CHAPTER II.

Dentitio.

THERE is no process which requires greater attention than that of dentition, as, when disregarded, it often lays the foundation for diseases in their nature the most formidable. Among these, hydrocephalus internus, convulsions, and tabes mesenterica, hold the first rank; symptomatic fever, a deranged state of the stomach and bowels, eruptions upon the head, face, and neck, and sometimes over the whole body, are next in order.

As soon as swelling of the gums, an undue degree of heat in the mouth, and attendant symptoms of irritation arise, we ought to employ every means we possess to expedite and facilitate the progress of the teeth; this is more particularly necessary when there is reason to suspect the existence of a scrophulous diathesis in the infant. When treating of hydrocephalus internus, I observed" that I had uniformly seen the disease in scrophulous subjects." It arises from no source of irritation more frequently than from painful and protracted dentition.

Upon a free division of the gums we must chiefly rely for the prevention or removal of the diseases to which the process renders children liable. In less than two hours after the operation, I have frequently seen the most violent symptoms diminished, hydrocephalus internus arrested in its progress, convulsions cease, symptomatic fever subside, and, in a few days, cutaneous eruptions disappear.

Even were there nothing to apprehend from allowing the process to be completed by natural means, we should be justified in lancing the gums, for we thereby spare the little sufferers many painful, restless moments. The pain which the instrument inflicts in dividing the gums, is trifling when compared with that occasioned by con

stant pressure and distention from a tooth. A gentleman declared to me that one of the most pleasurable sensations he ever experienced, was that which immediately succeeded the division of the gum distended by a dens sapientiæ.

In performing the operation, care should be taken that the edge of the instrument comes in contact with the teeth or but little benefit will be derived.

I have heard the operation objected to, upon the ground that when the teeth are deeply seated, a hard cicatrix will be formed over them, which will be absorbed with more difficulty than the original gum; the reverse however happens.

It is now I believe almost universally admitted, that the absorbents act with much greater facility upon parts which have been deposited for the purpose of repairing a breach of continuity, than they do upon parts originally formed.* It is upon this principle that the operation is recommended.

CHAPTER III.

Odontalgia.

THE toothach is sometimes permanently relieved by the application of the fumes of henbane seed. The smoke may be directed to the affected tooth by being drawn through a tobacco pipe; this method however will upon some persons produce extreme nausea. The following process will be found more eligible and equally efficacious.

Put from one to two drachms of the seed upon a red hot iron or some lighted cinders and immediately cover them over with a bason. As soon as you suppose the

* A similar opinion is expressed by Mr. Fox, in his excellent Treatise on Dis eases of the Teeth.-See second edition, pages 86 and 87.

seed to be consumed and the vessel impregnated with the fumes; place it upon its bottom and fill it with boiling water. The person affected with the toothach is then to inhale the vapour for twenty minutes or half an hour, a blanket or some other covering being previously thrown over the head and shoulders to prevent its escape. It will be advisable to go to bed immediately afterwards, as it often induces profuse perspiration.

Should this seed fail of producing its desired effect, if the tooth be much decayed, its extraction ought to be recommended; if however it has only a small foramen in it, its removal will not be advisable. By simply applying the odontagra to it with some degree of force, a force sufficient to effect a partial destruction of its natural adhesions, but not violent enough to remove it from its alveolar processes, the tooth may be sometimes preserved without ever again proving painful. When the pain induced by the operation has subsided, the hollow should be filled up by the Dentist.

French bole finely levigated, forms the best dentrifice. It may be deprived of its disagreeable earthy taste by having a small quantity of the essential oil of cinnamon added to it. It may be prevented from dashing surrounding objects and its powers as a dentrifice increased by previously rubbing the brush dipped in warm water upon a square of Windsor soap. Whether in the summer or winter season the teeth should always be washed with luke-warm water.

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CHAPTER IV.

Cynanche.

Pyrexia aliquando typhodes; rubor et dolor faucium; deglutitio et spiratio difficiles, cum angustiae in faucibus sensu.-Cl. i. O. ii. G. x. CULLENI.

CYNANCHE from whatever cause proceeding is more frequently aggravated than relieved by gargles. The force which the neighbouring muscles are obliged to exert to perform the process, often occasions great pain and sometimes increases the inflammation. The inhalation of the steam of hot vinegar or the gradual deglutition of small quantities of honey acidulated with muriatic acid will be found more effectual in allaying irritation or in giving tone to whatever parts may be in a state of relaxation.

When suppuration has commenced in the tonsils the steam of vinegar will be peculiarly serviceable by accelerating its progress. As soon as it is evident that pus is formed, if the tonsils are much enlarged and deglutition or respiration thereby impeded, we must not wait for their bursting spontaneously, but pass a lancet into them, bearing in our recollection however the im portance of the parts* in their vicinity.

In syphilitic sore throats fumigations with cinnabar will be found highly useful, particularly when the disease is extending itself with great rapidity. If the superior part of the soft palate be affected, advantage will sometimes be derived from drawing a weak solution of muriate of mercury through the nostrils into the throat. In this way the lotion will be applied to the diseased parts with a greater degree of certainty.

*The internal carotid arteries pass very near the tonsils.

CHAPTER V.

Pharyngis Ulceratio.

CASE IX.

MARGARET SEMAY, aged 30 years, was admitted on the 14th of December, 1814, with the usual symptoms of Pneumonia. For their relief she was bled, antimonial medicines prescribed, and a strict antiphlogistic regimen enjoined.

Under this treatment, persisted in for fourteen days, she appeared to be nearly recovered; when she began to complain of a disagreeable sensation about the throat, attended with a disposition to cough, and a frequent discharge of frothy mucus. These symptoms gradually became more urgent and distressing; a disagreeable hoarseness succeeded, which sometimes was so great as to prevent what she said from being understood; at other times she could only whisper faintly and indistinctly.

Difficulty in deglutition and respiration was next experienced; deglutition occasioned much pain; the inhalation and expulsion of the air, produced a peculiar and disagreeable sound. A sound somewhat similar may be feigned by drawing air quickly and forcibly down the trachea, at the same time contracting the glottis, and making an effort to form the guttural sound ur-r-rh-r. Instead of this noise, occasionally an unpleasant whistling prevailed.

These symptoms evidently pointed out a diminution, from some cause, in the capacity of the glottis or trachea; while the incessant cough, copious expectoration of frothy mucus, and pain felt upon handling or pressing upon the sides of the thyroid cartilage, seemed to indicate that ulceration existed upon some portion of the membrane lining the larynx.

Upon inspection of the posterior parts of the fauces