same time accomplish the work in less than 
 half the time without strain upon the patient. When the cuspids 
 have been carried back as far as required, the appliance will 
 answer the purpose of holding them in position until the rest 
 of the operation is completed. A bar should then be fitted to 
 the incisors with hooks extending over the centrals to prevent 
 •he bar from slipping upward. Owing to the diverging screws, 
 the bars may be made with long slots or the central piece may be 
 
 a tube with loose ends (Fig. 289). The alveolar process should 
 then be cut away and force applied. As the teeth move backward 
 the ends of the bar lengthens. When all is completed, the 
 appliance is removed and a wire soldered to bands which have 
 been so adjusted to molars or second bicuspids to hold all in 
 position. 
 
 The cuspids on the lower jaw sometimes erupt forward, caus- 
 ing contraction of the jaw and irregularities of the incisors. 
 From the dense bone in that locality, this is one of the most 
 difficult conditions to correct. Proceeding in the manner 
 described in the previous case, the operation becomes at once 
 simple and easy (Fig. 277). 
 
446 
 
 IRREGULARITIES OF THE TEETH. 
 
 The application of the screw for moving the various teeth 
 in or out into the dental arch by a surgical process is illustrated 
 in Fig. 290. 
 
 A method employed to obtain space in the dental arch and 
 which in many cases is admirably adapted for the purpose, is 
 illustrated in Fig. 291. 
 
 The lever "is an inflexible bar, capable of being moved about 
 a fixed point, called the fulcrum." The resistance is the object 
 to be moved ; the fulcrum is the fixed point of support ; the power 
 is in the force which overcomes the resistance. According to 
 the relative position of these are three kinds of levers :* 
 
 I. Lever of the first kind: Power — Fulcrum — Resistance. 
 
 Fig. ■30•^. 
 
 2. Lever of the second kind : Power — Resistance — Ful- 
 
 crum. 
 
 3. Lever of the third kind: Resistance — Power — Fulcrum. 
 An example of the first kind is the crow^-bar; of the second, 
 
 the w^heelbarrow ; of the third, the forceps. 
 
 Intensity of force is gained and time is lost in proportion as 
 the distance between the power and the fulcrum exceeds the dis- 
 tance between the resistance and the fulcrum. 
 
 In using the lever for the correction of irregularities it under- 
 goes modifications. Thus, when it is applied in the form of a 
 lig-ature or an elastic band, it becomes flexible instead of rigid, 
 the fulcrum frequently becomes a surface instead of a mere point 
 and the power is changed into resistance. 
 
 * These can be remembered by the formula, i 2 3. F R P. In the first, 
 the fulcrum is in the middle, the second resistance, the third power. 
 
SURGICAL CORRECTIONS. 
 
 447 
 
 Where the leverage can be multipHed most stubborn cases 
 succumb, as is ilhistratcd in rotating teeth set very firmly in the 
 jaw, or those crowded closely, or teeth of persons in advanced 
 years, where the alveolar process has become very dense and 
 
 Fig. 303. 
 
 hard. The increase of power in the lever is obtained by length- 
 ening the rod proportionately or in combining the leverage with 
 another fqrce. 
 
 The application of an increased length of rod is limited, for 
 
 Fig. 304. 
 
 want of space in the mouth; for in above rather limited dimen- 
 sions it interferes with the tongue or lips. The lever is required 
 in wherever the anterior superior teeth occlude inside of the 
 inferior teeth, if the case appear early enough. It is always 
 desirable to regulate these teeth as soon after their eruption as 
 
448 
 
 IRREGULARITIES OF THE TEETH. 
 
 possible, i. e., before the bony tissue becomes dense and hard 
 (Fig. 292). 
 
 This is a lever of the first kind. The upper incisor that strikes 
 inside is the resistance to be moved, the lower incisor against 
 which the stick rests is the fulcrum and the hand holding the 
 stick is the power. The greater the distance between the hand 
 
 Fig. 305. Fig. 306. 
 
 and the resting place of the stick, the greater the force exerted. 
 When such cases are to be treated, the patient comes to the 
 office at 9 A. M., and sits in front of the operating chair where 
 the operator can watch what is going on. A long, flat file handle 
 or similar instrument is placed in the mouth, as illustrated. The 
 patient holds the instrument firmly against the teeth. A day and 
 sometimes half a day is suf^cient to bring the tooth outside of 
 
 Fig. 30r. Fig. 308. 
 
 the lower teeth. As soon as the upper tooth strikes outside the 
 lower the operation is completed on the principle of the wedge. 
 Every time the patient closes the teeth with any degree of force, 
 the wedge (the lower incisors) is driven a little farther under the 
 upper, thus forcing it outward until even with the rest. This 
 appliance is of little use after the patient has arrived at the age 
 of twelve or fourteen. The lever is more successfully used in 
 
SURGICAL CORRECTIONS. 
 
 449 
 
 connection with bands and tubes for rotating teeth as observed 
 under the heading, "The Pulley, Wheel and Axle." 
 
 The simplest form of leverage is a wedge of cotton, gutta 
 percha or wood. The yielding tooth becomes the resistance, the 
 
 Fig. 309. 
 
 resisting tooth the fulcrum, and the elasticity of the intervening 
 wedge the power. When cotton or wood are used capillary 
 attraction becomes the source of power, inasmuch as it results 
 in the absorption of moisture. 
 
 Fisr. 310. 
 
 Leverage depends for its efficiency on the point where it is 
 applied. Judgment and thought exercised in this will amply 
 repay in the time gained and pain saved. In case the tooth is to 
 be brought in, it is a matter of some consequence whether force 
 is applied half-way betwen the cutting-edge and the neck or at 
 
 30 
 
450 
 
 IRREGULARITIES OF THE TEETH. 
 
 the cutting-edge. The apex of the root always being the ful- 
 crum, the farther from this it can be applied, the better; hence, 
 it is desirable to apply it as near as possible to the cutting-edge. 
 A tooth with a long root furnishes the advantage of distance 
 from the fulcrum, which is, however, more than counterbalanced 
 by the additional resistance thus offered, as it is easier to move 
 a tooth with a short root. 
 
 Fig. 311. 
 
 The pulley is a wheel with a groove cut into its circumference, 
 and is movable upon its axis. In mechanics the common term 
 for pulley is sheave. The pulley or sheave is placed between the 
 oblong blocks of wood through which the axis passes and sup- 
 ports the pulley in the center. The cord passing around the 
 pulley is called the tackle. The bucket and weight in the old- 
 fashioned well illustrate the pulley. The wheel and axle is a 
 modification of the pulley. The wheel is fastened securely to the 
 A A 
 
 Fig. :iVi. 
 
 Fig. 313. 
 
 axle ; the weight is attached by a rope to the axle, and the power 
 by a rope to the wheel, or to handles fixed at right angles to 
 its rim. The steering-gear of a vessel is an illustration of this 
 kind of lever. The wheel, axle and pulley are modifications of 
 the lever of the first kind, the circumference of the wheel or 
 pulley corresponding to the long arm ; the axle or block to the 
 short arm, the axis in both cases the fulcrum. The general 
 law corresponds to that of the lever. Intensity of force is gained 
 and time is lost in proportion as the circumference of the wheel 
 
SURGICAL CORRECTIONS. 
 
 451 
 
 exceeds that of the axle. The advantage of the wheel and axle 
 over the simple lever is the change of direction of power which 
 it affords. The power, instead of being in the same straight 
 line with the fulcrum and weight, may be applied at an angle. 
 This is convenient in producing the rotation of a tooth. 
 
 In its application to regulating, the elasticity of the rubber 
 band is the power; the tooth or teeth over which it passes is 
 the fulcrum and the tooth to be moved the weight. 
 
 Fig. 293 illustrates the rotation of a tooth by having a gold 
 band with an arm fitted to the tooth and a rubber band attached 
 to the arm and stretched to the first bicuspid; as the tooth 
 rotates, the arm is bent at right angles to the band. This appli- 
 
 Fi>. 314. 
 
 cation of the wheel and axle will accomplish the rotation of the 
 teeth in the majority of cases. 
 
 It should be observed that the powder of an elastic band is 
 increased wdth the tension until this becomes greater than the 
 strength of the material, w^hen it will break. Hence, the greater 
 the number of teeth over which it passes, the greater the power 
 of the band ; but at the same time it is lessened by the friction 
 of the surfaces over which it passes. 
 
 The inclined plane — a plane surface incHned to the horizon 
 at any angle— is used for raising weights. The longer the 
 inclined plane, the easier it is to raise a body a given height. 
 When the power acts parallel to the inclined plane, intensity of 
 force is gained and time is lost in proportion as the length of 
 the plane exceeds its height. 
 
 In dentistry this force has been found as of peculiar value 
 
452 
 
 IRREGULARITIES OF THE TEETH. 
 
 in cases where the arch is to be widened by an appliance ; under 
 such circumstances the teeth exert an outward pressure on the 
 opposite jaw and the articulation of the cusps makes an inclined 
 plane. 
 
 If the anterior superior teeth close inside of the inferior teeth 
 they should be brought out with the lever, and if the inferior 
 teeth be too short to exert a pressure on their opponents, they 
 may be fitted with a platinum cap and cemented securely with 
 zinc oxyphosphate. This arrangement maintains a constant out- 
 ward pressure upon the superior teeth (Fig. 294). In the illus- 
 tration a metal plate is fastened to the teeth by a ligature instead 
 of an elastic band. Although I have had good results with 
 this method, I do not consider it of anv great value, for the 
 
 Fig. 315. 
 
 reason that as soon as the teeth begin to get sore to touch, pres- 
 sure is unconsciously removed by the patient and the method 
 proves in most cases -to be a failure. 
 
 The wedge is a modification of the inclined plane. The 
 power is applied with a hammer or a sledge to the back of the 
 wedge. It is employed in various ways in ordinary mechanics, 
 as in raising buildings, splitting wood, etc. It is an unsatisfac- 
 tory force to calculate upon, because the large, f^at surfaces pro- 
 duce so much friction. On the other hand, its friction is useful 
 in retaining the wedge in its position. The power (acting paral- 
 lel to the base instead of the inclined surface) counterbalances 
 a weight as many times greater than itself as the height of the 
 wedge is contained in the base. When applied to the teeth, the 
 
SURGICAL CORRECTIONS. 
 
 453 
 
 wedge increases the diameter of the arc of a circle in which 
 the teeth are implanted. It is usually made of fine-grained wood 
 or India-rubber. It is a direct, positive, very elTective force. 
 Teeth with long roots, deep in the alveolar process, when the 
 latter is dense and hard, are difficult to start with ordinary appli- 
 
 Fig. 3:tJ. 
 
 ances. In such cases the wedge is of great service. It will 
 readily move one or two teeth and not infrequently three will 
 be influenced by its pressure. Wedges made from orange wood 
 are very serviceable, as they can be readily reduced in size as 
 the case may require. When applied to the teeth they become 
 saturated with saliva, swell, and in so doing force the teeth 
 apart. When a rubber wedge is used one slightly larger than 
 
 Fig. 317 
 
 the space between the teeth is selected and by its elasticity the 
 teeth are spread. The rubber wedge performs its work with 
 greater rapidity, perhaps, but it causes more pain than the 
 wooden wedge. Owing to elasticity of rubber the teeth vibrate 
 with each efifort of mastication, whereas they are held firmly by 
 the wooden wedge. 
 
454 
 
 IRREGULARITIES OF THE TEETH. 
 
 Each of the six mechanical forces has its proper place in the 
 art of regulating teeth and when skillfully applied each is an 
 effective agent. The application of these forces, however, is 
 limited. Elasticity, as found in the spring of metals and India- 
 rubber, combines much that is necessary to render effective 
 either the most rudimentary deficient or the most intricate appli- 
 ance. The simplicity of the application of this force makes it 
 peculiarly suitable to dentistry. 
 
 Next to the screw, elasticity of metals gives more satisfac- 
 tion in correcting deformities than any other appliance. Although 
 it is not a positive force, yet it has the advantage of being readily 
 held under control. 
 
 Fig. 318. 
 
 Metal molecules are held together by cohesion. These parti- 
 cles change in their relative positions when the metal is acted 
 upon by an external force. If this force be removed before 
 these changes exceed a certain limit, the particles return to. their 
 previous positions. This power of returning to original form 
 is called elasticity. This elasticity of metals may be utilized in 
 regulating teeth with results only limited by the amount of 
 spring which a metal possesses. There are many degrees of 
 elasticity. A metal cannot be absolutely elastic ; that it cannot go 
 back exactly to its previous form. Every body is elastic in a 
 degree. Gold belongs to the inelastics, alloyed with other met- 
 als (platinum) it becomes a markedly elastic metal. 
 
 German silver and piano wire are my favorite metals. A 
 little appliance, which I have used for thirty years, has given as 
 
SURGICAL CORRECTIONS. 
 
 455 
 
 much satisfaction in correcting irregularities of the teeth as the 
 screw. Take commercial German silver plate and roll it to Nos. 
 29, 31 and 32, U. S. gauge. These thicknesses are required to 
 obtain different strengths of metal. Cut into strips, take the 
 thinnest strip, place flat nose pliers in the center (Fig. 295), and 
 bend the strip the width of the tooth to be brought into line. 
 Then with round nose pliers bend the ends in the opposite 
 direction, just a little shorter than the adjoining teeth, cut and 
 trim the corners and edges so that the lips and cheeks may not 
 be injured ; this is to be crowded into place. This afifords double 
 leverage, inasmuch as it draws one tooth in and the other out 
 (Fig. 296). d is the weight, the proximal surfaces of the two 
 
 Fig. .319. 
 
 adjoining teeth at c are the fulcrum and a the power, or a the 
 resistance, c the fulcrum and d the power. The strongest tooth 
 affords, of course, the greatest resistance. 
 
 The power in cases like this depends largely on the elasticity 
 and tenacity of the metal. If the intervening medium between 
 the proximal surfaces of the resisting tooth and that of the tooth 
 to be moved have little or no elasticity, the intervening medium 
 will yield readily, and nothing can be accomplished. 
 
 Rolling the German silver into fixed thicknesses gives the 
 metal its elasticity, hence it must not be heated after it is run 
 through the mill. Fig. 297 shows some of the positions in 
 which this metal may be used. All teeth, however, anterior to 
 the first permanent molars may be brought froin either direction 
 
456 IRREGULARITIES OF THE TEETH. 
 
 into line by this process. The surgical procedure is Hkewise 
 here ilhistrated. The superior incisors situated just inside the 
 lower may be brought into line without the use of a plate to keep 
 the jaws apart. This appliance must be removed every day and 
 with round nose pliers the ends are bent, the spring shortened 
 and forced into place upon the tooth, so easily that caution must 
 be observed not to exceed the intended results. 
 
 Piano wire manufactured in Germany, England and America 
 is made of the best steel, drawn through a draw-plate to the 
 required size ; polish and temper are given during this process. 
 The wire must be extremely pliable and strong to endure the 
 tension which it undergoes during the tuning process of a piano. 
 It must also be perfect in construction, since a flaw in the wire 
 makes it to snap when being manipulated. It has great advan- 
 
 Fii,' 3^0 Fig. .3-,'l. 
 
 tages for dental purposes. It is inexpensive, has greater elas- 
 ticity than other wires and can be more easily adapted to a 
 variety of cases. It can be bent in any way necessary to obtain 
 the greatest amount of force and can be applied to any place 
 in the mouth, on account of its small size and weight. Sizes 
 i8, 19, 20 are better suited to the majority of irregularities, the 
 strength of the wire to perform a given operation depending 
 upon the age and constitution of the individual and the character 
 of the irregularity. In -youth or in delicate organizations. No. 
 20 is the size best adapted to regulate ; the sizes should decrease 
 to No. 17 as the years advance, or as the stubbornness of the 
 irregularity demands. The selection of the wire and adaptation 
 to each special case so as to secure the best results and avoid 
 inflammation requires nice discrimination. 
 
 In order to obtain the best results, the elasticity of the wire 
 
SURGICAL CORRECTIONS. 457 
 
 was increased by coiling it from one to three times around a 
 mandril. The idea of the coil in connection- with piano-wire 
 occurred to me at the 1881 International Medical Congress. 
 These coil springs have been placed at the dental depots for 
 the benefit of those who have not the time to make their own 
 springs. The mandril is driven into the bench and with the 
 right hand the wire is coiled about it as many times as required, 
 the short end being held firmly by the left hand. The coil ends 
 directly at the starting point and gives thereby the greatest 
 elasticity and length of arms. When necessary, the long end 
 of the wire can be bent with square-nose pliers to make it on 
 the same plane with the other arm. Fig. 298 shows the coil 
 spring. 
 
 The coil of the spring works on the same principle as the 
 mainspring of an American watch, which, between two points, 
 measures a uniform period of time. The extremities of the 
 
 Fig. :m. 
 
 arms of the spring travel over a given space with like uniformity, 
 which gives a mild uniform pressure to the jaws and teeth. The 
 arms may be bent in any 'position and cut at any length to suit 
 the case in hand. One or more coils may be used on the same 
 wire. They may be used in connection with a rubber plate, or 
 with bands of gold or platinum fastened to the teeth with zinc 
 oxyphosphate. With holes properly drilled in the plate or bands 
 and the arms fitted into them, the spring will stay in position. 
 When the spring is used without a plate, it will be well to fasten 
 the wire in some of the teeth to prevent its being swallowed, 
 should it accidentally spring out of place. 
 
 The following histories illustrate some difficulties in prac- 
 tice : 
 
 The following models of the mouth of a sixteen-year-old 
 girl, a patient of Dr. J. F. Austin, of Chicago, show a deformity 
 I corrected. The right cuspid had encroached upon the lateral 
 incisor to such an extent as to twist and force it out of position, 
 
458 
 
 IRREGULARITIES OF THE TEETH. 
 
 leaving only about one-half of the space necessary to rotate 
 the tooth into place. A plate was made to fit the mouth and 
 teeth and a coil-spring inserted, with arms meeting the cuspid 
 and central incisor. The spring was secured to the plate by a 
 pin driven into the plate (Fig. 299). By the lateral pressure 
 of the spring the teeth were pushed apart, making space for 
 the teeth to be rotated into place. Fig. 300 shows the tooth 
 secured in position by the Magill retainer. 
 
 On an exact plaster model of the case to be regulated a thin, 
 narrow vulcanite plate is formed, with a short, vertical post fixed, 
 either before vulcanizing or afterward, by drilling centrally in 
 
 Fig. 3^4. 
 
 the plate on the median line. Grooves or slots" are, with a wheel 
 bur, cut in the sides of the plate to receive the ends of the spring 
 and prevent its displacement after the coil has been placed on the 
 post. Fig. 301 represents such an appliance in position on a 
 plaster cast of the inferior maxilla of a boy aged twelve years 
 and it will thus be seen that the movements of the tongue would 
 not be, as in practice they were not, seriously restricted. The 
 tension of the spring is changed by simply bending outward or 
 inward its arms. In many cases the apparatus may be inserted 
 or removed with great facility and its action so continued and 
 controlled that required expansion is obtained and maintained 
 
SURGICAL CORRECTIONS. 
 
 4".n 
 
 by merely one plate. This plate, with spring attached, was 
 removed by the boy twice a day and the teeth and plate cleaned. 
 In spreading the dental arch the majority of cases require 
 the greatest pressure on the anterior teeth and an appliance that 
 can be placed inside the arch will exert the greatest influence. 
 The force is equally distributed on both sides of the mouth and 
 if constant the work will be accomplished rapidly, without incon- 
 venience to the patient. Such an appliance is here illustrated 
 (Fig. 302). It was used in the mouth of a young girl fourteen 
 years of age. A plate made to fit the teeth and alveolar process 
 was cut away so that the anterior parts extend far enough 
 forward to inclose the teeth to be moved. A piece of wire was 
 bent to either of the forms shown in Fig. 303, wherein a is the 
 
 Fig. 325. 
 
 coil and fixed point and b b movable arms extending from a 
 and also fixed points, cc, movable arms extending from b b. 
 
