During the last half year she had occasionally suffered from toothache on the right side of the lower jaw. In a few months it became more severe and ceased to be limited to the carious teeth, an extended through the whole jaw, over the cheek, and even to the temporal region and the neck. At the same time considerable febrile disturbance, with occasional rigors, supervened, accompanied by swelling of gums and cheek, with erysipelatous redness of the latter. On admittance, the examination showed the right cheek much swollen, and very tense towards the eye, the mouth, the chin, and neck; the tenderness most considerable in the vicinity of the lower jaw. Pain deep seated, throbbing, piercing, concentrated at the angle of the jaw, and radiating thence over the adjacent soft parts. Extreme tenderness on pressure. The gums of the diseased side of the jaw much swollen, tense, darkened, and tender; the mucous membrane of the cheek equally so; between the angle of the jaw and first molar, fetid pus of a phlegmonous character oozed out on pressure. The first and fourth molars on the right side of the lower jaw were carious, the other molars deficient. The swelling of the gums increased, became more tense, extended to the soft palate; dysphagia and salivation supervened, and the jaw became almost immovable. Suppuration increased, pus laudable, but fetid. During the second week, the four incisors and one molar became loosened, suppuration ichorous and rusty, gums softened and livid, formation of sinuses on the external and internal surface, through which the probe reached the bone, which appeared in part rough in part smooth. In the progress of the disease, increased retraction of gums from the alveolar surface, fresh abscesses, increased discoloration, and burrowing sinuses, so that the entire jaw was exposed to the probe, both externally and internally. The bone appeared almost entirely detached from the soft parts, floating in an excessively sanious fluid. The disease appeared to commence by a swelling in that part of the jaw whence a tooth had been extracted two years before; the swelling continued to extend until the entire bone became affected. He said that he had suffered great pain through the entire jaw, and that his nights had been sleepless. He looked very ill, was much emaciated, and he presented a curious appearance of the mouth, which was pursed up into a round aperture in consequence of the protrusion forward of the enlarged jaw. There were two fistulous openings, one on each side of the upper part of the neck; and a probe introduced struck the angle of the jaw, which was quite dead. I examined the mouth and found the jaw quite dead. I could distinguish every part of the bone except the condyles, which were imbedded in soft tissue. There was a large quantity of fetid discharge around the bone, but the principal part came from the vicinity of the condyles. The outside of the cheeks about the masseteric regions was much thickened. The teeth were all gone, and the appearance of the jaw was that from an edentulated cranium. Toothache in the left lower jaw, formation of an ulcer on the side of the middle back tooth with violent pains; as the ulcer opened a piece of bone was discharged; at last the cheek became swollen and erysipelatous and abscesses formed, which discharged much matter; the necrosis of the bone progressed until the whole half of the lower jaw had to be removed. A carious molar of the right side of the lower jaw was extracted; from this time (seven months since) the peculiar Phosphorus necrosis may be said to have fairly begun, and it progressed rapidly, for the subject of it was compelled to give up the charge of his department about a fortnight after the tooth was drawn. The face was very much deformed by indurated swelling, which was particularly conspicuous on the right side and about the chin; three fistulous openings, surrounded by flabby granulations, were upon the right side of the neck; from these fetid pus exuded freely; a horribly offensive odor came from the mouth, and saliva and pus were constantly dribbling out; the gums were spongy on the margin, but partook of the general induration at the sides; four sound but loose teeth occupied the right alveolar cavities; the upper jaw seemed healthy; the patient could not part the two jaws sufficiently to introduce a finger with facility; a probe detected necrosed bone both on examination in the mouth and through the sinuses; the examination gave excessive pain; a portion of the left lower jaw only seemed clear of the disease; the symphysis was completely involved. The disease seems first to attack the gum of diseased teeth; it usually makes its appearance in year or a year and a half after beginning work in the factory; it is still questionable whether the disease is due to Phosphorus, Phosphoric acid, or to the ozone generated by the Phosphorus, or even whether it may not be due to general chronic Phosphorus poisoning. The lower jaw was affected in nine cases out of ten, the upper jaw in one case; the disease very seldom spread from the upper to the bones of the face. The first symptom was tensive pain in the teeth, then looseness of the teeth and discharge of matter between the gum and teeth; if now the teeth be drawn the swelling and pain increase and involve the whole half of the jaw; usually the disease progresses slowly and irregularly, with transient periods of improvement; the soft parts covering the jaws, cheeks, sides of the mouth, become swollen and intolerably painful; one tooth after another becomes loose, and every pressure upon the gum causes discharge of pus; the pus often is discharged through the cheek externally. The skin of the margin of the lower jaw becomes red, soft, looseness and at last infiltrated; from this infiltration there follows a discharge of matter that seems to come from the alveolar process; wherever the opening is probed denuded bone is found; at same time it is found that the periosteum that has been loosened from the bone has a new deposit of bone on its inner surface, so that the sound passes between two surfaces of bone, one consisting of old bone, the other of new growth; the denuded bone decays in various directions and is gradually discharged with the matter.
