TYPE SEEN IN AMERICA.

37

was little above zero-there were teeth which, for size, regularity, density, and perfection of form, would answer as models. There were also teeth which were faulty in every respect and relation; but on the whole we had to admit they were about an average lot, neither better nor worse than those of the same number of similarly neglected people of ordinary intelligence."

Professor Stellwagen, of the Philadelphia Dental College, visited the same institution, and says: "I examined the mouths of ninety-seven males and eighty-seven females, making in all one hundred and eighty-four patients. Among these there was a very small percentage that, had they been presented to me in my office, would have warranted interference in any manner as regards the regularity of the teeth.... The jaws were unusually large as compared with the same number of jaws in the mouths of intelligent children-such as would seek the services of the dentist."

Professor C. N. Pierce, of the Pennsylvania Dental College, says: "While traveling through the Tyrol of Southern Austria, and Lombardy, Italy, I had the opportunity of seeing a large number of cretins-disgusting, jabbering idiots as they were, unable to articulate a word distinctly. By the aid of a few small coins I obtained a hasty glance at the oral cavity, which, though not critical or satisfactory, was sufficient to satisfy me of an unusually large development of both superior and inferior maxillæ, with an abundance of room for the teeth. Opportunities have also not unfrequently offered for viewing the mouths of negroes, where mental growth was far below the average, with a decidedly retreating forehead; in such the jaws were invariably large, the teeth far from crowded, and quite projecting. In my regular practice, cases have not unfrequently occurred where one or two in a family would have what might be termed straggling teeth, or teeth standing alone with an unusually wide space between them; while with other members the reverse condition would predominate. In the former the

38

IRREGULARITIES IN DIAGNOSIS OF IDIOCY.

mental condition was always far below the latter, being a marked reversion to a lower order of development."

In these apparent contradictions between Dr. Down and other observers, it is difficult to form an opinion which will reconcile the differences; and it might be just as well to leave it as it is, were it not for the startling conclusion to which Dr. Down comes and its bearing upon the welfare of the community. In his essay he says: "It was in my inquiry into the condition of the teeth and mouth especially, that I arrived at the conclusion that, in by far the larger number of instances, I was able to indicate the period at which the depressed condition commenced, and to predict in some degree the amount of improvement which physical, intellectual, and moral training might possibly effect. In children where idiocy is accidental, arising from causes operating after uterine life, there is but slight deviation from a normal condition in the state of the mouth and teeth; while it is in those whose malady is congenital, especially where arising from causes operating at a very early period of embryonic life, that the deviation of the mouth and its appendages from a normal condition is most pronounced."

The bearing of this opinion may not seem at first of much consequence, but it becomes of the utmost importance when applied, as it has been by Dr. Down, in determining the mental capacity of an heir to manage his estates. In such a case the contracted condition of the mouth was the deciding point of evidence, in the opinion of Dr. Down, that the patient was a congenital idiot.

We do not believe that any irregularity in the position of the dental organs is any evidence per se of idiocy in the individual. The cases are so common where such deformities are found associated with the highest order of intelligence that, if we are to draw any inference from that condition in the abstract, we should say that it was more likely to indicate a precocity of mental development, with a

POSSIBLE CORRELATION OF IRREGULARITIES TO IDIOCY. 39

stimulated emotional nature in the child, and possibly a more brilliant intellect in the adult. There are so many cases where the proof is incontestable that the idiocy is of congenital origin and where the dental development is perfect, that we can also reasonably say that the regularity of the dental organs showed conclusively that there had been no lesion or cerebral disturbance (in the true sense) after birth, but that the teeth grew in accordance with physiological laws under a low order of intellect.

We do not see any connection between these phenomena and causes acting especially "at a very early period of embryonic life," when we consider that the deciduous teeth are well arranged, and that it is only after they pass away that abnormality appears; also, as it is only at the very latest period of embryonic life that even the germs of the permanent teeth are found, it is difficult to conceive the connection or correlation. If the cause antedates the birth of the child, we should seek for its origin not during intra-uterine life, but in a like deformity existing in the parents or ancestry, which may appear exaggerated in the child under favoring circumstances. An inherited taint, disturbance, lesion, predisposition, or tendency to idiocy (of which these irregularities may be a symptom, but not a proof) may show itself in a precocious mental development in one instance, and be the precursor of insanity in the same individual, or appear as idiocy in posterity.

CHAPTER III.

DIAGNOSIS.

MUCH of the success in treating irregularities will depend upon a correct diagnosis and prognosis.

This is one of the most difficult problems in the practice of dentistry, and its proper performance must take into consideration the efficiency of the masticating apparatus, the enunciation of the voice, the organism of the teeth, the ravages of decay, the family type, and the relation of the features; the constitution, temperament, and systemic condition of the patient; the sex, age, and social status; the causes of displacement, whether accidental, congenital, or hereditary; the means and appliances for correction; the time, trouble, and skill required of the operator, and the time, annoyance, and endurance of the patient; the risk of inflammation and of destruction of pulps; and, finally, the character and permanency of the change wrought.

It is not a question of the ability to bring one or more teeth into the line of a regular dental arch, so much as it is, Will the result, when obtained, be permanent and justify the means used? For example, a bicuspid or a canine in a person of mature years may be turned upon its axis to the extent of a quarter of a circle; the mechanical difficulty in returning it to its place being in some instances very serious, involving much time, ingenious appliances, and often the perforation of the enamel for a pin to obtain an attachment, and the result being no probable gain to its masticating

PERFECT UNIFORMITY UNNATURAL.

41

power nor its preservation, and so little benefit to the appearance as to be of doubtful expediency.

Cases are constantly coming before our observation where most remarkable achievements are within the scope of scientific skill, but where a conservative view would not justify the means required to produce such a result. Neither can it be asserted incontrovertibly that all irregularities in the position of teeth are deformities, and require our interposition. A fine æsthetic taste may maintain that there are multitudinous departures from a normal type where neither the utility nor the beauty of these organs, nor the symmetry of surrounding features, is seriously affected by the malposition.

Nowhere in developmental nature will we find mathematical uniformity in size, shape, or position. The trees of the forest take every conceivable form within the limits of their type. No two leaves are precisely alike. The two sides, even, of every leaf differ in outline. Every human figure differs from every other human figure; face from face —even the two sides of the same face are not mechanically mated. Variation from mathematical precision in nature is universal, and any appearance of absolute regularity always suggests the interference of man.

The eye soon tires of the stiffness and formality of unbroken uniformity, and is only permanently pleased with the beauty which comes from graceful variation. If it were possible to bring all dental arches to one standard of arrangement, deformities of facial expression would probably be more common than now. An apt illustration of such a result is found in the limited variety in form of the artificial teeth in the market, and the still more limited skill in arranging and adapting them for service; consequently, there are seen all over the country prevailing patterns of teeth made in rows, devoid of grace, and inserted indiscriminately in the mouths of the beautiful and the mouths of the ugly.