 Grooves were cut into the anterior and posterior parts of 
 the plate to correspond with and receive the points b b and c 
 c Holes were drilled at these points and the wires tied to the 
 rubber plates. In order that the anterior teeth may be moved 
 with the greatest force, the arms are so adjusted that the greatest 
 pressure is exerted on the anterior parts of the plates. This 
 appliance is readily removed for cleansing and returned to place 
 by the patient. A coil spring, however, with two pomts of 
 attachment is not as efficient at the second as at tlie first pomt. 
 Another appliance for widening the dental arch that has been 
 successfully used is illustrated in Fig. 304- It consists of a rubber 
 plate made to fit the teeth and jaw. The plate is then sawed length- 
 wise-commencing at a point anterior to the teeth to be moved; 
 a hole is drilled at the point where the slot stops to prevent the 
 
460 IRREGULARITIES OF THE TEETH. 
 
 arms breaking. At the extreme end holes are drilled to receive 
 the spring. To adjust the plate press the arms together and 
 drop the plate into place. Fig. 305 shows the plate out of the 
 mouth. This can be removed and inserted by the patient. 
 
 A form of dental irregularity difficult to correct occurs when 
 the cuspids are situated near or in contact with the centrals, 
 while the laterals stand inside of the arch, and, when the jaws 
 are closed pass behind the central incisors. If these laterals 
 be in near relations, ordinary means do not interact upon them 
 with sufficient pressure to force them apart ; the space being 
 quite too short to admit a jack-screw. 
 
 Fig. 306 represents such a condition. The cut is made from 
 the cast of an eighteen-year-old woman, who came under care 
 in 1883. The superior laterals were then only one-fourth of an 
 inch apart and closed behind the inferior incisors. There were 
 but small spaces between the superior centrals and cuspids. 
 
 Thin platinum collars were made to fit the laterals, on which 
 after driling a hole in the side of each collar, they were firmly 
 fixed with zinc oxyphosphate. A spring was bent into the form 
 shown in Fig. 307, the ends of the arms being turned at a sharp 
 angle and cut short as seen in the figure. 
 
 The spring was then put in place, the arm ends entering the 
 holes in the collars and the curved arms were closely conformed 
 to the surface of the gums and palatine parts so that the fixture, 
 while no obstruction to occlusion, could be easily sprung out 
 of position for cleansing purposes or for increasing the expansive 
 power of the spring, by simply widening the lateral spread of 
 the arms. Fig. 306 shows the progress made in four weeks' 
 treatment. When the laterals had been moved past the sides 
 of the centrals, they were by other means forced outward into 
 line. 
 
 To force out central and lateral incisors, I have found the 
 following methods useful : Around the tooth to be moved and 
 around the molars, as nearly opposite the direction the incisor 
 is to travel as possible, fit platinum collars. Solder cups upon 
 the collars directly opposite and in line. Make a spring of piano- 
 wire (Fig. 308) and spring it into the cups soldered upon the 
 collars. In Fig. 309 the appliance is seen in place. 
 
SURGICAL CORRECTIONS. 
 
 461 
 
 Another method is to make a plate to fit the teeth, thick- 
 ening it nearly to the cutting edge of the tooth to be moved, and 
 drilling a hole through the thickened part. Directly opposite, 
 at some convenient point on the back part of the plate, drill 
 another hole just deep enough to hold the spring in place (Fig. 
 310). If the hole in the thickened part be drilled in the proper 
 place, the end of the spring will hit the tooth midway between 
 its cutting-edge and the margin of the gum. The spring is 
 very effective. The pressure is constant and the spring is readily 
 removed for adjustment or for any other purpose. 
 
 A single tooth is often so situated inside the dental arch 
 
 FiK. :m. 
 
 that there is trouble in contriving an apparatus suited to its cor- 
 rection. 
 
 The illustrations represent some simple appliances that have 
 been thoroughly tested and found satisfactory ; they do the work 
 effectively, are easy of adjustment and removal and they may 
 be readily cleansed. 
 
 Fig. 311 illustrates a second inferior bicuspid of the right 
 side, having a lingual presentation equal to one-half the thickness 
 of the tooth inside of its normal position. The cut also shows 
 teeth in other malpositions. 
 
 For this case a thin, narrow, close-fitting vulcanite plate was 
 made, and a hole was drilled through the middle of the plate 
 opposite the center of the tooth to be moved. In the other side 
 another hole was drilled, but not quite through the plate. A 
 suitable spring (Fig. 312) was then made of piano-wire, having 
 a single coil, A, and the ends of its arms bent at about a right 
 
462 IRREGULARITIES OF THE TEETH. 
 
 angle. One of these ends, C, was cut short to enter the corre- 
 sponding hole in the plate, and the other end, B, left long enough 
 to go through the plate and impinge on the lingual surface of 
 the bicuspid, leaving a full eighth of an inch between that arm 
 of the spring and the plate, as is clearly shown by Fig. 311. Fig. 
 313 shows both arms, B B, of the same length, to pass through 
 the plate and impinge on lingual surfaces of teeth upon opposite 
 sides. 
 
 Fig. 314 shows an appliance for pulling out the central incis- 
 ors. A plate is made to fit the jaw and teeth and into it were 
 vulcanized two of the Talbot springs at the lateral incisor region. 
 The wire arms were turned into loops at the extremities to 
 secure a ligature. When the plate was adjusted, the arms were 
 bent horizontally and brought in close proximity to the labial 
 surfaces of the central incisors and securely tied. By this means 
 constant pressure was applied and the teeth were carried outside 
 of the inferior incisors. Moving individual teeth in or out into 
 line or rotating them in their sockets by the use of piano-wire 
 is illustrated in Fig. 315 and Fig. 316. The surgical procedure 
 is likewise demonstrated. 
 
 I have succeeded in erupting teeth by the following method : 
 Fig. 317 illustrates the right superior lateral arch of an eighteen- 
 year-old boy. At about the tenth year I was able to indicate 
 in outline the crown and root of the cuspid and noticed the 
 marked obliquity of its position. The posterior column was 
 crowding the bicuspids forward so that they eventually filled 
 the space allotted to the cuspid. The teeth in the left superior 
 lateral arch came into position in the natural order, and that 
 arch was nearly normal. I waited until the point of the cuspid 
 made its appearance, extracted the first bicuspid. Platinum 
 bands were fitted to the second bicuspid and lateral incisor and 
 these were connected with a bar of platinum extending to and 
 impinging upon the central incisor. A flat tube was then sol- 
 dered to the bar for the purpose of securing a coiled spring, 
 made of the smallest size piano-wire, the arms being cut to 
 about the same length. One arm was doubled upon itself and 
 so adjusted that when it was passed into the flat tube the suitably 
 bent end of the other arm would reach forward and catch upon 
 
SURGICAL CORRECTIONS. 
 
 403 
 
 the poinj; of the cuspid. The alveolar process was then cut 
 away, care being- taken not to injure the outer plate and peri- 
 osteum. By this means the cuspid was swung backward and 
 pulled downward until the crown was in direct line with the 
 position it was to occupy when in place. An impression was 
 then taken and a vulcanite plate made (Fig. 318), in which 
 another spring of piano-wire was inserted in such a manner that 
 when properly adjusted the end of the arm reached over and 
 just inside of the space of the cuspid. A ligature was then 
 tied around the neck of the tooth and the arm of the spring 
 drawn close to the crown and fastened. By glancing at Fig. 
 318 it will be observed that the action of the spring must be 
 to draw the tooth not only down, but also inward to its position. 
 In locating the spring in the plate, the position of the crown 
 
 < ] 
 
 ^}n-u 
 
 Fig. 327. 
 
 before and after it is brought into place must not be lost sight 
 of. When the spring is applied for the purpose of drawing the 
 tooth out of the alveolar process, the patient must be seen every 
 day, because in most cases this movement is so easily accom- 
 plished that only twenty-four hours are necessary to complete 
 the operation. If, on the other hand, two or more days super- 
 vene before the patient is seen, the tooth would be erupted 
 further than is required. 
 
 Teeth wholly imbedded in the jaw may be erupted with a 
 spring, as shown in Fig. 319, by first removing a piece of mucous 
 membrane and "alveolar process over the crown with Rollins' 
 revolving knife. The advantages of this peculiar kind of spring 
 in these difficult cases are: ist, it can be adjusted to any special 
 angle required, and, 2nd, the force is constant and need not be 
 readjusted for three or four days after it is applied (if the move- 
 
464 IRREGULARITIES OF THE TEETH. 
 
 ment be not rapid), thus relieving the operator and patient from 
 the expenditure of time in frequent office attendance. 
 
 A form of irregularity of the teeth is occasionally observed 
 wherein the cuspids erupt inside of the arch. Sometimes the 
 case presents, when the point of the cusp has just penetrated 
 the mucous membrane of the mouth, and again the tooth will 
 have erupted its normal length. Frequently it will erupt in close 
 contact with the lateral incisor and first bicuspid, or it may make 
 its appearance in the roof of the mouth. Occasionally only 
 one cuspid will be misplaced. Again, both cuspids will thus 
 erupt out of position. Fig. 319 illustrates an instance of this 
 kind occurring in the mouth of a sixteen-year-old girl. Both 
 cuspids were in process of eruption inside the arches and in con- 
 tact with the adjoining tooth. The roots could be outhned on 
 the outer alveolar plate as far as their apices, demonstrating the 
 fact that the crypts containing the crowns were originally in 
 normal positions, but that their crowns had subsequently pointed 
 toward the roof of the mouth. A vulcanite plate was made and 
 a hole drilled through it so that the point of a wire spring would 
 touch the cuspid just above the margin of the gum. On the 
 opposite side of the plate a hole was drilled just deep enough 
 to hold the other end of the spring when in position. A cap 
 was cemented and a small hole drilled in it to prevent the spring 
 from slipping when adjusted in position. A strong spring was 
 made of piano-wire, No. 17 or 18 U. S. gauge, and the ends bent 
 at right angles. One of the ends was cut short to fit into the 
 hole made in the plate opposite the tooth to be moved, the 
 other end left long enough to pass through the plate and sharp- 
 pointed to enter a hole in the band of the tooth to be moved. 
 The alveolar process was then cut away in the direction of the 
 moving tooth. In many cases such a spring will keep the plate 
 in position, but should the plate slip it may be fastened to the 
 bicuspid with ligatures. 
 
 Fig. 320 illustrates the left side of the lower denture of a 
 thirteen-year-old boy. The second deciduous molar had been 
 retained in the jaw beyond the natural period and its mesial 
 and distal surfaces had been so destroyed by caries that the 
 first permanent molar had come forward and greatly diminished 
 
SURGICAL CORRECTIONS. 
 
 465 
 
 its normal distance from tlic first bicuspid. The removal of the 
 deciduous molar left an insufficient space for the accommodation 
 of the coming second bicuspid, which consequently had become 
 locked between the molar and first ])icuspid, so that complete 
 eruption was impossible. 
 
 A narrow vulcanite jilate was made and a coiled wire si)rin^' 
 was so applied as to force the teeth a])art. When sufficient 
 room had been g-ained, a cavity was formed in the crown of 
 the second bicuspid and small wire eye-bolt set in the cavitv 
 with amalgam. Another coiled wire spring was fixed in the 
 plate and the spring lever inserted in the eye of the bolt, as 
 shown in Fig. 321. The lifting action of the spring soon com- 
 pelled the eruption of the bicuspid into its proper position and 
 relations with the occluding teeth. 
 
 The removal of the eye-bolt after cutting away the amalgam 
 
 Fig. 328. 
 
 with a small round bur and the subsequent filling of the small 
 cavity with gold completed the operation. 
 
 Obviously a ligature could have been forced down upon the 
 submerged crown of the bicuspid and the loop-hitch of the liga- 
 ture be made a substitute for the eye-bolt. This was preferred as 
 a more positive means of attachment to the lifting spring lever. 
 
 June, 1884, the following treatment was begun for rotating 
 the central incisor of a patient. A platinum band was made to fit 
 the tooth and a tube of the same material w^as soldered length- 
 wise with the band (Fig. 322). The band was secured to the 
 tooth with zinc oxyphosphate, a piece of piano-wire being passed 
 into the tube and allowed to extend to the left central incisor 
 (Fig. 323). The wire was bent every day and the tooth thus 
 rotated into place. When practicable a flat tube should be sol- 
 dered to the band for the purpose of holding a flat lever, which 
 
 81 
 
466 IRREGULARITIES OF THETEETH. 
 
 would prevent the rotation of the arms. For rotating a tooth the 
 most efficient contrivance is the combined lever and collar, fitting 
 and fixed upon the tooth by cement (Fig. 324). The soldering 
 of a flattened tube across the face of the collar affords a means 
 for the insertion and removal of the lever at will. 
 
 I prefer a lever made of a piece of thin piano -wire, No. 27, 
 U. S. gauge, one end of which is folded upon itself for about a 
 quarter of an inch and the wire then coiled once or twice close 
 to the folded end (see illustration). The other end is bent to 
 hook around a molar or other posterior tooth. The illustration 
 shows such a tubed collar and wire lever separately and also in 
 place on the tooth which is to be rotated. It is obvious that the 
 lever can be removed or applied without detaching the cemented 
 collar. In operation, the compound lever effects a complex 
 movement of the tooth, which is being rotated by the lever as a 
 whole and is at the same time thrown outward by the hinge- 
 like action of the short lever turning on the coil as on an axis — 
 the result being the proper alignment of the tooth, if the spring 
 of the coil and the elasticity of the lever be judiciously adapted 
 to the case. 
 
 The other central incisor can Hkewise be simultaneously 
 rotated, and, after both teeth had been brought into position, a 
 folded wire bar through both tubes would retain them in place 
 so long as might be deemed desirable. 
 
 Elastic bands cut from French rubber tubing are applicable 
 to every case of irregularity of the teeth. Elasticity is peculiarly 
 adapted to the correction of irregularities, because of its con- 
 stant equable pressure, which may be increased or diminished 
 by varying the size of the bands. This constant pressure pro- 
 (iuces rapid absorption of the bone, which opposes the restora- 
 tion of the tooth to its normal position. 
 
 When the rubber bands are applied to the teeth, the point of 
 resistance becomes very important. The resistance must equal 
 or exceed that of the body to be moved; otherwise, the weaker 
 will be moved by the stronger force. If a tooth upon one side be 
 irregular, a tooth, or if necessary, several teeth, at the opposite 
 point must be selected to withstand the pressure of the tooth 
 to be moved. This requires thorough knowledge of the anat- 
 
SURGICAL CORRECTIONS. 4G7 
 
 omy of the teeth and jaws and ability to judge comparative 
 resistance of each tooth. 
 
 When the rubber bands are employed in cases requiring 
 much force, it is generally a good plan to fit a rubber plate to 
 the teeth and jaw, to which arms of rubber or gold are attached 
 in such a manner that the teeth may be drawn in or out, as the 
 case requires. The plate should be fastened by ligatures to fix 
 teeth, and acts as the point of resistance. Rubber bands cut 
 from tubing (or better, from rubber dam, as suggested by Dr. 
 G. V. Black) are attached to the arms and carried over the teeth 
 to be moved. Fig. 325 is from the model of the teeth of a four- 
 teen-year-old boy. The lower jaw occludes outside the upper. 
 A piece of gold wire (Fig. 326) was bent to the contour of the 
 dental arch, allowing a space of 3-16 of an inch between the 
 teeth and the wire and soldered to two bands attached to the 
 second bicuspids (first bicuspids or molars may be used if 
 desired). The surgical procedure is also illustrated. Rubber 
 
 Fiij. ;Wil. Fig. 330. 
 
 dam rings were fastened to the band and carried over the incisors 
 and cuspids. These teeth were dried and cleansed with alcohol. 
 Zinc oxyphosphate was then mixed until it became sticky, when 
 it was placed upon the lingual surfaces of the teeth for the pur- 
 pose of holding the bands. Protruding teeth may be brought 
 into line in the same manner by reversing the wire, placing it 
 upon the inside of the mouth and proceeding as before. The 
 teeth were in a short time brought out into place by the attach- 
 ment of rubber rings to the gold band and over the teeth. The 
 result is illustrated in Fig. 327. 
 
 Teeth may be rotated in their sockets with rubber bands in 
 the following manner: Cut away the alveolar process. Fit a 
 band of platinum accurately to the crown and solder. Make 
 a hook by inserting and soldering a pin from an artificial tooth 
 into a hole drilled in the labio-distal angle of the band. Fasten 
 this band upon the tooth with zinc oxyphosphate. Attach a 
 band of rubber at one end to the hook and at the other to a 
 bicuspid, the tooth being thus rotated into place. Another 
 
468 IRREGULARITIES OF THE TEETH. 
 
 plan : dry the tooth, coat it with sandarac varnish and while 
 moist wind about it a strip, cut from rubber dam, three-six- 
 teenths of an inch wide and two inches long, with a string tied 
 in its middle, so that the rubber dam doubles upon itself. Zinc 
 oxyphosphate may be used upon the tooth for the same purpose. 
 The band should be wound in the same direction in which the 
 tooth is to be rotated and the winding should be continued until 
 the end of the rubber reaches the distal edge of the tooth ; the 
 string should now be drawn across the mouth and tied to a 
 molar or bicuspid tooth. This has not been as successful as the 
 use of the Chinese grass line. 
 
 Ligatures are cords, strings, or wires for regulating and bind- 
 ing the teeth for the attachment of other appliances to the teeth 
 or for holding them securely after they have found their places. 
 Silk, linen or Chinese grass (raw silk fish line) ligatures serve a 
 good purpose. When ligatures are used to regulate, they act 
 upon the teeth to be moved by attaching them to a fixed point 
 and also by the shrinkage of the fiber when moistened. Care 
 should be taken in tying the knot of a ligature to avoid its work- 
 ing up under the gum. \'arious knots can be made for this 
 purpose. Since the introduction of Dr. Magih's band for regu- 
 lating teeth, the ligature has become a very useful adjunct for 
 fastening appliances at any point upon the band where a pin 
 or tube has been previously soldered. The raw silk fish line has 
 been found far superior to any ligature or rubber band, since, as 
 it contracts, it holds the tooth steady, therefore prevents soreness 
 on account of vibration. 
 
 A quicker and easier method of holding ligature wire or rub- 
 ber bands to teeth to prevent their slipping is to wipe the tooth 
 dry, clean it thoroughly with 95-per-cent alcohol and mix zinc 
 oxyphosphate into a sticky paste, apply this to the tooth or 
 teeth and allow it to dry before coming in contact with moisture. 
 Ligatures may then be fastened to the teeth without fear of 
 slipping. 
 
 To rotate teeth, double the silk, pass the loose ends through 
 the loop and apply it to the tooth to be rotated and fasten the 
 end to a bicuspid or molar. To regulate the six anterior inferior 
 teeth make a figure of 8 knot (Fig. 328). Figure of 8 knot may 
 
SURGICAL CORRECTIONS. 469 
 
 be used with the upper teeth in the same manner. Teeth may 
 be moved in or out. The ingenuity of the operator will devise 
 other operations on similar principles. 
 
 Dr. Guilford's retainer consists of a band of gold or platinum 
 (Fig. 329) swaged or fitted accurately to the tooth and of suffi- 
 cient strength to resist the rotary strain and friction in mastica- 
 tion. By trimming the labial surfaces as narrow as compatible 
 with strength, the band will not appear conspicuous. The bands, 
 bars or levers may be therefore firmly soldered for rotating or 
 retaining the teeth after regulating. Fig. 330 shows the appli- 
 cation of two of these bands when two teeth are secured in 
 position by a bar extending past fixed teeth on both sides. When 
 two or more teeth are to be held in position, the bands may 
 be secured to the bicuspids or molars on both sides and a bar 
 
 Fig. 331. 
 
 of gold extended from one to the other, upon the lingual or 
 labial surface, as illustrated in Fig. 331. "Platinum bands were 
 fitted to the two cuspitls and these were connected by a very 
 thin platinum wire passing along and conforming to the outline 
 of the labial surfaces of the incisors." A method of retaining two 
 or more teeth in position is illustrated in Fig. 332. It consists 
 of bands of gold, platinum or German silver, made in such a 
 manner that only one thickness of the metal goes between the 
 teeth. This was a case where the four anterior teeth were held 
 in place by uniting them to the cuspids. Bands made in this 
 manner do not leave spaces between the teeth. 
 
 Talbot's retainer consists of a band of platinum or gold fitted 
 to the tooth or teeth, with a tube of the same material, the width 
 of the tooth, soldered lengthwise of the band, as illustrated in 
 Fig. 333. The band is fastened to the tooth with zinc oxyphos- 
 
470 
 
 IRREGULARITIES OF THE TEETH. 
 
 phate and a piece of gold, platinum or piano-wire is passed 
 through the tube and allowed to come in contact with the sur- 
 face of a firm tooth. Should the tooth that has been regulated 
 move, the wire may be so bent that the tooth is restored to its 
 proper position. Two or more teeth may be retained at any 
 locality in the mouth in the same manner. The tube may be 
 attached to the labial, buccal, palatine or lingual side of the band, 
 according to the requirements of the case. 
 