After two or three years these necrosed pieces of bone separate from the whole extent of the jaw. With this the patient suffers from fever, at times violent, considerable emaciation; nutrition is very much disturbed on account of the difficulty of swallowing, and the digestion suffers on account of the mixture of offensive matter with the food; sleep at night is possible only by means of increasing doses of Morphia, and the patient gradually sinks with hectic and exhaustion. During the prostration tuberculosis frequently develops; at times also lobular pneumonia, terminating in gangrene of the lung and pyohaemia. The Phosphorus disease of the jaw consists in the first stage of an inflammatory swelling of the gum and soft parts of the mouth, extending over the face and neck, associated with the development of masses of osteophyte of varying extent and thickness about the jaw; in the second stage the teeth become black, the gum recedes, the osteophyte suppurate, and the jaw becomes denuded, rough, and blackish or grayish-green, and the teeth fall out; this stage is associated with the most violent pain in the face and head, disturbance of digestion, sleeplessness, fever, salivation, fistulous burrowing of the matter in the muscles and integuments of the face, which became erysipelatous, followed by exfoliation of the bone, and sometimes by extension of the necrosis to all the bones of the skull, and death with hectic fever. Necrosis of the jaw; the disease begins as toothache, involving one or more teeth in the upper or lower jaw; the disease spreads to the jawbone, which increases in volume and becomes painful to pressure; afterwards the soft parts become swollen, especially the gums and cheeks, in the latter erysipelatous inflammation develops, even extending over the whole side of the face and down on to the neck; the patients have fever, yellow color of the skin, especially of the face, loss of appetite, thirst irregular stools; the pain at last extends to the ear and temple, with increased secretion of saliva. Various teeth become loose, and between them there is a discharge of offensive matter, that collects in various parts of the jaw under the gum or under the skin externally, and gradually makes its way into the mouth or through the skin, usually by a number of circuitous channels. The teeth fall out, the jaw becomes denuded, and the necrosis either becomes circumscribed or involves the whole jaw. Diseases of the gums and maxillary bones, terminating in necrosis and sometimes in death, were not uncommon; the complaints only appeared after a sojourn in the factory for at least two years, and in individuals habitually exposed to the fumes; all the workmen whom he had observed had decayed teeth before the disease commenced, not unfrequently before commencing the manufacture; many other workmen with sound teeth have preserved them in the midst of phosphoric vapors, a fact which induces him to believe that carious teeth constitute a predisposing cause of the disease. The disorder at first resembled ordinary toothache, attended, however, with swelling of the face; as the severity of the symptoms increased she became a patient at the Royal Infirmary, but derived little benefit from the treatment; six months later all the teeth on the right of the lower jaw fell out, or were removed without difficulty, before the jaw was removed, and on the left side as far as the second bicuspid, all the teeth were sound. There is a great deal of new callus thrown out in the situation of the old bone, so much so that there will be scarcely any disfigurement from the loss of the jaw, a little from the loss of the teeth; she can close her jaw and chew her meat and bread well; the bone and teeth of the upper jaw are in a perfectly healthy state, and she now enjoys excellent health. Scrofulous subjects are most affected, and in them the disease is most fatal; almost all the girls employed have the gums more or less affected, and at their junction with the teeth a red ulcerated line, like that produced by mercurial salivation, is apparent. When the individual is robust and the necrosis is confined to a small portion of the bone, exfoliation takes place and a gradual cure follows, but where there exists any tendency to scrofula, phthisis becomes developed, and the patient sinks under the combination. Sharp pain and difficulty when masticating, in the middle of the left jaw (first day).
Born in 1837in Westminster, Vermont. . He was an orthodox doctor who converted to homeopathy
Dr. Allen compiled the Encyclopedia of Pure Materia Medica over the course of 10 years.
In 1881 Allen published A Critical Revision of the Encyclopedia of Pure Materia Medica.