 After the retaining appliance has been cemented to the teeth, 
 tincture of iodin should be applied every other day to reduce the 
 inflammation in the alveolar process. This will require from 
 
 two to four weeks. Two elements governing the time required 
 to retain the plate upon the teeth are, first, the age of the patient ; 
 second, the nature of the operation. The time cannot be defi- 
 nitely stated for all persons, even of the same age and condition 
 of cases ; approximation only is possible. In young and healthy 
 persons, in whom reconstruction of tissue is rapid, the retainer 
 will be needed but a short time. If the superior or inferior arches 
 have been enlarged a retaining plate must be worn until all the 
 teeth have accommodated themselves to their new position — a 
 period that will vary from six months to a year. 
 
 Where the teeth have been forced into the arch little or no 
 retention will be required, the pressure of the lips and cheeks 
 often being all that is necessary. Occlusion of the teeth of 
 
SURGICAL CORRECTIONS. ' 471 
 
 the opposite jaw aids greatly in retaining the bicuspids and 
 molars. 
 
 The most difficult teeth to retain are those that have been 
 rotated in their sockets. The difficulty of correcting the ten- 
 dency to return to their original positions is so great that the 
 retainers must be kept in place from one to two years and occa- 
 sionally even longer. The operator will have to use his best 
 judgment as to the proper time to remove them. The number of 
 teeth being moved does not affect the time required, as the 
 bone is as rapidly deposited in one part of the jaw as another. 
 The health of the patient will have considerable influence in the 
 time required. A strong, robust person will recover from the 
 operation more rapidly than one that is angemic. The retainer 
 should remain as long as circumstances will warrant, when a 
 model should be secured. After the lapse of not longer than a 
 day an examination should be made and the appliance adjusted. 
 
 Fig. 333. 
 
 If the teeth have not deviated, a week may elapse before making 
 another examination, when the appliance should again be 
 adjusted. These examinations should be continued until the 
 operator is satisfied the teeth are secure. If the teeth should 
 move, the retainer must be replaced and allowed to remain from 
 three to six months, when it can be removed and if any devia- 
 tion is noted, it should be returned and worn until the teeth will 
 remain as desired. 
 
 The movement of the teeth is always a predisposing cause 
 of interstitial gingivitis. The interstitial gingivitis set up in the 
 alveolar process is often difficult to reduce. Occasionally a low 
 form of inflammation will remain many years, if not throughout 
 life. The use of iodin is here indicated. It is a good plan to use 
 it in all cases after the teeth have been properly secured in place. 
 The tissues will recover much more rapidly and the chances of 
 success more satisfactory. 
 
APPENDIX. 
 
 TABLE I. 
 
 Crania of Modern and Ancient Races : Hunterian and Oxford 
 
 University Museums and Private Collections. 
 
 By Dr. Mummery. 
 
 
 No. 
 
 
 LATERAL 
 
 DIAMETER. 
 
 
 MODERN AND ANCIENT 
 RACES 
 
 Minimum. 
 
 Maximum. 
 
 Average. 
 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 Esquimaux 
 
 69 
 56 
 23 
 19 
 38 
 79 
 21 
 67 
 
 132 
 33 
 24 
 27 
 
 152 
 71 
 33 
 49 
 29 
 
 236 
 92 
 
 68 
 32 
 59 
 
 44 
 
 143 
 76 
 36 
 
 2.375 
 2.375 
 2.375 
 2.500 
 2.500 
 2.375 
 2.375 
 2.500 
 2.375 
 2.375 
 2.375 
 2.250 
 2.250 
 2.125 
 2.125 
 2.375 
 2.125 
 2.250 
 2.500 
 
 2.125 
 2.125 
 2.125 
 
 2.125 
 
 2.125 
 2.250 
 2.125 
 
 60.32 
 60.32 
 60.32 
 63.50 
 63.50 
 60.32 
 60.32 
 63.50 
 60.. 32 
 60.32 
 60.32 
 57.14 
 57.14 
 53.97 
 53.97 
 60.32 
 53.97 
 57.14 
 63.50 
 
 53.97 
 53.97 
 53.97 
 
 53.97 
 
 53.97 
 57.14 
 53.97 
 
 2.750 
 2.750 
 2.625 
 2.750 
 2.875 
 2.625 
 2.625 
 2.875 
 2.750 
 2.625 
 2.750 
 2.625 
 2.750 
 2.500 
 2.750 
 2.875 
 2.375 
 2.750 
 2.875 
 
 2.625 
 2.500 
 2.500 
 
 2.500 
 
 2.625 
 2.625 
 2.625 
 
 69.85 
 69.85 
 66.68 
 69.85 
 73.02 
 66.68 
 66.68 
 73.02 
 69.85 
 66.68 
 69.85 
 66.68 
 69.85 
 63.50 
 69.85 
 73.02 
 60.32 
 69.85 
 73.02 
 
 66.68 
 63.50 
 63.50 
 
 63.50 
 
 66.68 
 66.68 
 66.68 
 
 2.562 
 2.562 
 2.500 
 2.625 
 2.687 
 2.500 
 2.500 
 2.687 
 2.562 
 2.500 
 2.562 
 2.437 
 2.500 
 2.312 
 2.437 
 2.625 
 2.250 
 2.500 
 2.687 
 
 2.375 
 2.312 
 2.312 
 
 2.312 
 
 2.375 
 2.4.37 
 2.375 
 
 65.07 
 
 NoKTK Americans (Coast) . . 
 North Americans (Interior) 
 South Americans (Chili) . . . 
 Fiji Islanders 
 
 65.07 
 63.50 
 66.67 
 68.26 
 
 Polynesians (Various) 
 
 Sandwich Islanders 
 
 New Zealanders 
 
 63.50 
 63.50 
 
 68.26 
 
 Australians 
 
 65.07 
 
 Tasmanians 
 
 63.50 
 
 M.-VLAYS 
 
 65.07 
 
 Chinese 
 
 61.91 
 
 East Indians (North) 
 
 East Indians (South) 
 
 Africans (East) 
 
 63.49 
 58.73 
 61.91 
 
 Caffres 
 
 66.67 
 
 BosjESMEN and Hottentots 
 Africans (West) 
 
 57.14 
 
 63.50 
 
 Ash ANTE es 
 
 68.26 
 
 Ancient BRiTONs(Dolicho- ) 
 cephaHc) f 
 
 60.32 
 
 ANciENTBRiTONs(Brachy- } 
 cephalic) f 
 
 Ancient Britons (Canon [ 
 Greenwell's Explorations) ) 
 
 Ancient Britons (Miscel- ) 
 laneous) ) 
 
 Romano-Britons 
 
 Anglo-Saxons 
 
 Ancient Egyptians 
 
 57.73 
 58.73 
 
 58.73 
 
 60.32 
 61.91 
 60.32 
 
 473 
 
474 
 
 APPENDIX. 
 
 TABLE II. 
 
 Crania: Peabody Museum, Harvard University; Academy of 
 Natural Sciences, Philadelphia ; Davenport Academy ; 
 Army Museum ; Roman, French, and English Crania in 
 European Museums and Private Collections ; Miscellaneous 
 Crania. By Doctors Peirce, Newton, Schuhmann, Barrett, 
 Pratt, Betty, and Talbot. 
 
 RACE. 
 
 Europeans — Ancient and( 
 Modern Romans, Italians, K 
 French, English ( 
 
 Sandwich Islanders | 
 
 Ancient Peruvians < 
 
 Ancient Californians, 
 from Santa Cruz Islands, 
 Coast of California; Santa 
 Catalina Island, Brazil; 
 Nicaragua, St. Miguel 
 
 Mexicans 
 
 Californian Indians ] 
 
 Mound Builders, Mounds ( 
 in Kentucky and Tennes- -( 
 see ( 
 
 Stone Grave People, Cum- ( 
 berland Valley, Tennessee; 
 Illinois River, Indiana, 
 Arkansas, Michigan, and 
 various places 
 
 Indians — North American. 
 Different Tribes 
 
 Negro — Rio de Favino 
 
 Flat Heads from Oregon, 
 Washington, Gulf of Geor- 
 gia, Peru 
 
 From San Lorenzo Cave, j 
 Mexico / 
 
 From Caves in Tennessee, 
 Kentuckj', Mexico 
 
 Esquimaux from Labrador, j 
 Norton Sound / 
 
 No. 
 
 Sex. 
 
 276 
 
 ? 
 
 36 
 
 M 
 
 .SO 
 
 F 
 
 26 
 
 M 
 
 26 
 
 F 
 
 S 
 
 ? 
 
 1.37 
 
 M 
 
 124 
 
 F 
 
 117 
 
 ? 
 
 M 
 
 M 
 
 38 
 
 F 
 
 27 
 
 ? 
 
 29 
 
 M 
 
 26 
 
 F 
 
 56 
 
 M 
 
 47 
 
 F 
 
 57 
 
 ? 
 
 87 
 
 M 
 
 89 
 
 F 
 
 11 
 
 ? 
 
 17 
 
 M 
 
 n 
 
 F 
 
 191 
 
 ? 
 
 1 
 
 
 3 
 
 M 
 
 2 
 
 F 
 
 18 
 
 •? 
 
 4 
 
 M 
 
 3 
 
 F 
 
 4 
 
 M 
 
 9 
 
 ■? 
 
 3 
 
 V 
 
 40 
 
 ? 
 
 2 
 
 M 
 
 L.A-TERAL DIAMETER. 
 
 Minimum. < Maximum. Average. 
 
 In. Mm. 
 
 1.94 '49 
 2.06 52 
 1.88 47 
 2.13 53 
 2.06 
 2.22 
 2.00 
 1.88 
 
 2.00 50. 
 
 2.06 
 2.06 
 
 1.94 
 2.06 
 2.06 
 2.06 
 2.00 
 2.06 
 
 52.32 
 52.32 
 
 49.19 
 52.. 32 
 52.. 32 
 52.32 
 50.80 
 52.32 
 
 2.13 53.95 
 1.88 47.62 
 2.13 53.95 
 
 2.13 
 2.13 
 1.88 
 2.19 
 2.25 
 
 2.06 
 1.75 
 2.25 
 
 In. 
 
 2.69 
 2.-37 
 2.44 
 2.50 
 2.37 
 2.50 
 2.63 
 2.56 
 2.56 
 
 2.63 
 2.44 
 
 2.50 
 2.50 
 2.37 
 2.63 
 2.50 
 2.69 
 
 2.69 
 2.50 
 2.44 
 
 2.50 
 2.31 
 2.63 
 2.19 
 2.50 
 2.44 
 2.75 
 2.37 
 2.. 37 
 2.19 
 
 Mm. 
 
 68.26 
 60.30 
 61.90 
 63.50 
 60.30 
 63.50 
 66.67 
 65.08 
 65.08 
 
 66.67 2.31 
 61.90 2.25 
 
 In. 
 
 2.34 
 2.20 
 2.08 
 2.29 
 2.20 
 2.30 
 2.30 
 2.22 
 2.30 
 
 63.50 
 63.50 
 60.30 
 66.67 
 63.50 
 68.26 
 
 2.31 
 2.31 
 2.22 
 2.33 
 
 2.28 
 2.39 
 
 68.26 2.42 
 63.50! 2.28 
 61.90 2.28 
 
 2.25 
 2.63 
 2.31 
 
 63.50 
 58.84 
 66.67 
 55.56 
 63.50 
 61.90 
 69.85 
 60.30 
 60.30|2 
 55.56 2 
 2 
 
 57.13 2 
 66.67 2 
 58.84 2 
 
 Mm. 
 
 58.84 
 55.95 
 52.81 
 58.17 
 55.95 
 58.45 
 58.45 
 56.34 
 58.45 
 
 58.84 
 57.14 
 
 58.84 
 58.84 
 56.34 
 59.48 
 57.92 
 60.70 
 
 61.90 
 57.92 
 57.92 
 
 58.45 
 56.69 
 58.84 
 55.56 
 62.31 
 57.92 
 64.29 
 58.45 
 55.95 
 54.. 38 
 56.69 
 55.56 
 56.69 
 
 28 '57.92 
 
APPENDIX. 
 
 TABLE II— Continued. 
 
 475 
 
 RACE. 
 
 Hindoos. 
 
 Herney Islanders . 
 Hawaiian Islander. 
 
 Negroes, African Negroes.. -! 
 
 Zulus, South Africa j 
 
 Probably Africans 
 
 Negro Criminal (Giles) 
 
 Aleutian Islander 
 
 Guanche 
 
 Pegu, Burmah 
 
 Mauritian Dwarf 
 
 Unknown j 
 
 Fiji Islanders 
 
 Loo Choo Islander 
 
 Burmese 
 
 Marquesas Islanders 
 
 Assiniboin 
 
 Kankakee 
 
 Malay 
 
 Tahitian 
 
 Tatlit Koochin 
 
 Laplanders 
 
 Japanese 
 
 Parsee 
 
 Australians 
 
 Armenians 
 
 Samoan Islander 
 
 Ancient Egyptian (Egyp- [ 
 
 tian Type) \ 
 
 Ancient Egyptian (Negroid } 
 
 Type) f 
 
 Copt 
 
 Egyptian Negroes 
 
 Arab 
 
 Choctaw and Negro 
 
 Hispano-Peruvian 
 
 Dutch 
 
 Anglo-American 
 
 Recent Crania, Pa. (?) 
 
 Total 1840 
 
 No. 
 
 1 
 1 
 3 
 3 
 1 
 1 
 2 
 9 
 
 79 
 1 
 1 
 2 
 1 
 1 
 1 
 1 
 1 
 3 
 5 
 2 
 1 
 1 
 4 
 3 
 5 
 
 13 
 2 
 2 
 2 
 1 
 2 
 
 10 
 4 
 1 
 
 45 
 
 11 
 
 1 
 3 
 2 
 1 
 2 
 1 
 1 
 
 90 
 
 Sex 
 
 LATERAL DIAMETER. 
 
 Minimum. 
 
 In. 
 
 2.13 
 2.22 
 2!o6 
 2.19 
 2.13 
 2.31 
 2.13 
 1.88 
 2.25 
 2.25 
 2.44 
 2.00 
 2.31 
 2.13 
 2.06 
 2 19 
 2.19 
 2.31 
 1.88 
 2.31 
 2.37 
 2.47 
 2.28 
 2.28 
 2.16 
 2.16 
 2.25 
 2.22 
 2.37 
 2.37 
 1.97 
 2.09 
 2.00 
 2.25 
 1.88 
 1.88 
 
 2.13 
 
 13 
 
 Mm. 
 
 53.95 
 56.35 
 52.32 
 55.56 
 53.95 
 58.84 
 53.95 
 47.62 
 57.13 
 57.13 
 61.90 
 50.80 
 58.84 
 53.95 
 52.32 
 55.56 
 55.56 
 58.84 
 47.62 
 58.84 
 60.30 
 62.70 
 57.92 
 57.92 
 54.75 
 54.75 
 57.13 
 56.35 
 80.30 
 60.30 
 50.07 
 53.13 
 50.80 
 57.13 
 47.62 
 47.62 
 
 53.95 
 
 2. 
 
 1.88 
 2.19 
 2.19 i55. 
 2.13 [53. 
 2.56 65. 
 
 2.50 
 1.97 
 
 Maximum. 
 
 In. 
 
 2.13 
 2.22 
 2.37 
 2.50 
 2.13 
 2.31 
 2.50 
 2.47 
 2.25 
 2.25 
 2.44 
 2.25 
 2.31 
 2.13 
 2.06 
 2.19 
 2.19 
 2.44 
 2.31 
 2.44 
 2.37 
 2.47 
 .44 
 .37 
 .31 
 .53 
 2.47 
 2.34 
 2.50 
 2.37 
 2.00 
 2.69 
 2.09 
 2.25 
 
 90 
 
 2.50 
 2.69 
 
 Mm. 
 
 53.95 
 56.35 
 60.30 
 63.50 
 53.95 
 58.84 
 63.50 
 62.70 
 57.13 
 57.13 
 61.90 
 57.13 
 58.84 
 53.95 
 52.32 
 55'. 56 
 55.56 
 61.90 
 58.84 
 61.90 
 60.. 30 
 62.70 
 61.90 
 60.30 
 58.84 
 64.29 
 62.70 
 59.57 
 63.50 
 60.30 
 50.80 
 68.26 
 53.13 
 57.13 
 56.35 
 63.50 
 
 68.26 
 
 53.95 
 53.95 
 58.84 
 55.56 
 22!56.35 
 56165.08 
 50r63.50 
 50 63.50 
 
 47.62 2.69 68.26 2.28 57.94 
 
 Average. 
 
 In. 
 
 2.13 
 2.22 
 2.25 
 2.33 
 2.13 
 2.31 
 2.31 
 
 2! 25 
 2.25 
 2.44 
 2.13 
 2.31 
 2.13 
 2.06 
 2.19 
 2.19 
 2.37 
 2.13 
 2.37 
 2.37 
 2.47 
 2.36 
 2.31 
 2.25 
 2.37 
 2.36 
 2.28 
 2.44 
 2.37 
 1.98 
 2.31 
 2.06 
 2.25 
 2.06 
 2.20 
 
 2.37 
 
 2.13 
 2.01 
 2.25 
 2.19 
 2.17 
 2.56 
 2.50 
 2.30 
 
 Mm. 
 
 53.95 
 56.35 
 57.14 
 59.13 
 53.95 
 58.84 
 58.84 
 57.58 
 57.13 
 57.13 
 61 . 90 
 53.95 
 58 84 
 53.95 
 52.32 
 55.56 
 55.56 
 60.30 
 53.95 
 60.30 
 60.. 30 
 62.70 
 59.91 
 58.84 
 57.14 
 60.30 
 59.91 
 57.92 
 61.90 
 60.30 
 50.40 
 58.84 
 
 .29 
 57.13 
 
 .59 
 55.95 
 
 60.30 
 
 53.95 
 51.05 
 57.14 
 55.56 
 55.16 
 65.08 
 63.50 
 58.45 
 
476 
 
 APPENDIX. 
 
 TABLE III. 
 
 Measurement of the Superior Maxilla in Life. 
 
 LATERAL DIAMETER. 
 
 RACE 
 
 Residents of Athens, 
 Greece 
 
 Stockholm, Sweden 
 Copenhagen, Denmark 
 Brussels, Belgium 
 Warsaw, Poland 
 
 China 
 
 East Indians 
 Italians 
 Santiago, Chile 
 London, England 
 Dublin, Ireland 
 American-born Negroes 
 
 Dispensary — Philadelphia, 
 Baltimore, and Boston. . . . 
 
 Burlington, Vermont 
 
 Boston, Massachusetts 
 
 New York City 
 
 Chicago and Illinois 
 
 Marshpee Indians. . . 
 
 Total '8296 
 
 T 1.87 '47.54' 2.41 62.08 2.14 51.19 
 
APPENDIX. 
 
 477 
 
 TABLE IV. 
 
 RACE. 
 
 Ancient and Modern Ro- 
 mans, Lake Dwellers, 
 French prior to nineteenth 
 century 
 
 Sandwich Islanders 
 
 Ancient Peruvians. 
 
 Ancient Californians. 
 Californian Indians. .. 
 Mound Builders. . . . . 
 
 Negro — Rio de Favino 
 
 Flat Heads from Oregon, ( 
 Washington, Georgia,- 
 Peru ( 
 
 From San Lorenzo Cave, j 
 Mexico t 
 
 From Caves in Tennessee, ) 
 Kentucky, Mexico ) 
 
 Esquimaux from Labrador, \ 
 Norton Sound ( 
 
 Hindoos - 
 
 Herney Islanders . 
 Hawaiian Islander 
 
 Negroes, African Negroes. 
 
 Zulus, South Africa 
 
 Probably Africans 
 
 Negro Criminal 
 
 No. 
 
 Stone Grave People — \ 
 Cumberland Valley i 
 
 Indians -( 
 
 31 
 
 30 
 
 26 
 
 29 
 
 122 
 
 104 
 
 2 
 
 26 
 
 32 
 
 130 
 
 32 
 
 30 
 
 157 
 
 83 
 
 1 
 
 83 
 
 80 
 
 7 
 
 110 
 
 58 
 
 3 
 
 1 
 
 3 
 
 2 
 
 1 
 
 4 
 
 3 
 
 4 
 
 .Sox, 
 
 M 
 F 
 
 M 
 F 
 M 
 F 
 
 ? 
 
 M 
 F 
 
 ? 
 
 M 
 F 
 
 M 
 F 
 
 ? 
 
 M 
 F 
 
 ■? 
 
 M 
 F 
 
 ? 
 ? 
 
 M 
 F 
 
 ? 
 
 M 
 F 
 
 M 
 
 ? 
 
 F 
 
 ? 
 
 M 
 M 
 
 ? 
 
 F 
 M 
 
 ? 
 
 M 
 
 M, 
 ? 
 
 F 
 F 
 M 
 F 
 M 
 
 ANTI':i<() I'OS'll'-.RIOR 
 iJlAME'IER. 
 
 Minimum. 
 
 In. Mm. 
 
 1.69 
 1.56 
 
 1.63 
 1.63 
 1.56 
 1.56 
 1.69 
 1.63 
 1.69 
 
 1.69 
 1.69 
 1.56 
 1.63 
 2.00 
 1.63 
 1.63 
 1.88 
 1.75 
 1.38 
 1.81 
 2.06 
 1.88 
 1.88 
 2.00 
 1.69 
 1.75 
 1.69 
 
 1.75 
 
 1.69 
 1.69 
 
 1.81 
 
 1.88 
 
 2.00 
 2.06 
 
 1.94 
 2.00 
 
 2.19 
 
 42.86 
 39.69 
 
 86 
 
 69^2 
 
 28 
 
 80 
 
 28 
 
 28 
 
 62 
 
 46 
 
 09 
 
 04 
 
 46 
 
 44.46 
 
 42.86 
 42.86 
 
 46.04 
 47.62 
 
 50.80 
 52.32 
 
 49.14 
 
 50.80 
 
 55.56 
 
 Maximum. 
 
 In. Mm. 
 
 2.00 
 2.06 
 
 2.00 
 
 2.13 
 2.00 
 
 1.81 
 2.00 
 
 2.00 
 2.13 
 
 1.94 
 2.00 
 
 2.19 
 
 50. 80 
 52.32 
 
 50.80 
 
 53.95 
 50.80 
 
 46.04 
 50.80 
 
 50.80 
 53.95 
 
 49.14 
 50.80 
 
 55.56 
 
 Average. 
 
 In. Mm. 
 
 1.86 
 1.83 
 
 1.83 
 
 1.72 
 
 1.69 
 
 1.81 
 1.92 
 
 2.00 
 2.09 
 
 1.94 
 2.00 
 
 2.19 
 
 47.23 
 46.43 
 
 48.38 
 46.43 
 47 62 
 45.64 
 46.83 
 48.02 
 47.23 
 46.40 
 48.38 
 46.43 
 50.80 
 48.02 
 50.80 
 50.00 
 48.41 
 49.21 
 50.55 
 47.44 
 48.38 
 52.32 
 50.80 
 49.21 
 50.80 
 46.43 
 46.43 
 45.64 
 
 46.43 
 
 43.65 
 42.86 
 
 46.04 
 
 48.81 
 
 50.80 
 53.18 
 
 49.14 
 50.80 
 
 55.56 
 
478 
 
 APPENDIX. 
 
 TABLE IV— Continued. 
 
 RACE. 
 
 Aleutian Islander 
 
 GUANCHE 
 
 Pegu, Burmah 
 
 Mauritian Dwarf 
 
 Unknown j 
 
 Fiji Islanders ] 
 
 Bavarian . . .'. j 
 
 New Zealanders j 
 
 Austrians -j 
 
 Chinese - 
 
 Japanese j 
 
 Australians ■ 
 
 Samoan Islander 
 
 Gallo-Roman \ 
 
 Romano-British 
 
 Whites - 
 
 Egyptian 
 
 American Negroes j 
 
 Marshpee Indians 
 
 Recent, Illinois \ 
 
 Total 
 
 No. 
 
 2015 
 
 Sex. 
 
 ANTERO-POSTERIOR 
 DIAMETER. 
 
 Minimum. 
 
 In. 
 
 2.13 
 1.63 
 1.88 
 2.13 
 1.81 
 1.69 
 2.28 
 2.09 
 2.13 
 
 2.09 
 1.94 
 1.91 
 2.06 
 2.25 
 1.75 
 1.94 
 2.00 
 1.88 
 1.84 
 1.75 
 2.19 
 1.81 
 2.03 
 2.06 
 1.75 
 
 1.56 
 
 1.66 
 
 Mm. 
 
 39.69 
 
 45.84 
 
 Maximum. 
 
 In. 
 
 2.13 
 1.63 
 1.88 
 2.13 
 2.06 
 2.00 
 2.28 
 2.09 
 2.13 
 1.81 
 2.13 
 2.03 
 2.01 
 2.13 
 2.09 
 1.94 
 1.91 
 2.06 
 2.25 
 2.28 
 1.94 
 2.00 
 1.88 
 1.84 
 2.13 
 2.19 
 1.81 
 2.19 
 2.13 
 2.07 
 
 2.19 
 
 2.04 
 
 Mm. 
 
 53.95 
 41.28 
 47.62 
 53.95 
 52.32 
 50.80 
 57.92 
 53.19 
 53.95 
 46.04 
 53.95 
 51.56 
 51.05 
 53.95 
 53.19 
 49.25 
 48.23 
 52.32 
 57.13 
 57.92 
 49.25 
 50.80 
 47.62 
 46.74 
 53.95 
 .55.56 
 46.04 
 55.56 
 53.95 
 52.29 
 
 55.56 
 
 Average. 
 
 In. 
 
 2.13 
 1.63 
 1.88 
 2.13 
 l!95 
 1.91 
 2.28 
 2.09 
 2.13 
 1.81 
 1.92 
 1.93 
 1.96 
 1.94 
 2.09 
 1.94 
 1.91 
 2.06 
 2.25 
 2.01 
 1.94 
 2.00 
 1.88 
 
 1 
 1 
 2 
 1 
 2 
 2 
 1.98 
 
 1.84 
 
 51.42, 1.78 49.33 
 
 Mm. 
 
 53.95 
 41.28 
 47.62 
 53.98 
 49.60 
 48.41 
 .57.92 
 53.19 
 53.95 
 46.04 
 48.76 
 49.00 
 49.78 
 49.25 
 53.19 
 49.25 
 48.23 
 52.32 
 57.13 
 51.05 
 49.25 
 50.80 
 47.02 
 46.74 
 50.29 
 55.56 
 46.04 
 53.95 
 52.73 
 50.27 
 
 46.74 
 
APPENDIX. 
 
 TABLE V. 
 
 479 
 
 RACli. 
 
 Ancient and MonF.KN Ro- 
 mans; Lake Dwellers; 
 French prior to nineteenth 
 century 
 
 Sandwich Islanders 
 
 Ancient Peruvians. 
 
 Ancient Californians -j 
 
 Californian Indians -j 
 
 Mound Builders 
 
 Stone Grave People — 
 Cumberland Valley 
 
 Indians, 
 
 Negro — Rio de Favino 
 
 Flat Heads from Oregon, ( 
 Washington, Gulf oi ■} 
 Georgia, Peru ( 
 
 From San Lorenzo Cave, j 
 Mexico ( 
 
 From Caves in Tennessee, j 
 Kentucky, Mexico ) 
 
 Esc)UI^L\ux from Labrador, j 
 Noi'ton Sound 
 
 Hindoos. 
 
 Herney Islanders . 
 Hawaiian Islander. 
 
 No. 
 
 Negroes, African Negroes. . -I 
 
 Zulus, South Africa j 
 
 Probably Africans 
 
 Negro Criminal (Giles) 
 
 Aleutian Islander 
 
 34 
 30 
 
 25 
 
 26 
 
 137 
 
 12-i 
 
 17 
 
 34 
 
 38 
 
 29 
 
 26 
 
 56 
 
 47 
 
 7 
 
 HEIGHT OF VAULT, 
 
 Minimum. 
 
 In. Mm. 
 
 .31 
 
 .37 
 .31 
 .25 
 .37 
 .44 
 .44 
 .44 
 .41 
 .44 
 .44 
 .44 
 .41 
 .41 
 .37 
 .37 
 .44 
 .41 
 .50 
 
 .50 
 .50 
 .50 
 .50 
 .44 
 .53 
 
 .47 
 
 Maximum. 
 
 In. Mm. 
 
 6.35 
 7.65 
 
 9.39 
 
 7.62 
 
 6.35 
 
 9.39 
 
 11.17 
 
 11.17 
 
 11.17 
 
 10.45 
 
 11.17 
 
 11.17 
 
 11.17 
 
 10.45 
 
 10.45 
 
 9.39 
 
 9.39 
 
 11.17 
 
 10.45 
 
 12.70 
 
 12.70 
 12.70 
 12.70 
 12.70 
 11.17 
 13.46 
 
 .50 
 .50 
 
 .44 
 .44 
 
 .63 
 .53 
 
 .44 
 .50 
 .75 
 .44 
 .50 
 .31 
 
 11.93 
 
 12.70 
 12.70 
 
 11.1 
 11.17 
 
 16.00 
 13.46 
 
 .69 
 .63 
 
 .75 
 .69 
 .81 
 .75 
 .63 
 .69 
 .75 
 .69 
 .69 
 .72 
 .69 
 .66 
 .88 
 .75 
 .56 
 .69 
 .59 
 .63 
 
 .75 
 .56 
 .50 
 .69 
 .66 
 .53 
 
 .53 
 
 .56 
 .50 
 
 17.52 
 16.00 
 
 19.05 
 
 17.52 
 
 20.57 
 
 19.05 
 
 16.00 
 
 17.5 
 
 19.05 
 
 17.5- 
 
 17.52 
 
 18.29 
 
 17.52 
 
 16.78 
 
 22.35 
 
 19.05 
 
 14.23 
 
 17.52 
 
 14. 
 
 16.00 
 
 Average. 
 
 In. Mm. 
 
 19.05 
 14.23 
 12.70 
 17.52 
 16.78 
 13.46 
 
 13.46 
 
 14.23 
 12.70 
 
 .69 
 .63 
 
 .63 
 .63 
 
 11.17 
 12.70 
 19.05 
 11.17 
 12.70 
 7.62 
 
 .44 
 .50 
 .75 
 .50 
 .50 
 .31 
 
 17.52 
 16.00 
 
 16.00 
 16.00 
 
 11.17 
 12.70 
 19.05 
 12.70 
 12.70 
 7.62 
 
 .53 
 
 .48 
 
 .55 
 .52 
 .57 
 .57 
 .49 
 .55 
 .55 
 .54 
 .52 
 .55 
 .56 
 .51 
 .60 
 .55 
 .50 
 .57 
 .47 
 .56 
 .50 
 .65 
 .53 
 .50 
 .60 
 .54 
 .53 
 
 13.46 
 12.19 
 
 13.97 
 13.21 
 14.47 
 14.47 
 12.45 
 13.97 
 13.97 
 13.71 
 13.21 
 13.97 
 14.23 
 12.95 
 15.02 
 13.97 
 12.70 
 14.47 
 11.93 
 14.23 
 12.70 
 16.51 
 13.46 
 12.70 
 15.02 
 13.71 
 13.46 
 
 .51 
 
 12.95 
 
 .53 
 .50 
 
 13.46 
 12.70 
 
 .60 15.02 
 .57 14.47 
 
 .63 
 .57 
 
 16.00 
 14.47 
 
 .44 
 .50 
 .75 
 .47 
 .50 
 .31 
 
 11.17 
 12.70 
 19.05 
 11.93 
 12.70 
 7.62 
 
480 
 
 APPENDIX. 
 
 TABLE V— Continued. 
 
 R.A.CE. 
 
 Xo. 
 
 Sex. 
 
 GUANCHE 
 
 Pegu, Burmah 
 
 Mauritian Dwarf. 
 
 Unknown 
 
 Marshpee Indians. 
 
 1 
 1 
 3 
 5 
 46 
 
 Total I 954 
 
 HEIGHT OF VAULT. 
 
 Minimum. Maximum. 
 
 In. 
 
 Mm. I In. 
 
 Mm. 
 
 1 F .44 11.17 .44 11.17 .44 11.17 
 
 .50 
 .50 
 .53 
 
 Average. 
 
 In. 
 
 Mm. 
 
 12.70 .50 12.70 .50 
 12.70 .50 12.70' .50 
 13.46 ..56 14 23 .54 
 
 12.70 
 12.70 
 13.71 
 
 .53 13.46 .69 17.52 .57 il4.47 
 .41 ,10.45 .63 16.00 .52 :i3.22 
 
 .44 111.36 .62 15.48 .51 13.57 
 
 [The averages in Table I are maximum and minimum figures alone, while 
 those in the other tables are deduced from the total of all the measurements.] 
 
 TABLE VI. 
 
 No. 
 
 Lateral. 
 
 Anteroposterior. 
 
 Height of Vault. 
 
 1 
 2 
 3 
 4 
 
 5 
 6 
 
 1.31 In. = 33.22 Mm. 
 1.25 " =31.75 " 
 1.37 " =34.79 " 
 1.56 " =39.51 " 
 1.62 " =41.12 " 
 1.25 " =31.75 " 
 
 2 In. =50.80 Mm. 
 2.12 " =53.84 " 
 2 " =50.80 " 
 2.37 " =60.70 " 
 2.25 " =57.15 " 
 2.12 " =53.84 " 
 
 0.37 In. = 9.42 Mm. 
 0.62 " =15.74 " 
 0.43 " =10.92 " 
 0.75 " =19.05 '.' 
 0.50 " =15.24 " 
 0.31 " = 7.87 " 
 
 TABLE VIL 
 
 THIRTY-FOUR EUROPEAN SKULLS. 
 
 
 Length in 
 Millimeters. 
 
 Width in 
 Millimeters. 
 
 Height in 
 Millimeters. 
 
 Maximum 
 
 58 
 40 
 
 49 
 
 42 
 
 31 
 
 *35 
 
 15 
 
 Minimum .... 
 
 Average 
 
 5.5 
 *9 
 
 TABLE VIII. 
 
 THIRTY-TWO MIXED SKULLS. 
 
 
 Length in 
 Millimeters. 
 
 Width in 
 Millimeters. 
 
 Height in 
 Millimeters. 
 
 Maximum 
 
 65 
 43 
 54.9 
 
 40 
 
 29 
 
 *35 
 
 18 
 
 Minimum 
 
 6 
 
 Average 
 
 *12 
 
 
 
 'Taken at second bicuspid. 
 
APPENDIX. 
 
 481 
 
 TABLE IX. 
 
 Examination of criminal youth at Elmira, N. Y. (i,oi8), and 
 Pontiac, 111. (414). 
 
 
 
 Jaws. 
 
 Teeth. 
 
 Alveolar 
 Process. 
 
 
 
 
 
 
 
 4J 
 
 
 
 
 Tuber- 
 
 
 Abnor- 
 
 
 6 
 
 OJ 
 D, 
 re 
 
 > 
 
 > 
 
 u 
 
 re 
 
 > 
 E 
 
 _a3 
 
 re 
 c/} 
 
 St/3 
 
 ■a 
 re 
 
 S 
 
 C/3 
 
 re 
 E 
 
 
 7. 
 
 _re 
 
 OJ 
 
 _re 
 3 
 
 u 
 u 
 
 cles. 
 
 "re 
 E 
 
 u 
 
 
 
 mal. 
 
 
 c 
 
 e 
 
 OJ 
 
 1/1 
 
 Si 
 
 < 
 
 lS. 
 (u a 
 
 QO 
 
 6 a 
 
 Illinois State 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Reformatory. 
 
 414 
 
 75 
 
 71 
 
 3 
 
 66 
 
 63 
 
 16 
 
 171 
 
 123 
 
 342 
 
 13 
 
 452 
 
 371 
 
 93 
 
 1 
 
 New York State 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Reformatory. 
 
 1,018 
 
 381 
 
 49 
 
 1 
 
 157 
 
 26 
 
 . . . 422'220 821 
 
 26 
 
 1,015 
 
 968 
 
 73 
 
 
 TABLE X. 
 
 The following table shows the different deformities of the 
 jaws and teeth found among 477 criminals at Joliet, 111.: 
 
 d 
 'A 
 
 X 
 
 a; 
 
 re 
 
 E 
 
 u 
 
 
 
 5^ 
 
 re 
 '-) 
 
 OJ 
 
 u 
 re 
 
 c re 
 3 1- 
 
 u OJ 
 
 3 u 
 D-D 
 
 3 
 re 
 > 
 
 S 
 
 T3 
 
 Partial 
 V-Shaped 
 Arch. 
 
 > 
 E 
 
 -a 
 
 . OJ . 
 
 a; a.c 
 -a "= ^^ 
 
 if} 
 
 re 
 •-) 
 
 "re 
 
 E 
 
 72 
 
 ret/3 
 
 —■a 
 E '^ 
 
 72 
 
 468 
 9 
 
 M 
 F 
 
 163 
 9 
 
 66 
 9 
 
 17 
 
 5 
 
 70 
 
 13 
 
 79 
 
 19 
 
 59 
 
 30 
 
 92 
 
 24 
 
 
 
 
 
 
 
 
 
 
 
 
 Per cent. 
 
 36.06 
 
 15.72 
 
 3.56 
 
 1.04 
 
 14.67 
 
 2.70 
 
 16.56 
 
 3.98 
 
 12.36 
 
 6.29 
 
 19.28 
 
 5.03 
 
 TABLE XI. 
 
 JAWS OF PROSTITUTES. 
 
 
 3 
 
 3 -d 
 ;5 
 
 j= a> 3 
 
 "0^ 
 
 0) 
 Q 
 
 re 
 j= 
 73 
 
 > 
 
 0) 
 
 Q 
 re 
 
 ■-7} 
 
 OJ 
 Q 
 re 
 
 72 
 
 -a 
 re 
 
 72 
 
 a; 
 
 rtt55 
 
 -a 
 —-a 
 
 £72 
 72 
 
 Average. . 
 Per cent. . 
 
 2.00 
 
 1.69 
 
 1.06 
 
 49 
 
 
 
 
 
 
 
 io 
 
 i7 
 
 7 
 
 27 
 
 10 
 
 10 
 
 
 
 
 
 TABLE XII. 
 
 The following table shows the results of the examination of 
 the jaws and teeth of 700 insane cases of patients in Chicago, 
 111. (Cook County), Insane Hospital. 
 
 6 
 
 X 
 
 72 
 
 
 
 re 
 
 "—) 
 
 OJ 
 he 
 
 re 
 
 re 
 «^ 
 3 1-- 
 
 Protrusion 
 Upper Jaw. 
 
 re 
 > 
 
 T3 
 
 72^ 
 > 
 
 a 
 
 — "^ r-: 
 re>< 
 
 a, 
 
 •a 
 
 . . 
 
 OJ C.J3 
 72 
 
 ::r a! 
 re a> 
 EH 
 7: 
 
 430 
 270 
 
 M 
 F 
 
 317 
 139 
 
 10 
 
 - 8 
 
 4 
 6 
 
 2 
 4 
 
 18 
 26 
 
 12 
 14 
 
 29 
 
 18 
 
 3 
 
 9 
 
 5 
 2 
 
 700 1 
 
 486 1 18 
 
 10 
 
 6 
 
 44 
 
 26 
 
 47 
 
 12 
 
 7 
 
 32 
 
482 
 
 APPENDIX. 
 
 "3 
 
 ■*-> 
 
 a, 
 
 en 
 
 O 
 
 G 
 
 ui 
 
 S 
 
 Bi 
 O 
 (b 
 
 a 
 Q 
 
 VS. 
 
 ^- ic >.t :c ^H r- 'M o cc • 
 CO I- o 00 1~ 00 1~ 00 1- • 
 
 -*< 
 
 : 2 5 i^ 
 
 t^ X ox 
 
 
 
 CO 
 
 CO 
 
 T— 1 
 
 CI 
 
 . : ; ; I ; ! ,<<,-( 
 I— 1 1— 1 
 
 
 
 02- 
 
 IMCCO'NQOt-OCO'-l • 
 i-H r-li— 1 
 
 
 • - I-H ■ ■ 
 
 
 
 
 <U 
 
 r. ii 
 
 to 
 
 00 ■<* r- O O O fC O CI • 
 
 1— 1 I— 1 r-r 
 
 
 • • • • 1-H 
 
 1-hCI 
 
 
 
 > 
 
 (Tl • O O • (M CO -CI 
 
 
 '.'.'.'.'. T^ '. f (M 
 
 
 
 ;=! o 
 
 a) 
 
 Mi-IOOCMJCCSOO-* 
 
 - 
 
 • • Cl • rH 
 
 ClrH XO 
 i-hCJ 
 
 
 
 1— t _t« 
 
 a; 'O 
 
 1*-. "i' 
 0-5 
 
 > 
 
 r-liMCSCg-^r-IOi-teCi-li-l 
 I— 1 
 
 : : :-^-^ 
 
 •I-H Xt- 
 I-H 
 
 
 
 ID" 
 
 o<z 
 
 <9 
 
 > 
 <5 
 
 m ci icTi oc o ^ '^ iM 
 vz m Ct i,t O iC lO o o 
 
 
 • • Cl Cl o 
 
 CO Cl -* Cl 
 
 s 
 
 
 CO «*- 
 <u O 
 
 If: 
 
 
 t— 01 r- Lt X i~ i^ t~- 1- 
 
 CI 
 
 • -i-cit- 
 - -Cl ;ore 
 
 1— o L-; t- 
 
 M ic Cl ro 
 
 « 
 
 
 ^ 
 s 
 
 •Jl i.t iCJl r- iC Lt i-'T -M 
 
 :s t- t^ cc X I- t- I- ;o 
 
 I- 
 
 • • i.T Cl o 
 
 • • I- ;c i- 
 
 u; Cl o o 
 t-co oo 
 
 rH rH 
 
 •* 
 
 
 O *« ! 
 
 O 1- 
 
 
 > 
 < 
 
 re t- ci s; '.T -- -^ r^ :c 
 cj o ci c; CI ^ ci cii 
 
 ci 
 
 1— 1 
 
 • • r- I-H 
 
 XO <Z:^ 
 O t- I— 1 rH 
 
 I— 1 rH I-H I-H 
 
 1-^ 
 
 Cl 
 
 I-H 
 
 
 gl ^llii 
 
 c 
 
 S 
 
 O r- '-t t- o i~ 11 r- O 
 ooct-occx^aco 
 
 rH 1— ( .— 1 i-H 
 
 o 
 
 1—1 
 
 • • i.e i.t iC 
 
 • • r- t- t- 
 
 • - 1— ' 
 
 O t- xr- 
 
 r-< rH 
 
 ?; 
 
 
 O o 
 cr> C 
 
 ^"^££2 
 
 r^ 
 
 
 O i.'t 11 1- O >C r- CI t— 
 
 O C) ;o re ir; r- 00 -^ CO 
 
 • 1— ( 
 
 • • r; •-- Cl 
 
 
 3 
 
 
 z fc- C . 
 
 a c r ^ 
 
 > 
 
 O c: w I — f I— t- w- '— 1 
 cr. I- S-. r- sr. t^ 00 t- cj 
 
 • 1—1 
 
 • - r- -j; Cl 
 - -x O :o 
 
 • - r-^ Cl r-- 
 
 re i.e r- o; 
 a^.tr- X r- 
 
 rH rH rH I-H 
 
 X 
 
 
 O "5 E ..' a^ - z 
 
 
 i2.?Si^SS?^l^g 
 
 •I-H 
 
 • • iS £ Cl 
 
 »~ O Cl t- 
 
 rH 
 
 
 1 § 
 |re 
 
 Ml 0) 
 
 < - = ^ z 
 
 
 11 ?i ci ci 11 ci ci 11 ci 
 
 • ci 
 
 • "cicici 
 
 cn.-^ »- Cl 
 
 r- t- Cl -H 
 
 ci—i cici 
 
 O 
 T-H 
 
 cj 
 
 
 Z J- t-f- 
 
 1 M D v. Z . « 
 
 m'T t.z<: = 
 
 =! & C < - - 
 
 <5 "" 
 
 > 
 
 < 
 
 -t"t-rext-re-ft-'?J 
 
 cioiJO'-H^'rioci 
 
 ei ci ci ci ci 11 -ri ci ti 
 
 • ci 
 
 : :gZ2S 
 
 • -cicici 
 
 X O C. Cl 
 
 Cl -^ O — ' 
 
 cici cici 
 o o '-:ci 
 c c; r-r- 
 
 cici r-rH 
 
 ci 
 
 
 
 iS 
 
 o 00 .-1 •-- X 00 o X o 
 ,»i ^ ^ ^ ^ ^Vi ,- c^i 
 
 •Cl 
 
 • ci 
 
 • • X 5 1-- 
 
 ' -r^cir-H 
 
 
 the resii 
 akee, cla 
 
 
 O '.e CI o o o o o o 
 tr: CI — r- <c •-- ct ci U2 
 
 cicicicicicici ci ci 
 
 • o 
 
 • o 
 
 • CI 
 
 • • t- " *: '" 
 
 • recici 
 
 • -cicici 
 
 gc^ Sx 
 Cl Cl ci ci 
 
 ci 
 
 
 (9 
 
 
 st,2feS^;s-s- 
 
 'S- 
 
 -S^S^ 
 
 SU4 S^ 
 
 
 
 
 Z 
 
 xu:r-iDrt-fOOC:t- 
 
 '-— >;OiP;oci-i"-irH 
 
 ■ic: 
 
 : : u- Cl -* 
 
 Ci C5 r- Cl 
 -f o 
 
 r- 1 rH 
 
 re 
 
 I-H 
 
 <o 
 
 
 
 
 'e 
 
 e 
 
 Z 
 < 
 
 r 
 c 
 
 [3 
 
 CO 
 
 •i ••= 
 
 
 > 
 
 < 
 
 
 ■ ^ tn ' .2 
 
 ►S .o 6 
 111 « 
 
 |J6 J 
 111 1 
 
 — * 
 
 Eh 
 
 
 
 ■ ^ -^ c' 
 rnrH CO El 
 
AI'I'ENDIX. 
 
 483 
 
 The examinations were made by able dentists and myself 
 in the following- named institutions: 
 
 Asylum for Idiots of the State of New York, at Syracuse; 
 Massachusetts School for Feeble-minded, at South Boston; 
 Illinois Asylum for Feeble-minded Children, at Lincoln; Asvlum 
 for Idiots, Randall's Island, N. Y.; Minnesota Training-school 
 for Idiots and Imbeciles, Faribault; Kansas State Asylum for 
 Idiots and Imbeciles, South Winfield; Cook Countv Insane 
 Asylum, Dunning, 111.; Pennsylvania Institution for Feeble- 
 minded Chiklrcn, at Elwyn. 
 
 The following tables show the total number of irregularities 
 in each grade and sex: 
 
 TABLE XIV. 
 
 DEFORMITIES IN THE JAWS.* 
 
 6 
 
 C3 
 
 E 
 
 u 
 O 
 
 a; 
 id 
 u 
 
 c 
 o 
 
 ui-l--) 
 
 c 
 o 
 
 Oh 
 
 3 
 > 
 
 II 
 
 > 
 
 a 
 
 _ CO . 
 
 a. 
 
 T3 
 
 ;5 ceo 
 
 73 
 
 CC OJ 
 
 EH 
 
 1,977 
 
 1,095 
 55. 3~ 
 
 152 
 
 92 
 
 159 
 
 318 
 
 129 
 
 236 
 
 207 
 
 71 
 
 Per cent. 
 
 7.6 
 
 4.6 
 
 7.9 
 
 16 
 
 6.5 
 
 11.9 
 
 10.4 
 
 3.5 
 
 * All tables show irregularities that are the result of small jaws. 
 
 TABLE XV. 
 
 Stature and weight, general population and inmates of the 
 Earlswood, Royal Albert, and Larbert Asylums. (Shuttleworth.) 
 
 Age 
 
 HEIGHT, INCHES. 
 
 WEIGHT, POUNDS. 
 
 Last 
 
 Birth- 
 
 dav. 
 
 General 
 Population, 
 
 Idiots AND 
 Imbeciles. 
 
 General 
 Population. 
 
 Idiots and 
 Imbeciles. 
 
 
 M. 
 
 F. 
 
 M. 
 
 40.00 
 42.25 
 44.00 
 45.75 
 47.50 
 49.00 
 51.00 
 52.50 
 54.75 
 56.50 
 59.25 
 60.75 
 62.50 
 63.25 
 63.25 
 64.00 
 64.25 
 
 F. 
 
 39.50 
 41.25 
 43.25 
 45.25 
 47.50 
 49.00 
 51.00 
 53.00 
 55.00 
 56.50 
 58.00 
 59.00 
 59.25 
 
 59 [56 
 
 M. 
 
 5.5! 06 
 
 60.00 
 
 65.00 
 
 70.00 
 
 77.50 
 
 85.00 
 
 92.50 
 
 102.50 
 
 117.50 
 
 135.00 
 
 142.50 
 
 143.70 
 
 145.00 
 
 146.20 
 
 F. 
 
 M. 
 
 F. 
 
 5 
 
 6 
 
 7 
 
 8 
 
 9 
 
 10 
 
 11 
 
 12 
 
 13 
 
 14 
 
 15 
 
 16 
 
 17 
 
 18 
 
 19 
 
 20 
 
 21 
 
 41.00 
 43.00 
 45.00 
 47.00 
 49.00 
 51.00 
 53.00 
 55.00 
 57.50 
 60.00 
 62.20 
 64.00 
 65.50 
 66.50 
 67.00 
 67.25 
 67.50 
 
 40.55 
 42.88 
 44.45 
 46.60 
 48.73 
 51.05 
 53.10 
 55.66 
 57.77 
 59.80 
 60.93 
 61.75 
 62.52 
 62.44 
 62.75 
 62.98 
 63.03 
 
 39.20 
 
 41.70 
 
 47.50 
 
 52.10 
 
 55.50 
 
 62.90 
 
 68 10 
 
 76.40 
 
 87.20 
 
 96.70 
 
 106.30 
 
 113.10 
 
 115.50 
 
 121.10 
 
 123.80 
 
 123.40 
 
 121.80 
 
 39.00 
 
 43.00 
 
 46.50 
 
 50.50 
 
 55.50 
 
 59.00 
 
 64.50 
 
 70.50 
 
 77.00 
 
 85 '.50 
 
 94.50 
 
 103.00 
 
 110.00 
 
 116.00 
 
 120.50 
 
 121.50 
 
 122.00 
 
 37.50 
 
 41.00 
 
 45.00 
 
 49.00 
 
 53.00 
 
 59.00 
 
 66.00 
 
 72.00 
 
 80.00 
 
 88.00 
 
 95.00 
 
 102.00 
 
 106.00 
 
 108.00 
 
 108.50 
 
 108.. 50 
 
484 
 
 APPF.XDIX. 
 
 TABLE XV— Continued. 
 
 Age 
 
 HEIGHT. 
 
 INCHES. 
 
 WEIGHT. 
 
 POUNDS. 
 
 Last 
 Birth- 
 
 General 
 Population 
 
 Idiots and 
 Imbeciles. 
 
 General 
 Population. 
 
 Idiots and 
 i.vibeciles. 
 
 
 M 
 
 F 
 
 M. 
 
 F 
 
 M. 
 
 F. 
 
 M. 
 
 F. 
 
 22 
 23 
 24 
 
 25-30 
 30-40 
 40-50 
 50-60 
 
 67 . 75 
 68! 00 
 
 62.87 
 63.01 
 62.70 
 62.02 
 
 6i!i5 
 
 
 64.50 
 64! 75 
 
 59! 75 
 
 147.50 
 148.70 
 150.00 
 151.20 
 152.50 
 155.00 
 157.50 
 
 123.40 
 124.10 
 
 120.80 
 120.00 
 120.80 
 118.60 
 104.00 
 
 122.50 
 
 ioo^oo 
 
 TABLE XVI. 
 
 DEFORMITIES OF JAWS OF INEBRIATES. 
 
 6 
 
 re 
 E 
 
 Z 
 
 re 
 
 
 u 
 
 re 
 
 re 
 > 
 
 T3 
 
 > 
 
 •a 
 
 D 
 Q 
 
 re>-< 
 
 Oh 
 
 Semi 
 V-Shaped 
 Arch. 
 
 Saddle 
 Arch. 
 
 Partial 
 Saddle 
 Arch. 
 
 
 e " r: 
 
 514 
 
 25 A 
 
 6.4 
 
 59.5 
 
 1.5 
 
 24.4 
 
 0.3 
 
 9.3 
 
 13.2 
 
 7.7 
 
 *The examination of inebriates was made in The Keeley Institute, Dwight 111 ; 
 The Inebriates' Home, Ft. Hamilton, N. S: WashinKton Home. Chicago; Wasli- 
 intiton Mume, Boston, and Dr Crother's Institute, Hartford, Conn. 
 
 TABLE XVII. 
 
 DEFORMITIES IN JAWS OF THE BLIND, 
 
 One case cleft palate. 
 
 
 
 re 
 c 
 
 u 
 
 C 
 
 re 
 1-1 
 
 OJ 
 u 
 
 re 
 
 c 
 
 
 0-, 
 
 c 
 
 
 
 < 
 
 be 
 X 
 
 73 
 UJ 
 
 > 
 
 i) 
 
 a 
 
 re . 
 
 re>< 
 
 
 J5 
 
 — 01 
 
 reo 
 in 
 
 107 
 100 
 
 M 
 F 
 
 53 
 
 52 
 
 8 
 8 
 
 9 
 
 7 
 
 10 
 5 
 
 20 
 18 
 
 4 3 
 3 6 
 
 6 
 5 
 
 7 
 3 
 
 207 
 
 
 105 
 
 16 
 
 16 
 
 15 
 
 38 
 
 7 
 
 9 
 
 11 
 
 10 
 
 Per cent. . . . 
 
 50.7 
 
 7.7 
 
 7.7 
 
 7.2 
 
 18.3 
 
 3.3 
 
 4.3 
 
 5.3 
 
 4.8 
 
 In twenty-seven examinations of congenitally blind patients, 
 all possessed either deformities of the head, face, jaws or teeth. 
 
APPENDIX. 
 
 48^ 
 
 TABLE XVIII. 
 
 TOTAL DEFORMITIES IN lllb: JAWS OT THK DF^AK AND DUMli. 
 
 d 
 
 2: 
 
 
 o 
 
 538 
 363 
 
 —) 
 o 
 
 •_ 
 
 CO 
 
 c 
 
 
 
 cu 
 
 o 
 
 £:§4 
 
 c 
 
 116 
 
 89 
 
 C8 
 > 
 
 "si 
 
 a- 
 
 T3 
 
 a 
 _ re . 
 
 «>< 
 
 Oh 
 
 .Q reo 
 
 = a! 
 
 1,111 
 
 824 
 
 M 
 F 
 
 197 
 108 
 
 41 
 51 
 
 241 
 177 
 
 91 
 
 78 
 
 115 
 
 77 
 
 108 
 95 
 
 51 
 
 62 
 
 1,935 
 
 nt.... 
 
 901 
 45.3 
 
 305 
 
 92 
 
 205 
 
 • 418 
 
 169 
 
 192 
 
 203 
 
 113 
 
 Per ce 
 
 15.7 
 
 4.7 
 
 10.5 
 
 21.7 
 
 8.7 
 
 9.9 
 
 10.4 
 
 5.8 
 
 Two cases cleft palate. 
 
 TABLE XIX. 
 
 NEUROSES OF DEVELOPMENT OF TAWS OF SEEM- 
 INGLY NORMAL INDIVIDUALS. 
 That the deformities of the jaws of the neurotics and degen- 
 erates as found in our asyhims may be comparer] witli those 
 whom we meet in every-day hfe, the author examined tlie mouths 
 of I, coo school chiklren over twelve years of age and i,ooo adults, 
 patients and friends, with the following- results: 
 
 DEFORMITIES IN CHILDREN'S JAWS. 
 
 d 
 
 1) 
 
 u 
 
 O 
 
 o 
 
 c 
 o 
 
 ^ & > 
 
 a, 
 
 c 
 o 
 
 a. 
 
 re 
 > 
 
 -0 
 > 
 
 ID 
 Q 
 
 lip 
 CL, 
 
 • « . 
 in 
 
 re Oy 
 
 EH 
 
 73 
 
 396 
 604 
 
 M 
 F 
 
 303 
 463 
 
 11 
 
 8 
 
 3 
 
 4 
 
 5 
 2 
 
 26 
 30 
 
 5 
 6 
 
 18 
 43 
 
 12 
 21 
 
 13 
 17 
 
 1,000 
 
 766 
 
 19 
 
 7 
 
 7 
 
 56 
 
 11 
 
 61 
 
 33 
 
 30 
 
 Per cent 
 
 76 
 
 1.9 
 
 .7 
 
 •^ 
 
 5.6 
 
 1.1 
 
 6.1 
 
 3.3 
 
 3.0 
 
 
 
 
 DEFORMITIES IN ADULT 
 
 JAWS 
 
 
 
 
 d 
 
 72 
 
 5 
 2 
 
 o 
 re 
 
 
 re-g 
 > 
 
 Q 
 _ re . 
 
 •-XP 
 73 
 
 .1- u 
 73 
 
 11 
 
 •a 
 
 .-TJ 
 
 c re 
 ■f. 
 
 284 ' M 
 716 F 
 
 211 
 403 
 
 9 
 23 
 
 32 
 
 48 
 62 
 
 10 
 19 
 
 10 
 50 
 
 10 
 
 8 
 
 14 
 29 
 
 27 
 24 
 
 9 
 25 
 
 1,000 1 
 
 014 
 
 110 
 
 35 
 
 72 
 
 18 
 
 43 
 
 51 
 
 34 
 
 Per ce 
 
 nt.... 
 
 61 
 
 3.2 
 
 11.0 
 
 3.5 
 
 7.2 
 
 1.8 
 
 4.3 
 
 5.1 
 
 3.4 
 
486 
 
 APPENDIX. 
 
APPENDIX. 
 
 487 
 
 X 
 H 
 
 EH 
 
 c 
 
 E 
 « 
 
 a 
 E 
 
 
 Sanguine. 
 
 Nervo-bilious. 
 
 Sanguine. 
 
 Sanguine. 
 
 Nervous. 
 
 Nervo-sanguine. 
 
 Nervo-bilious. 
 
 Nervous. 
 
 Lymphatic. 
 
 Nervo-bilious. 
 
 Neurotic. 
 
 Neurotic. 
 
 O . 
 
 S> 
 
 1 
 
 oi c-l (M O r- iM "M t^ r^ (M r^ O 
 C} !>} (M I- (M (M Ol tH T-|(M QO r- 
 
 r-l ,— 1 rH T-l tH 1— 1 ,-H tH T— 1 i-H i-H 
 
 d 
 
 
 oooooooooooo 
 
 in 
 
 O . 
 
 62 
 
 « as 
 
 ^^ 
 Z 
 
 < 
 
 2 
 
 O • -lO -lO -'O -oo • 
 CO • • r-{ •!— 1 -fH -0100 • 
 
 O • -r- -t— -r^ -oo • 
 
 lO • -O -iC -O •^lO • 
 
 c 
 
 o • -c^ -c^ "S -c^o • 
 
 (M • -IM -(M '(M -(MC^I • 
 
 z 
 
 Id • 
 
 si 
 
 dq 
 
 
 l—iOOOi'MCftt-OOKtiOiO 
 
 Oi ^H lO -t< «C -^ CI LO »0 -^ liO r-H 
 
 " 
 
 cOiOOr-Or-QOOOtOOin 
 1— iMOroaocoi— lOOCvlOC-j 
 
 
 Qcn 
 
 Si 
 
 E 
 
 OOiOiClO-^OOiCTtfiOO 
 OOaOi— I^H-^GOCOQO-^QO-^QO 
 
 
 d 
 
 011.0100100100-1100 
 O O CO Ol t- r^ O O I-- --H r- O 
 
 Ol Ol i-H Ol rH Ol Ol Ol 1-1 Ol 1—1 Ol 
 
 Q 
 t« OS 
 
 I** 
 
 E 
 
 lO lO O O •* O lO 'O Ol O O t- 
 
 ^H,— (GOlOOOOli— lr-(CV^GOCOfO 
 
 t-I—OfOCOO't— r-0100»0 
 lO'OiOCOOO'O'OiO'^DOO 
 
 d 
 
 lO lO O O Ol 1— lO lO CO t- O 00 
 OlOlOOi-lfOOlOlOfOO'-H 
 
 OIOIOJOIOIOIOIOIOIOIOIOI 
 
 c 
 
 CiOi CS35QOOOt-t-OCOlOlO 
 
 1— r- 1- t- r- r- Jt- t- r^ t- 1- t- 
 
 
 
 Z 
 
 
 >— lOlOtTHiOCOt-OOOSOt— lOl 
 
 1— 1 T-( I— 1 
 
 
 1 6 5 S o 
 (ur7= <u rt rt 5 
 
 Zpazc/)cnZ 
 
 6 
 C.2 
 
 b 
 O . 
 
 2< 
 
 62 
 
 WW 
 
 
 
 w 
 o 
 
 
 »0 Tf lO lO »o >o 
 o r- o or- o 
 
 C5 lO 0> Ol O Oi 
 1— 1 1— 1 r-( 1— 1 Ol 1— t 
 
 d 
 
 lO Ol »o »0 1— < "O 
 t- CD r^ t— OO t^ 
 
 o' d o d d d 
 
 Ol Ol 00 1— t 
 
 rH I— I i-H CO 
 01 Ol 01 Ol 
 
 01 Ol i-H Ol 1— I Ol 
 
 Ol Ol 01 Ol Ol Ol 
 
488 
 
 APPENDIX. 
 
 TABLE XXIII. 
 
 BRACHYCEPHALIC COLORED. 
 
 
 x' 
 
 Width Out- 
 side 1st 
 Molar. 
 
 Width Out- 
 side 2d 
 Bicuspids. 
 
 Width Be- 
 tween 2d 
 Bicuspids. 
 
 Antero-Pos- 
 
 TERIOR. 
 
 Height of 
 Vault. 
 
 z 
 
 In. 1 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In 
 
 Mm. 
 
 55.37 
 53.84 
 
 56! 80 
 57.15 
 57.15 
 
 In. 
 
 Mm. 
 
 1 
 
 2 
 3 
 4 
 5 
 6 
 
 87 
 87 
 85 
 84 
 84 
 81 
 
 2.87 
 2.50 
 2.37 
 2.25 
 2.50 
 2.50 
 
 72.90 
 63.50 
 60.20 
 57.15 
 63.50 
 63.50 
 
 2.00 
 2.25 
 2.00 
 2.00 
 2.12 
 2.00 
 
 50.80 
 57 . 15 
 50.80 
 50.80 
 53.84 
 50.80 
 
 1.31 
 1.62 
 1.37 
 1.31 
 2.50 
 1.37 
 
 33.27 
 41.15 
 34.77 
 33.27 
 63.50 
 34.79 
 
 2.18 
 2.12 
 
 2!66 
 
 2.25 
 2.25 
 
 0.56 
 0.50 
 0.62 
 0.75 
 0.50 
 0.75 
 
 14.22 
 12.70 
 15.74 
 19.05 
 12.70 
 19.05 
 
 TABLE XXIV. 
 
 MESOCEPHALIC COLORED. 
 
 
 
 Width Out- 
 
 Width Out- 
 
 Width Be- 
 
 Antero-Pos- 
 
 Height of 
 
 
 • 
 
 side 1st 
 
 side 2d 
 
 
 
 
 
 •a 
 
 c 
 
 Molar. 
 
 Bicuspids. 
 
 Bicuspids. 
 
 
 
 z 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 1 
 
 80 
 
 2.50 
 
 63.. 50 
 
 2.25 
 
 57 . 15 
 
 1.62 
 
 41.15 
 
 2.31 
 
 58.67 
 
 0.62 
 
 15.74 
 
 ?, 
 
 79 
 
 2.81 
 
 71. 37 
 
 2.50 
 
 63.. 50 
 
 1.62 
 
 41.15 
 
 2.25 
 
 57.15 
 
 0.62 
 
 15.74 
 
 3 
 
 79 
 
 2.25 
 
 57 . 15 
 
 2.00 
 
 .50.80 
 
 1..50 
 
 38.10 
 
 2.00 
 
 50.80 
 
 0.62 
 
 15.74 
 
 4 
 
 78 
 
 2.50 
 
 63.50 
 
 2.50 
 
 63.50 
 
 1.50 
 
 38.10 
 
 2.37 
 
 60.20 
 
 0.62 
 
 15.74 
 
 5 
 
 78 
 
 2.12 
 
 .53.84 
 
 1.50 
 
 38.10 
 
 1.31 
 
 33.27 
 
 2.12 
 
 53.84 
 
 0.62 
 
 15.74 
 
 6 
 
 75 
 
 2.37 
 
 60.20 
 
 2.00 
 
 50.80 
 
 1.37 
 
 34.79 
 
 
 
 0.50 
 
 12.70 
 
 TABLE XXV. 
 
 dolichocephalic COLORED. 
 
 
 
 Width Out- 
 
 Width Out- 
 
 Width Be- 
 
 \ntero-Pos- 
 
 Height of 
 
 
 
 side 1st 
 
 side 2d 
 
 tween 2d 
 
 
 Vault 
 
 
 •a 
 
 c 
 
 70 
 
 Molar. 
 
 Bicuspids. 
 
 Bicuspids. 
 
 
 
 z 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 1 
 
 2.12 
 
 53.84 
 
 1.87 
 
 47.49 
 
 1.18 
 
 29.97 
 
 2.18 
 
 55.37 
 
 0.56 
 
 14.22 
 
 •:> 
 
 69 
 
 2.50 
 
 63.50 
 
 2.12 
 
 53.84 
 
 1.50 
 
 38.10 
 
 2.25 
 
 57.15 
 
 0.62 
 
 15.74 
 
 3 
 
 67 
 
 2.50 
 
 63.50 
 
 2.18 
 
 55.37 
 
 1.50 
 
 38.10 
 
 2.25 
 
 57 . 15 
 
 0.62 
 
 15.74 
 
 4 
 
 67 
 
 2.25 
 
 57.15 
 
 2.00 
 
 50.80 
 
 1.18 
 
 29.97 
 
 2.25 
 
 57.15 
 
 0.62 
 
 15.74 
 
 5 
 
 63 
 
 2.25 
 
 57.15 
 
 2.12 
 
 53.84 
 
 1.50 
 
 38.10 
 
 2.25 
 
 57.15 
 
 0.62 
 
 15.74 
 
 6 
 
 60 
 
 2.50 
 
 63*50 
 
 2.25 
 
 57.15 
 
 1.75 
 
 44.45 
 
 2.37 
 
 60.20 
 
 0.68 
 
 17.27 
 
 TABLE XXVI. 
 
 BRACHYCEPHALIC, AVERAGE WHITE AND COLORED. 
 
 RACE. 
 
 White . . 
 Colored. 
 
 Width Out- 
 side 1st 
 Molar. 
 
 In. 
 
 2 22 
 2.33 
 
 Mm. 
 
 56.38 
 59.18 
 
 Width Out- 
 side 2d 
 Bicuspids. 
 
 Width In- 
 side 2d 
 Bicuspids. 
 
 Antero-Pos- 
 
 TERIOR. 
 
 In. 
 
 1.98 
 2.06 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 50.29 
 52.32, 
 
 1.19 30.22 I 2.16 
 1.53 38.86 2.16 
 
 Mm. 
 
 54.86 
 "54.86 
 
 Height of 
 Vault 
 
 In. 
 
 0.54 
 0.61 
 
 Mm. 
 
 13.71 
 15.49 
 
.•\PrF.XDIX. 
 
 489 
 
 TABLE XXVII. 
 
 MESOCEPHALIC, AVERAGE WHITE AND COLORED. 
 
 RACE. 
 
 Width Out- 
 side Isr 
 Molar. 
 
 Width Out- 
 
 SIDE2D 
 
 Bicuspids. 
 
 Width In- 
 side 2d 
 Bicuspids. 
 
 .AnteroPos- 
 
 TERIOR. 
 
 Height of 
 Vault. 
 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 White.. 
 Colored. 
 
 2.21 
 2.42 
 
 56.13 
 61.36 
 
 1.95 
 2.12 
 
 48.53 
 
 53.84 
 
 1.16 
 1.49 
 
 29.47 
 37.55 
 
 2.18 
 2.16 
 
 55.37 
 
 54.86 
 
 0.52 
 0.60 
 
 13.20 
 
 15.24 
 
 TABLE XXVIIL 
 
 DOLICHOCEPHALIC, AVERAGE WHITE AND COLORED. 
 
 RACE. 
 
 Width Out- 
 side 1st 
 Molar. 
 
 Width Out- 
 side 2d 
 Bicuspids. 
 
 Width In- 
 side 2d 
 Bicuspids. 
 
 Antero-Pos- 
 terior. 
 
 Height of 
 Vault. 
 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 In. 
 
 Mm. 
 
 White. . 
 Colored. 
 
 2.19 
 2.35 
 
 55.62 
 59.69 
 
 1.97 
 2.09 
 
 50.03 
 
 53.08 
 
 1.50 
 1.42 
 
 38.10 
 36.06 
 
 2.18 
 2.26 
 
 55.37 
 
 57.40 
 
 0.74 
 0.62 
 
 18.79 
 15.74 
 
 The following' table exhibits the differences in the heights of 
 vaults in normal and defective jaws. The height is taken cen- 
 trally and vertically from the gingival plane on a transverse line 
 intersecting gingival crests between the second bicuspids and 
 lirst molars. Fig. 24 shows the instrument used, and the man- 
 ner of making the measurements. 
 
 TABLE XXIX. 
 
 NORMAL JAW. 
 
 Heigrhtof 
 
 No. of 
 
 Height of 
 
 No. of 
 
 Height of 
 
 No. of 
 
 Heightof 
 
 No. of 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 .21 
 
 1 
 
 .40 
 
 159 
 
 .56 
 
 936 
 
 .71 
 
 149 
 
 .25 
 
 2 
 
 .43 
 
 182 
 
 .59 
 
 218 
 
 .75 
 
 427 
 
 .28 
 
 70 
 
 .46 
 
 69 [ 
 
 .62 
 
 514 
 
 .78 
 
 69 
 
 .31 
 
 171 
 
 .50 
 
 199 I 
 
 .65 
 
 150 
 
 .81 
 
 (O 
 
 .34 
 
 169 
 
 .53 
 
 429 
 
 .68 
 
 568 
 
 .84 
 
 12 
 
 .37 
 
 146 
 
 
 ■■■ 1 
 
 
 
 
 
 Total number of cases. 4,614. Average, .58 of an inch. 
 
490 
 
 APPENDIX. 
 
 TABLE XXX. 
 
 SADDLE-SHAPED ARCH. 
 
 Heigrhtof 
 
 No. of 
 
 Heightof 
 
 No. of 
 
 Heightof 
 
 No. of 
 
 Heightof 
 
 No. of 
 
 Vault; 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 .21 
 
 
 .40 
 
 
 .56 
 
 (i 
 
 .71 
 
 5 
 
 .25 
 
 
 .43 
 
 
 .59 
 
 5 
 
 .75 
 
 5 
 
 .28 
 
 
 .46 
 
 3 
 
 .62 
 
 4 
 
 .78 
 
 1 
 
 .31 
 
 
 .50 
 
 5 
 
 .65 
 
 
 .81 
 
 1 
 
 .34 
 
 
 .53 
 
 5 
 
 .68 
 
 3 
 
 .84 
 
 
 .37 
 
 1 
 
 
 
 
 
 
 
 Total number of cases, 44. Average, .GO of an inch. 
 
 TABLE XXXL 
 
 V-SHAPED ARCH. 
 
 Heightof 
 
 No. of 
 
 Heightof 
 
 No. of 
 
 Heightof 
 
 No. of 
 
 Heightof 
 
 No. of 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 .21 
 
 
 .40 
 
 1 
 
 .56 
 
 15 
 
 .71 
 
 1 
 
 .25 
 
 
 .43 
 
 
 .59 
 
 4 
 
 .75 
 
 2 
 
 .28 
 
 
 .46 
 
 3 
 
 .62 
 
 9 
 
 .78 
 
 
 .31 
 
 >> 
 
 .50 
 
 8 
 
 .65 
 
 
 .81 
 
 i 
 
 .34 
 
 
 .53 
 
 3 
 
 .68 
 
 5 
 
 .84 
 
 
 .37 
 
 4 
 
 
 
 
 
 
 
 Total number of cases, 58. Average. .55 of an inch. 
 
 TABLE XXXII. 
 
 SEMI-V AND SEMI-SADDLE-SHAPED ARCH. 
 
 Heightof 
 
 No. of 
 
 Height of 
 
 No. of 
 
 Heightof 
 
 ■ No. of 
 
 Heightof 
 
 No. of 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 Vault. 
 
 Cases. 
 
 .21 
 
 
 .40 
 
 
 .59 
 
 1 
 
 .75 
 
 
 .25 
 
 1 
 
 .43 
 
 1 
 
 .62 
 
 4 
 
 .78 
 
 i 
 
 .28 
 
 
 .46 
 
 
 .65 
 
 o 
 
 .81 
 
 
 .31 
 
 
 .50 
 
 3 
 
 .68 
 
 
 .84 
 
 
 .34 
 
 
 .53 
 
 3 
 
 .71 
 
 9 
 
 
 
 .37 
 
 1 
 
 .56 
 
 5 
 
 
 
 
 
 Total number of cases, 24. Average, .56 of an inch. 
 
TABLE XXXIII. 
 
 Deformities of the Jaws Among the Degenerates of Europe. 
 ATHENS PRISON, 452 CONVICTS. 
 
 V-shaped arch o 
 
 Saddle-shaped arch o 
 
 Arrest of the lower jaw Frequent. 
 
 Recession of the forehead Frequent. 
 
 Irregular relation of the upper and lower jaw. .. Very common. 
 
 Third molars, upper and lower Usually present. 
 
 Vault Lower than average. 
 
 IDIOTS AND INSANE, GREEK INSANE HOSPITAL IN CON- 
 STANTINOPLE, 332, MALES 166, FEMALES 166. 
 
 V-shaped arch i 
 
 Saddle-shaped arch o 
 
 Arrest of the lower jaw 48% 
 
 Third molars ." Normally developed. 
 
 IDIOTS AND INSANE, ARMENIAN INSANE HOSPITAL, CON- 
 STANTINOPLE, 250 INMATES; MALES 175, FEMALES 75- 
 
 V-shaped arch i 
 
 Arrest of lower jaw 18% 
 
 Third molars Normal. 
 
 Third molars Many. 
 
 IDIOTS AND INSANE, VIENNA INSANE HOSPITAL, 
 326 INMATES. 
 
 V-shaped arch 4 
 
 Saddle-shaped arch i 
 
 Third molars Normal 311. 
 
 MOSCOW PRISON, 2,000 INMATES (INFIRMARY, 247). 
 
 Contracted jaws O . 
 
 Irregularities of the teeth 
 
 Jaws large and vaults low All. 
 
 MOSCOW REFOR^I SCHOOL. 112 BOYS. 
 
 Partial V-shaped arches 3 
 
 Saddle-shaped arches o 
 
 Jaws as a rule large and broad, with low vaults. 
 
 MOSCOW INSANE HOSPITAL, 400 PATIENTS, 12 IDIOTS. 
 
 Contracted crches o 
 
 Jaws large and broad, with low vaults. 
 
 491 
 
492 APPENDIX. 
 
 STOCKHOLM INSANE HOSPITAL, 270 PATIENTS. 
 
 V-shaped arches 6 
 
 Partial V-shaped arches 12 
 
 Semi V-shaped arches ". 4 
 
 Saddle-shaped 23 
 
 Partial saddle-shaped 4 
 
 Excessively developed upper jaws 11 
 
 Excessively developed under jaws 3 
 
 Hypertrophy of the Alveolar Process 9 
 
 Missing third molars 42 
 
 Missing laterals 6 
 
 Deformities of individual teeth Numerous. 
 
 STOCKHOLM SCHOOL OF IDIOCY, 120 INMATES. 
 
 80 40, 
 
 Boys. Girls. 
 
 Normal jaws 14 15 
 
 V-shaped 12 i 
 
 Partial V-shaped 10 5 
 
 Semi V-shaped 4 5 
 
 Saddle-shaped 8 8 
 
 Partial saddle-shaped i o 
 
 Semi saddle-shaped 2 i 
 
 Hypertrophy of the Alveolar Process 32 14 
 
 Macrocephalic 12 6 
 
 Microcephalic 5 4 
 
 One boy of thirteen, able to take care of himself, had a head 32 inches 
 in circumference. 
 
 HAMBURG PRISON, 1,800 INMATES. 
 
 Large, well developed jaws The rule. 
 
 Asymmetry in development Frequent. 
 
 HAMBURG SCHOOL OF IDIOCY, 600 INMATES. 
 
 396 204 
 
 Boys. Girls. 
 
 Normal jaws 62 28 
 
 V-shaped 12 4 
 
 Partial V-shaped 16 7 
 
 Semi V-shaped 8 3 
 
 Saddle-shaped 4 i 
 
 Partial saddle 3 I 
 
 Semi saddle 2 3 
 
 Hypertrophy of the Alveolar Process 46 25 
 
 Macrocephalic 3 5 
 
 Microcephalic 4 2 
 
 One boy of thirteen had a Igwer jaw excessively developed one and 
 one-half inches beyond the normal upper. 
 
APPENDIX. 493 
 
 AMSTERDAM INSANE HOSPITAL, 1,330 INMATES. 
 
 Contracted arches o 
 
 Low vaults 67 
 
 Hypertrophy of the Alveolar Process Frequent. 
 
 Missing third molars o 
 
 AMSTERDAM SCHOOL OF IDIOCY, 255 INMATES. 
 
 116 139 
 
 Boys. Girls. 
 
 V-shaped i i 
 
 Partial V-shaped 3 2 
 
 Semi V-shaped i o 
 
 Saddle i o 
 
 Hypertrophy of the Alveolar Process 19 
 
 Vaults low and jaws well developed. 
 
 PARIS SCHOOL OF IDIOTS, 667 INMATES. 
 
 500 167 
 
 Boys. Girls. 
 
 V-shaped i i 
 
 Partial V-shaped 40 6 
 
 Semi V-shaped 2 i 
 
 Saddle 2 8 
 
 Partial saddle I 2 
 
 Semi saddle 4 i 
 
 Hypertrophy of the Alveolar Process 7 4 
 
 The vaults were low. 
 
 PARIS PRISONS (4), INMATES 2,600. 
 Deformities of the jaw not obvious. 
 
 BROADMORE INSANE HOSPITAL (CRIMINALS). 
 Marked deformities of the jaw and teeth 80 to 85%. 
 
 HANWELL INSANE HOSPITAL, 2,080. INSANE AFTER 
 MATURITY. 
 Hypertrophy of the Alveolar Process frequent. 
 Excessive and arrested development of the jaws frequent. 
 Stigmata of degeneracy the rule. 
 
 FLETCHER BEACH IDIOTS' SCHOOL, 13 INMATES. 
 
 V-shaped 3 
 
 Partial V-shaped 8 
 
 Semi V-shaped i 
 
 Hypertrophy of the Alveolar Process 6 
 
 Notched and pitted teeth 8 
 
 High vaults 13 
 
 Laterals missing 4 
 
 These patients were too young to decide as to number of third molars. 
 
494 
 
 APPENDIX. 
 
 EARLSWOOD IDIOT SCHOOL, 670 INMATES. 
 
 400 270 
 
 Boys. Girls. 
 
 Normal j aws 31 24 
 
 V-shaped arch 108 67 
 
 Partial V-shaped 69 86 
 
 Semi V-shaped 11 24 
 
 Saddle-shaped 19 8 
 
 Partial saddle-shaped 2"] 23 
 
 Semi saddle 13 i 
 
 Marked arrest of upper jaw 104 87 
 
 Marked protrusion of upper jaw 64 24 
 
 Marked protrusion of lower jaw 11 i 
 
 Marked arrest of lower jaw 306 237 
 
 Lateral incisors arrested 46 30 
 
 Lateral incisors lost 28 16 
 
 Third molars lost 180 85 
 
 Showed malnutrition of teeth 160 78 
 
 Cleft palate o i 
 
 DARENTH SCHOOL, IDIOT, 1,000 INMATES (CHILDREN). 
 
 640 360 
 
 Boys. Girls. 
 
 Normal jaws 150 90 
 
 V-shaped jaws 143 118 
 
 Partial V-shaped jaws 140 80 
 
 Semi V-shaped jaws 105 65 
 
 Saddle 35 o 
 
 Partial saddle 20 8 
 
 Semi saddle 10 20 
 
 Marked arrest of upper jaw 450 310 
 
 Marked protrusion of upper jaw 150 90 
 
 Marked protrusion of lower jaw 23 9 
 
 Arrest of lower jaw 600 340 
 
 Lateral incisors arrested 68 2>2 
 
 Lateral incisors lost 42 19 
 
 Third molars lost 388 1 1 1 
 
 Hypertrophy of upper jaw 150 90 
 
 SHUTTLEWORTH SCHOOL FOR IDIOTS, 12 INMATES. 
 
 Normal j aw i 
 
 V-shaped 2 
 
 Partial V-shaped 5 
 
 Semi V-shaped i 
 
 Partial saddle 2 
 
 Semi saddle I 
 
 Hypertrophy of Alveolar Process 4 
 
 Notched and pitted teeth 9 
 
 High vaults 12 
 
 Third molars missing Patients too young to decide . 
 
 Laterals missing S 
 
APPENDIX. 495 
 
 DARENTH ADULT SCHOOL, 1,050 INMATES. 
 
 450 600 
 
 Males. Females. 
 
 Normal jaws 60 40 
 
 V-shaped 105 177 
 
 Partial V-shaped 93 121 
 
 Semi V-shaped 53 79 
 
 Saddle 31 o 
 
 Partial saddle 5 8 
 
 Semi saddle o 10 
 
 Marked arrest of upper jaw 295 436 
 
 Marked protrusion of upper jaw 162 209 
 
 Marked protrusion of lower jaw 8 17 
 
 Arrest of lower jaw 409 580 
 
 Lateral incisors arrested 48 72 
 
 Lateral incisors lost 37 62 
 
 Third molars lost 442 597 
 
 Hypertrophy of upper jaw 58 36 
 
 Of the children, five hundred and seventy-six boys showed malnutri- 
 tion in utero; two hundred and eighty-two girls showed malnutrition in 
 utero. Of the adults, three hundred and ninety-six males showed malnu- 
 trition in utero; five hundred and seventy-eight females showed malnutri- 
 tion in utero. 
 
 LANGDON DOWN'S IDIOT SCHOOL, 147 INMATES. 
 
 97 50 
 
 Boys. Girls. 
 
 Normal jaws 12 5 
 
 V-shaped 36 10 
 
 Partial V-shaped 20 9 
 
 Semi V-shaped 15 12 
 
 Saddle 9 7 
 
 Partial saddle 13 i 
 
 Semi saddle 28 16 
 
 Arrest of upper jaw 86 45 
 
 Third molars missing 92 47 
 
 Lateral incisors missing 16 8 
 
 Teeth showing arrest and grooves 46 21 
 
 Hypertrophy of the Alveolar Process 19 7 
 
 Of the twelve normal arches (males) seven were hypertrophied. Of 
 the five normal dental arches (females) three were hypertrophied. 
 
ANTERO-POSTERIOR AND LATERAL 
 ILLUSTRATIONS OF THE VAULT 
 
 33 - 497 
 
PLATE 1. 
 
 5eve« ycqr3 oPci^t 
 
 498 
 
PLATE 2. 
 
 5evcn yeQrscfadc 
 4" 
 
 499 
 
500 
 
PLATE 4. 
 B§ht"year5ofqge 
 
 io 
 
 IZ 
 
 501 
 
PLATE 5. 
 
 503 
 
PLATE 6. 
 
 Mirf« years of ag« 
 15 
 
 15 
 
 17 
 
 6fli? 
 
PLATE 7. 
 
 ~7en yccit^ of age 
 
 504 
 
PLATE 8. 
 
 Ten yeqrs of ad« 
 
 21 
 
 505 
 
PLATE 9. 
 
 CIcYcrr vcar^ ot'q<^e. 
 
a<r 
 
 30. 
 
 507 J 
 
PLATE 11. 
 
 Twelve year^ of ao'c. 
 
PLATE 12. 
 
 Twelve ye qrs of a^c 
 
 31 
 
 32 
 
 35 
 
 54 
 
 509 
 
PLATE 13. 
 
 Brqcbyccfihqii'c. White 
 
 510 
 
PLATE 14. 
 
 Bracfiycefiliql/c. Wfiite. 
 
PLATE IS. 
 
 ^rqcliycej-ifighc. White. 
 
PLATE 16. 
 
 BracfiycefrWic. WfiiTe 
 
 8 
 
PLATE 17. 
 
 Mesocefihqiic. WFtifc. 
 
 514 
 
PLATE 18. 
 
 Mes oce/i h q I ic . Wh i le 
 
PLATE 19. 
 
 Mesocejrfiqljc. White 
 
PLATE 20. 
 
 Mesoccfihafic. \^^h^tz 
 
 If 
 
 IZ 
 
 617 
 
PLATE 21. 
 
 DoIicliocehliQliC. White 
 
PLATE 22. 
 
 Dolichocefihal/c. WfiiTe, 
 
PLATE 23. 
 
 Brqchycc/ifiqlic. Colored. 
 
 520 
 
PLATE 24. 
 
 J5>rqcfiyce[ihqlfc. Colorc-q. 
 
 5. 
 
 6. 
 
 521 
 
PLATE 25. 
 
 MeaoccfiHcIic. Colored- 
 
PLATE 26. 
 
 Mesocefrhqlic. Colored. 
 "7 
 
PLATE 27. 
 
 DotichocefihaJic. Colored. 
 
 524 
 
PLATE 28. 
 
 Dolichoccfihalfc. Cojorecj 
 
 5. 
 
 6. 
 
 525 
 
PLATE 29. 
 
 V shqfiea Vqulf. 
 
PLATE 30. 
 
 V^jiqfied Vault. 
 
 527 
 
PLATE 31. 
 
 Seini Vshgjiecf Vqult. 
 
 528 
 
PLATE 32. 
 
 5erni Vshqfied VoalT. 
 
 35 
 
 529 
 
PLATE 33. 
 
 3q(fcflc-5hqfie4 VquWt. 
 
 530 
 
PLATE 34. 
 
 Saddle sliajied Vciixlt 
 
 3. 
 
 531 
 
PLATE 35. 
 
 Semi - 3q ddlg Vn trff 
 
 632 
 
PLATE 36. 
 
 6. 
 
 533 
 
EXPLANATION OF PLATES. 
 
 Plates I to 1 1 show the shape of the teeth, alveolar process, 
 and vault at the median line. 
 
 Plates 2 to 12 show the shape of the teeth, alveolar process 
 and vault at a line drawn laterally anterior to the first permanent 
 molar. 
 
 Plates 13 and 15 illustrate the shape of the teeth, alveolar 
 process and vault at the median line, of twelve brachycephalic 
 white adults. (For measurements of these cases see pages 486 
 to 489.) 
 
 Plates 14 and 16 illustrate the shape of the teeth, alveolar 
 process and vault at a line drawn laterally anterior to the first 
 permanent molar, of twelve brachycephalic white adults. 
 
 Plates 17 and 19 show the shape of the teeth, alveolar process 
 and vault at the median line, of twelve mesocephalic white adults. 
 
 Plates 18 and 20 show the shape of the teeth, alveolar process 
 and vault at a line drawn laterally anterior to the first permanent 
 molars of twelve mesocephalic white adults. 
 
 Plate 21 shows the shape of the teeth, alveolar process and 
 vault at a median line of six dolichocephalic white adults. 
 
 Plate 22 shows the shape of the teeth, alveolar process and 
 vault at a line drawn laterally anterior to the first permanent 
 molar of six dolichocephalic white adults. 
 
 Plate 23 shows the shape of the teeth, alveolar process and 
 the vault at the median line of six brachycephalic colored adults. 
 
 Plate 24 shows the shape of the teeth, alveolar process and 
 vault at a line drawn laterally anterior to the the first permanent 
 molar of six brachycephalic colored adults. 
 
 Plate 25 shows the shape of the teeth, alveolar process and 
 vault at the median line of six mesocephalic colored adults. 
 
 534 
 
EXPLANATION OF PLATES. 535 
 
 Plate 26 shows the shape of the teeth, alveolar process and 
 vault at a line drawn laterally anterior to the first permanent 
 molar of six mesocephalic colored adults. 
 
 Plate 27 shows the shape of the teeth, alveolar process and 
 vault at the median line of six dolichocephalic colored adults. 
 
 Plate 28 shows the shape of the teeth, alveolar process and 
 vault at a line drawn laterally anterior to the first permanent 
 molar of six doHchocephalic colored adults. 
 
 Plate 29 illustrates the shape of the teeth, alveolar process 
 and vault at the median line of six V-shaped vaults of white 
 adults. 
 
 Plate 30 illustrates the shape of the teeth, alveolar process 
 and vault at a line drawn laterally anterior to the first permanent 
 molars of six V-shaped vaults of white adults. 
 
 Plate 31 illustrates the shape of the teeth, alveolar process 
 and vault at the median line of six semi-V-shaped vaults of white 
 adults. 
 
 Plate 32 illustrates the shape of the teeth, alveolar process 
 and vault at a line dra\\Ti laterally anterior to the first permanent 
 molars of six semi-V-shaped vaults of white adults. 
 
 Plate 33 illustrates the shape of the teeth, alveolar process 
 and vault at the median line of six saddle-shaped vaults of white 
 adults. 
 
 Plate 34 illustrates the shape of the teeth, alveolar process 
 and vault at a line drawn laterally anterior to the first permanent 
 molars of six saddle-shaped vaults of white adults. 
 
 Plate 35 illustrates the shape of the teeth, alveolar process and 
 vault at the median line of six semi-saddle shaped vaults of white 
 adults. 
 
 Plate 36 illustrates the shape of the teeth, alveolar process 
 and vault at a line drawn laterally anterior to the first permanent 
 molar of six semi-saddle vaults of white adults. 
 
INDEX OF AUTHORS. 
 
 Aitken, VV., 98. 
 
 Alexander, Harriet C. B., ^iT, 128, 
 
 141. 
 Allen, 52. 
 
 Allen, H., 172, 173, 189. 
 Alvarez, L., 100. 
 Andronico, 138, 141. 
 Ansell, 22. 
 Aristotle, 20. 
 Arthur, 12. 
 Austin. J. F.. 457. 
 Aubezi, 2. 
 Awl, 108. 
 Ayres, H., 208. 
 Baas, I. 
 
 Baer, Von, 20, 2>Z- 
 Ballard, T., 4, 237. 
 Bannister. H. M., 99. 
 Bauchwitz, 17. 
 Baudelocque, 29. 
 Beaunis, 291. 
 Bell, T., 7. 
 Berdmore, 5. 
 Berwig, no. 
 Bigot, 29. 
 Bjornson, 116. 
 Black, G. v., 87, 95, 467. 
 Blake, 3. 
 
 Blount, A. A., 14. 
 Bock, 210. 
 Booth, B., 137. 
 Borelius, 378. 
 Bosworth, 175, 189. 
 Bouchard, 291. 
 Boullard, 235. 
 Boyd, 29. 
 
 Brideman, W. K., 12. 
 Brigham, 108, 135, 138. 
 Broca, 45, 136. 
 Bronzet, 380. 
 Brown, H. H., 257. 
 
 Bruce. 210. 
 
 Bruno, 2. 
 
 Bulwcr, 120. 
 
 Bunyan, 116. 
 
 Bureau, no. 
 
 Calkins, no. 
 
 Campagne, 136. 
 
 Camper, 153, 156. 
 
 Canton, A., 12, 235.* 
 
 Carpenter, G. T., 376. 
 
 Cartwright, 13, 14. 
 
 Carver, 380. 
 
 Catching, 380. 
 
 Catlin, 9. 
 
 Cazeaux, 29. 
 
 Celsus, I. 
 
 Charrin, 120. 
 
 Christopher, W. S., no. 
 
 Clapp, Dwight M., 399. 
 
 Clark, J. P., n. 
 
 Clarke, A., 10. 
 
 Cloquets, 153. 
 
 Clouston, 84. 238, 241. j8o. 282. 
 
 Cohnheim, 34. 
 
 Cole. Oakley, 65, 83, i}^, 293. 294. 
 
 Coleman, 14, 51. 
 
 Columbus, 29. 
 
 Colyer, 15. 
 
 Conger, 100. 
 
 Coolidge, F. S., 120. 
 
 Cravens, J. E., 338. 
 
 Crooke, 2, 3, 5, 10. 
 
 Cuylitz, 237. 
 
 Cuvier, 153. 
 
 Dahn, 100. 
 
 Dana, C. L.. 296. 
 
 Dareste, 25, 33, 209. 
 
 Darwin, C, 52. 378. 
 
 Davenport, 342. 
 
 Deah. L. W.. 208, 212. 
 
 Delabarre, C. F., 13. 
 
 537 
 
538 
 
 INDEX OF AUTHORS. 
 
 Demarquay, 294. 
 
 DeMoor, 2^, 38, 119. 
 
 Denniker, 100. 
 
 DesChampes, 130. 
 
 Despine, 135. 
 
 Dickens, C, 296. 
 
 Dionis, 2. 
 
 Dohrn, 36. 
 
 Donatus, M., 29. 
 
 Down, J. L., 14, loi, 130, 236, 238, 
 
 292, 295. 
 Dray, A. R., 154. 
 Duncan, J. M., 22, 100. 
 Duplay, 294. 
 Durkheim, 96. 
 Duval, J. R., 13. 
 Dwinell, Wm. H., 440, 441. 
 Ebers, I. 
 Ebner, V., 91. 
 
 Ellis, Havelock, 23, 30, 32, 93, 134. 
 Erasistratus, i. 
 Etienne, no. 
 Farrar, 411, 436, 438. 
 Fauchard, 2. 
 Fere, 28, 211. 
 Fitch, S. S., 6. 
 
 Fletcher, M. H., 205, 206, 207. 
 Flower, 44. 
 Follin, 294. 
 Folsom, J. R., 209. 
 Fournier, E., 122. 
 Fox, F., 2, 379. 
 Fox, J., 6. 
 Frigerio, 142. 
 Fuller, J., 10. 
 Galen, 2. 
 Gait, 135. 
 Gardien, 29. 
 Garriolt, J. B., 6. 
 Geddes, 18. 
 Gegenbauer, 95. 
 Ghimes, 9. 
 Gihon, 105. 
 
 Giovanni de Arcoli, 2. 
 Gley, 120. 
 
 Goddard, Paul, 11. 
 
 Goethe, 20. 
 
 Gomme, 114. 
 
 Gould, 29, 125, 214, 235, 380. 
 
 Gray, 88. 
 
 Grenser, 295. 
 
 Grimaldi, 138, 141. 
 
 Grohman, 135. 
 
 Guilford. S. H., 15, 2>77, 379, 396, 
 
 397, 469- 
 Gunnell, 13. 
 Gurlt, 235. 
 Hafner, 107. 
 Haller, 29. 
 
 Hammond, W. A., 146. 
 Hannover, 209. 
 Harbert, S., 12. 
 Harris, C. A., 12. 
 Harris, E., 136. 
 Harris, J., 3. 
 Haskell, L. P., 221, 223. 
 Hawley, G. F., 257. 
 Hepburn, 15. 
 Herodotus, i. 
 Herzog, M., 418. 
 Heyman, 113. 
 Hildebrand, O., 379. 
 Hippocrates, i, 102. 
 Hitchcock, 54. 
 Hogden, in. 
 Hughes, C. H., 135. 
 Humphreys, G. M., 7. 
 Hunter, 7. 
 Hutchinson, J., 124. 140, 371, 27^. 
 
 379. 
 Huxley, T. H., 44. 
 Imrie, 3, 237. 
 Ivy, R. S., 241, 244. 
 Jacquarts, 153. 
 James, B., 6 . 
 Jobson, D. W., II. 
 Kant, 41. 
 
 Keane, 44, 102, 113. 
 Keen, W. W., 247, 291. 
 Keith, R. P., 154. 
 
INDEX OF AUTHORS. 
 
 539 
 
 Kells, C. Edward, 399, 400. 
 Kiernan, J. G., 22, 23, 26, 28, 33, yj, 
 
 99, 100, loi, 108, III, 113. 
 
 114, IIS, 132, 141, 211. 
 Kingsley, 15, 228, 35s, 384, 44 1- 
 Kirk, E. C, 235. 
 Knecht, 295. 
 Koecker, 7. 
 KoUiker, 70. 
 Kollman, 95. 
 Kolster, 125. 
 Korosi, 100, 
 Kraft-Ebing, 143. 
 Lagorio, A., 28. 
 Laing, 115. 
 
 Lane, W. Arbuthnot, 15. 
 Landolt, 218. 
 Langenbeck, 189, 235. 
 Langenbuch, 293. 
 Lankester, R., 36. 
 Lazarus, 112. 
 Lefoulon, J., 4. 
 Lessert, A. A. de, 5. 
 Levison, 29. 
 Lind, J., 106. 
 Loeb, J., 38. 
 Lombroso, 130, 138, 141. 
 Loude, C. de, 9. 
 Luys, 18. 
 
 Lydston, G. P., 225. 
 Mackenzie, J., 172, 173, 189. 
 Maclean, M., 8. 
 Magalhaes, 129. 
 Magill, 468. 
 Magitot, 54, 95, 378. 
 Magnan, 127. 
 Mallan. 11. 
 Manning. 99. 
 Mantegazza, 116. 
 Marie, 16. 
 Marro, loi. 
 Marsh, 365, 366. 
 Matthews, W., 10. 
 Maurice, 235. 
 Maury, 11. 
 McCullom, A., 440, 441. 
 
 M'Dowell, J. N., 399, 401. 
 
 Merrick, 138. 
 
 Metschinkoff, 123. 
 
 Meynert, 133. 
 
 Mills, C. K., 134. 
 
 Milne-Edwards, 132. 
 
 Minot, 40, 93, 291, 292. 
 
 Mitchell, A., 22, loi. 
 
 Monteyel, de, 99. 
 
 Moreau, de Tours, 21, 22. 
 
 Morgagni, 175, 178. 
 
 Morgan, de, 71. 
 
 Morel, 142. 
 
 Mortimer, 8. 
 
 Muller, Max, 115. 
 
 Mummery, 14, 51, 52. 
 
 Murphy, J., 6. 
 
 Nasse, 125. 
 
 Nasmyth, 5. 
 
 Nessel, 9. 
 
 Nicholas, 235. 
 
 Nicholles, 8. 
 
 Nichols, 14. 
 
 Ogle, 295. 
 
 O'Neill, E. F., 155. 
 
 Osbom, 36, 375. 
 
 Osier, 125. 
 
 Otis, General, 106. 
 
 Otto, 379. 
 
 Palmer, W. €., 154. 
 
 Parmly, 6. 
 
 Parrot, 140. 
 
 Patterson, W. J., 108. 
 
 Pearsol, W. B., 377. 
 
 Petrie, Flinders, 115. 
 
 Phisalix, 210. 
 
 Pierce, 88. 
 
 Pinckard, C. P., 211. 
 
 Pliny, 29. 
 
 Poole, T. C, 26. 
 
 Porak, III. 
 
 Prenant, 235. 
 
 Prichard, 135. 
 
 Pruner Bey, 103. 
 
 Pyncheon, 257. 
 
 Quatrefages, 103. 
 
540 
 
 INDEX OF AUTHORS. 
 
 Quelmalz, 174. 
 
 Ray, 108, 135. 
 
 Recklinghausen, 139. 
 
 Rennert, in. 
 
 Ribot, 19. 
 
 Robertson, W. C, 11. 
 
 Robin, 95. 
 
 Roller, 99. 
 
 Rosser, 2>77- 
 
 Ross, H. H., 5. 
 
 Roux, 294. 
 
 Roux, 34. 
 
 Royce, 136. 
 
 Rush, 135. 
 
 Ruspini, 7. 
 
 St. Hilaire, 20. 
 
 Salter, Thomas, 5. 
 
 Saulle, L .de, 28. 
 
 Sayce, i. 
 
 Schaus, 175. 
 
 Scott, C. A., 35. 
 
 Scott, Joseph, 8. 
 
 Scott, Sir W., 114. 
 
 Schultz, 174. 
 
 Schultze, 100. 
 
 Semeleder, 172. 
 
 Sergi, 86. 
 
 Sewell, H., 14. 
 
 Shakespeare. W., 2, 29. 
 
 Sharpey, 87. 
 
 Shaw, Clay, 236. 
 
 Sigmond, 10. 
 
 Smith, B. Holly, 154. 
 
 Soemmering, 29. 
 
 Souques, 125. 
 
 Spencer, Herbert, 21, 22, 33. 
 
 Spitzka, E. C, 25, 27, 144. 
 
 Spooner, 8. 
 
 Starr, F. W., 103, 114. 
 
 Steams, H. M., 108. 
 
 Stockton, 4. 
 
 Strahan, 96, 97, 98. 
 
 Sutton, Bland, 292, 294, 295. 
 
 Swieten, Van, 29. 
 
 Tanquerel, des Planches, in. 
 
 Tamowsky, P., 138, 141, 157, 295. 
 
 Taylor, 114. 
 
 Theile, 189. 
 
 Thompson, A. H., 365, zTi, 381, 382. 
 
 Thomson, B., 135. 
 
 Thornton, W., 8. 
 
 Thurman, 378. 
 
 Tiedemann, 292. 
 
 Tomes, 9, 53, 65, 68. 71, 235, 379. 
 
 Topinard, 47, 115, 153. 
 
 Touvet-Fanton, 378. 
 
 Trelat, 294. 
 
 Trendlenburg, 175. 
 
 Tuke, D. H., 96. 
 
 Tyndall, J., 134. 
 
 Valenta, -22. 
 
 Valerian, 29. 
 
 Valude, 210. 
 
 Verduc, 2. 
 
 Virchow, 24, 148. 
 
 Virgilus, P., 29. 
 
 Vogt, C, 103, 247. 
 
 Volkmann, 70, 413. 414, 416, 417, 418. 
 
 Waite, G., 6. 
 
 Walker, W. E., 154. 
 
 Walther, 292. 
 
 Weber, M. J., 292. 
 
 Weismann. 23, 24, 25, 102. 
 
 Welcker, 17';, 247. 
 
 White, J. W., 5. 
 
 Whitney, J. M., 100, 173. 
 
 Williams, 378. 
 
 Wilson, G., 136. 
 
 Winckworth, J., 3. 
 
 Windle, 114. 
 
 Workman, 100. 
 
 Ziem, 193. 
 
 Zuckerkandl, 172, 173, 174, 185. 
 
INDEX OF SUBJECTS. 
 
 Aborigines, 155. 
 Acromegaly, 16. 
 Adenoids, 8, 10, 67, 79. 
 Admixture, 113. 
 Age, 
 
 Mouth and. 76, 78. 
 
 Pregnancy and, 22, 100. 
 
 Surgical Correction and, 435, 
 448. 
 
 Vault height and, 81. 
 Agn..thia, 235. 
 Altitude, 106, 107. 
 Alveolar Process, 15, 52, ^T, ^%, 90, 
 198, 273. 
 
 Articulation, 65. 
 
 Hypertrophy, 67. 
 
 In Idiots, 67. 
 
 Irregularities, 69. 
 
 Tropics, 106. 
 Annelid, 208. 
 Aniridia, 211. 
 Anomalies, 148. 
 
 Anthropoid A.pes, 30, 155, 208. 
 Antrum, 177, 185. 191, 194, 196, 198, 
 
 200, 202, 218. 
 Appliances, 427. 
 Arch, 74. 
 
 Dental, 83. 
 
 V-shaped, 297, 299, 301. 
 
 Widening, 74. 
 Areori, 100. 
 Aryan, 113, 115. 
 Ascidian, 208. 
 Atavism, 19, 21, -^Z- 
 Beloides, 86. 
 Bicuspids, 323. 
 
 Extraction of, 342. 
 Births, Multiple, 100. 
 Bleeders, 125. 
 Body Plasm, 24. 
 
 Bone Changes in Jaw, 406. 
 
 Brachycephaly, 45. 
 
 Brachygnathia, 235. 
 
 Brain Development, 38. 
 
 Canaliculi, 73. 
 
 Causes and Predispositions, 148. 
 
 Cephalic Index, 155. 
 
 Child not an Immature Adult, 30. 
 
 Promise Non-Fulfillment, 31. 
 Chondrocranium, 40, 93. 
 Climate, 102. 
 Colobomia, 211. 
 Congenital Factors, 27. 
 Concrescence, 94, 372. 
 Consanguinity, 
 
 Natural, 96. 
 
 Social, 96. 
 Constitutional Diseases, 120. 
 Contagions and Infections, 120. 
 Correction, Elastic Rubber, 439. 
 
 Metals in, 454. 
 
 Traction in. 439. 
 
 Surgical. 427, 431. 
 Corectopia, 211. 
 
 Cranio-Mandibular Index, 155. 
 Criminals, 134. 
 Crowns Flattened, zil- 
 Crown Teeth Changes, 59. 
 Cuspids, 323. 
 Cyclopia, 208, 210. 
 Deaf Mutes, 214. 
 
 Degeneracy, 19, 21, ZZ, 35, 37. 47, 
 121, 200. 
 
 Disease, 204, 206. 208. 
 
 Ear, 138, 141, 214. 
 
 Eye, 171, 208. 
 
 Hawaiian, 100. 
 
 Palate, 236, 238, 240. 
 
 Operations in, 203. 
 
 Stigmata, 198, 200, 202. 
 
 541 
 
542 
 
 INDEX OF SUBJECTS. 
 
 Dental Index, 94. 
 
 Ligament, 87. 
 
 Shelf, 93. 
 Dentistry, 
 
 Assyrian, i. 
 
 Chinese, i. 
 
 Egyptian, i. 
 
 Etruscan, 2. 
 
 Hindoo, i. 
 
 Hippocrates, i. 
 
 Shakespeare, 2. 
 Dentures, 224, 239. 
 Dermal Bones, 40. 
 Development, 
 
 Arrested, 20, 21. 
 
 Brain, 38. 
 
 Excessive, 20. 
 
 Face, 40. 
 
 Jaws, 48. 
 
 Mouth, 41. 
 
 Nose, 41. 
 
 Peridental Membrane, 87. 
 
 Tooth, 93. 
 
 Skull, 40. 
 
 Suppressive, 20. 
 
 Vault, 74. 
 Diet, Monotony of, 108. 
 Differentiation Theory, 374. 
 Diphyodontia, 93. 
 Disease and Jaw Arrest, 79. 
 Dogs' Gingivitis, 410. 
 Dolichocephaly, 55, 75, 155. 
 Dome, 74. 
 
 Duck Bill, Teeth of, 382. 
 Drug Habitues, 137. 
 Ductless Glands, 121. 
 Durencephaly, 127. 
 Edentates, 93. 
 Edentulousness, 378. 
 Ellipsoides, 86. 
 Enamel, 381. 
 
 Organs, 94. 
 Environment, 102. 
 
 Organs Change, 38. 
 Epilepsy, 109, 112, 121, 130, 133. 
 
 Alveolar Process, 67. 
 
 Teeth Eruption in, 68. 
 Eurygnathism, 46. 
 Eustachian Tube, 290. 
 Exanthemata, 14, 16. 
 Exogamy, 96. 
 Eye, 
 
 Degeneracy, 211. 
 
 Development, 208. 
 
 Lemurian, 208. 
 Face, 
 
 Developmental Neuroses, 153. 
 
 Origin of, 44. 
 
 Senile, 166. 
 
 Type of, 385- 
 Facial Angle, 47, 153, 154, 155. 
 Families, Large, 23. 
 Foetus, 
 
 Life of, 31. 
 
 Sensation in, 28. 
 Food and Jaw Changes, 54, 102. 
 Forces, 
 
 Correction in, 431. 
 
 Mechanical, 429, 443. 
 Function, Assimilation and, 35. 
 Genius, 130. 
 Germ Plasm, 24. 
 Gingivitis, Interstitial, 385, 431. 
 
 In Dogs, 410, 
 Gnathism, 46. 
 Gomphosis, 59. 
 Haemophilia, 125. 
 Halisteresis, 410. 
 Hare-lip, 292. 
 Haskell Jaw, 223. 
 Haversian Canals, 70. 
 Hawaii, 
 
 Degeneracy in, 172. 
 
 Race Admixture, 172. 
 Hawaiians, Degeneracy in, 100. 
 Heart Development, 38. 
 Hemiagnathia, 235. 
 Heredity, 
 
 Direct, 19, 23, 26. 
 
 Habit, 24. 
 
 Indirect, 19. 
 
 Jaw, 55, 84, 119. 
 
INDEX OF SUBJECTS. 
 
 543 
 
 Remote, 18. 
 
 Sex in, 18. 
 
 Telegenic, 19. 
 
 Tooth, 84. 119- 
 
 Transformed, 18, 21, 24, 98. 
 Hysterics, 130, 132. 
 Idiot, 
 
 Palate, 236. 
 
 Savants, 127. 
 
 Vault, 236. 
 Idiocy, Mouth-breathing and, 67. 
 Idiosyncrasy, Tension in, 92. 
 Imbeciles, Moral, 128, I43- 
 Impression Taking, 389. 
 In-and-In Breeding, 96. 
 Incest, 96. 
 Incisor, 323, 325. 
 "Indian" Change in the Yankee, 
 
 103. 
 Individuation, 22. 
 Inebriates, 137. 
 Intellectual Defects, 127. 
 Invertebrates, 208. 
 Iris Asymmetry, 211. 
 Irregularity Correction, 383, 385, 
 
 387. 
 Time of, 385. 387- 
 Jaw, 
 
 Age and, 76. 
 Arrest of, 38, 99, 170. 
 Asymmetry, 219, 224, 226. 
 Bone Changes in, 406. 
 Close Fitting, 80. 
 Contour, 220. 
 Deformity, 235. 
 Degeneracy, 216. 
 Diameter of, 47, 49, 5i- 
 Disuse, 53, 151. * 
 
 Dogs in, 151. 
 Evolution of, 155, 367. 
 Excessive Bone Growth, 216. 
 Foods and, 54, 117. 216. 
 Haskell, 223. 
 Hypertrophy, 217. 
 In Normal People, 215. 
 
 Irregular Growth, 7, 9, 11, 14. 
 
 383, 385. 
 
 Lower, 219, 222, 231. 
 " Absorption, 433, 435- 
 
 Muscles and, 218. 
 
 Narrow, 83. 
 
 Neuroses of, 215. 
 
 Orthognathous, 153. 
 
 Prognathous, 153. 
 
 Protrusion of, 231. 
 
 Recession of, 155. 
 
 Small Tooth Great, il. 
 
 Teeth and, 222. 
 
 Tobacco Chewing and, 216. 
 
 Upper, 182, 219, 222, 297. 
 Kahunas, 100. 
 Kava-Kava, 100. 
 Lacimae, 72. 
 Mammals, 
 
 Oviparous, 93. 
 
 Teeth of, 93. 
 Marriage, 
 
 Early, 96. 
 
 Late, 96. 
 
 Near-kin, 96. 
 Mastication Motion, 224. 
 Maternal Impressions, 26. 
 Maxillaries, 41. 
 Megadontia, 94. 
 Mesodontia, 94. 
 Metals in Correction, 454. 
 Microdontia, 94. 
 Microphthalmus, 211. 
 Models, Wire in, 391, 393- 
 Modeling Compound, 389, 391, 393- 
 Molar Teeth, 52, 370. 
 
 Extraction of, 340, 342. 
 
 First Permanent, 323, 335, 337. 
 
 339- 
 Temporary, 323. 
 Mouth, 
 
 Age and, 76, 78. 
 
 Breathing, 8, 67, 79, 182, 196, 
 
 249, 251, 253. 
 Origin of, 41. 
 
544 
 
 INDEX OF SUBJECTS. 
 
 Roof of, 74. 
 
 Vault of, 74. 
 Moral Insanity, 120. 
 Multiple Births, 22. 
 Myolonia, 208. 
 Nares External, 290. 
 Negroes, 
 
 Facial Angle, 153. 
 
 Jaws, 155. 
 
 Mesocephaly, 155. 
 
 Prognathism, 155. 
 Neuroses, 172. 
 
 Cavity, 180, 192. 
 
 Degeneracy, 191. 
 
 Fracture at Birth, 193. 
 
 Puberty and, 172. 
 
 Septum, 172, 193. 
 
 " Deformity, 175, 177. 
 " Fracture, 176. 
 Length, 178. 
 Neurotics, 130, 132. 
 Neuroticism, 157. 
 Nose, 
 
 Embryology, 290. 
 
 Degeneracy, 139. 
 
 Development, 172, 191. 
 
 Origin of, 41, 43. 
 Notochord, 41. 
 Nymphomania, 143. 
 Occlusion, 389, 391, 39'. 
 Odontogogues, i. 
 Organs, Struggle Between, 20, 33, 
 
 34- 
 Orbits, 
 
 Anthropoid Ape, 171. 
 
 Arrest of, 171. 
 
 Lemurian, 171. 
 Orthognathism, 46. 
 Osteomalacia, 418. 
 Ovoides, 86. 
 Palate, 
 
 Cleft, 292, 294, 296. 
 
 Contracted Vaults and. 292. 
 
 Degeneracy, 236, 238, 240. 
 
 Developmental Neuroses, 290. 
 
 Embryology, 291. 
 
 Hard, 74. 
 
 Horizontal Plates, 74. 
 
 Incisive Plates, 74. 
 
 Idiot, 236. 
 
 Irregularity, 4, 6. 14, 16. • 
 
 Lower Jaw and, 290. 
 
 Olfactory Nerve and, 292. 
 
 Plates, 74. 
 
 Soft, .75. 
 
 Shelves, 250. 
 
 Temperament, 241, 243. 
 Paranoia, 128, 144. 
 Parents, 
 
 Immature, 100. 
 
 Senile, loi. 
 Paris, Plaster of, 389. 
 Pathology or Nosology, 148. 
 Pathologic Changes, 405. 
 Paupers, 136. 
 Pellagra, 108. 
 Pentagoides, 86. 
 
 Peridental Membrane. 60, 87, 91. 
 Periods of Stress, 23, 37, 38, 66, TJ, 
 
 149. 
 Pessimism, 129. 
 
 Philippines, Americans in, 106. 
 Physiologic Changes, 405. 
 Pineal Body, 209. 
 Poisoning, 
 
 Brass, iii. 
 
 Carbon, Bisulphide, in. 
 
 Lead, iii. 
 
 Mercury, iii. 
 
 Phosphorus, in. 
 Polyphyodontia, 93. 
 
 In Man, 379. 
 Pregnancy, 
 
 Age and, 22, 100. 
 
 Brass Poisoning and. 111. 
 
 Diet and Offspring, no. 
 
 Infection and, 120. 
 
 Lead Poisoning and, ni. 
 
 Multiple, 100. 
 
 Opium Habitues, no. 
 
 Phosphorus and, in. 
 
 Plural, 22. 
 
INDEX OF SUBJECTS. 
 
 545 
 
 Tobacco Workers, no. 
 
 Too Frequent, lOO. 
 
 Strain During, 149. 
 Primitive Races, Teeth of, 14. 
 Prognathism, 46. 
 Prostitutes, 137. 
 Race, 
 
 Admixture, 14, lor. 
 
 Climate and, 102. 
 
 Egyptian, 115. 
 
 English Speaking, 103, 105, 115. 
 
 Hebrew, 115. 
 
 Indian, 115. 
 
 Scandinavian. 116. 
 
 Scotch-Irish, 112. 
 
 Teeth and, 94. 
 
 Tropic, 105. 
 
 Types, 113. 
 
 Vault and, 246. 248. 
 Rachitis, 216. 
 Reasoning Maniacs, 146. 
 Regulation, 
 
 Fees from, 386, 388, 402. 
 
 Time of, 383, 385, 387. 
 Rickets, 121. 
 
 Rubber in Correction, 439. 
 Salernum, School of, 2. 
 School Strain, 386. 388. 
 Scrofula, 217. 
 Scurvy, 212. 
 Senescence, 29, 31, ;i^. 
 Senile Intra-Uterine Period, 123, 
 
 125- 
 
 Tendency, 31. 
 Senility, Premature, 166. 
 Sexual Perverts, 143. 
 
 Strain, 386. 
 Shakespeare on Dentistry. 2. 
 Shearing Teeth, 3. 
 Skiagraph, Use of. 399. 
 Skull, 
 
 Dryness, 173. 
 
 Evolution of, 40. 
 
 Kant, 41. 
 
 Median, 74. 
 
 36 
 
 Roman, 2. 
 Types, 45. 
 
 Degenerate, 138. 
 Sergi's, 55. 
 Vault and, 246, 248. 
 Soil, 102. 
 
 Stress, Periods of, 23. 37. 
 Stigmata, Frequency of, 170. 
 Struggle Between Organs, 20, 2^, 34. 
 Supernumerary Teeth, 3. 
 Suppressive Economy, 382. 
 Surgical Diagnosis, 383. 
 Suture, Frontal. 41, 74. 
 Syphilis, 122, 216. 
 Teeth, 
 
 Altitude and, 107. 
 
 Antagonism, 64. 
 
 Bicuspid, 58. 
 
 Calcification, 56. 
 
 Canine, 57. 
 
 Civilization and, 151. 
 
 Choice in Removal, 396, 398. 
 
 Cone-shaped, 369. 
 
 Contagions and, 122. 
 
 Constitutional Disease and, 272. 
 
 Correction Forces Needed, 431. 
 
 Crown Changes, 59. 
 
 Cuspid, 58. 
 
 Decay of, 54. 
 
 Deciduous, 385. 
 
 Deformed, 371. 
 
 Degenerate, 140, 362, 364, 366, 
 368. 370, 372. 
 
 Development. 93. 
 
 Domestication and, 151. 
 
 Drilling, 432. 
 
 Embryology of, 362. 
 
 Eruption, 464, 
 
 Epilepsy in, 63. 
 
 Extraction, 5, 7, 9, 78. 150. 
 
 Finger Sucking and, 358, 360. 
 
 Food and, 150. 
 
 Four Sets of, 380. 
 
 Hairless Dogs, 378. 
 
 Hairiness and, 378. 
 
 Heredity, 119. 
 
546 
 
 INDEX OF SUBJECTS. 
 
 Horny, 382. 
 
 Hutchinson's, 123. 371. 
 
 Incisor, 57. 
 
 In Dogs, 151- 
 
 Irregularities, 67, 69. 383, 385- 
 
 Lower Jaw and. 223. 
 
 " Irregularities. 344. 346, 
 348, 350, 352, 356. 
 Mammalian, 93. 
 Measurements of, 49, 51. 
 Molar, 52. 
 Permanent, 4, 7, 9, 57. 61. 150. 
 
 323- 
 Pits in. 123. 
 Position Change. 66. 
 
 " Neuroses, 297, 299, 301. 
 Primitive Race, 14. 
 Protrusion and, 227. 
 Race and. 94. 151. 
 Reptilian, 93. 
 
 Sacrifice of, 392, 394, 396, 398- 
 Senility in, 380. 
 Shearing 3. 
 Stomach and, 58. 
 Supernumerary. 3. 5. 7. 366. 379. 
 
 381. 
 Temperature, 102. 
 Temporary. 4, 6, 8, 57, 60. 150, 
 
 323- 
 Third Molars, 52. 
 Thumb-Sucking, 3. 57. 227, 236. 
 Tobacco and Offspring, 110. 
 Tonsils Enlarged, 5. 7, 8, 10. 
 Traction in Correction. 439. 
 Tramps, 137. 
 Triophthalmia, 208. 
 Trophic Change, 16. 
 
 Tropho-neuroses. 372. 
 
 Tropics and, 106. 
 
 Turbinated Bones. 172. 177, 186, 
 190, 192. 196. 
 
 Upper Jaw Irregularity, 323. 
 325, Z'^l, 329, 331, 333, 335. 
 ZZ7, 339- 
 
 Vault and, 279. 
 
 Whales in, 93. 
 
 Worm in, i. 
 Telegony, 19. 
 Temperaments, 241. 243. 
 Trapezoides, 86. 
 Uvula, 76, 291, 296. 
 
 Degenerac}'. 296. 
 
 In Thieves, 296. 
 Vault, 
 
 Contracted, 85. 
 
 Degenerate, 85. 
 
 Development, 74. 
 
 Height. 80. 82. 84, 
 
 Low, 85. 
 
 Mouth-breathing and, 249, 251, 
 
 253- 
 
 Neuroses, 236. 
 
 Neurotic, 84. 
 
 Race and, 246, 248. 
 
 Septum and, 177. 
 
 Skull and. 246, 248. 
 Vegetarians, Degeneracy in. 108. 
 Volkmann's Canals. 70. 
 Vomer. 74, 174, 178. 181, 184. 188, 
 
 190, 192, 194, 240, 279, 292. 
 Von Ebner's Vessels, 70. 
 Weismannism, 23, 102, 149. 
 Wurtemburgers Georgian, 102. 
 
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