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toms attending the first dentition in man, and one which can be better supported by analogy than that attributing the disorders accompanying the appearance of the teeth to the mere piercing of the tissue enclosing them. This step in the process takes place in all animals, and they do not seem to suffer by it; and in the eruption of the permanent teeth in man, such difficulty is seldom if ever heard of. But while there would appear to exist in both these examples the same likelihood of disturbance from cutting the gum as there is during the first dentition, in neither of them have we the state of matters existing previous to and during this process to account for such symptoms, were they even to occur, since it is during the development of the first set of teeth alone that we have them arranged side by side in a regular linear series, and forming an arc so large, as with difficulty to be accommodated within the alveolar space, in coritradistinction-1st, to the permanent set, where we find them scattered up and down, wherever there is room in the maxillæ for their accommodation, and which have as many years allowed for their eruption as there are months to the first set; and 2d, in contradistinction to what is found in the lower animals, where there is more than sufficient lateral space in the maxillæ for the number of teeth with which they are destined to be furnished.
Although the treatment of such cases might not be very different, whether based upon the principles we have advanced, or upon those we have objected to, still its mode of action would be viewed in a very different light in either case ; for, in the familiar instance of cutting the gums of children at this period, allowing our theory to be correct, even if that operation did assist in opening a passage for a tooth through the gum, it would not necessarily afford the expected relief unless the tooth immediately made its way through the opening thus provided for it. When the gum, from induration or other causes, evidently opposes the egress of a tooth after it has completely passed the alveolus, an incision, dividing the bridle constituting such an obstacle, will be followed by the immediate appearance of the tooth, and the relief of those symptoms which may have at that particular period manifested themselves. Such cases occasionally present themselves, and are amenable to such a method of treatment; but, as is frequently done, an incision made in the gums, with the view of facilitating the cutting of a tooth which has not yet risen from the alveolus, cannot be expected to fulfil its purpose.
Cases are recorded where the gums have been again and again cut with this view, and the operation, although perhaps beneficial in other respects, yet unsuccessful for weeks in the anticipated result of the tooth's appearance. In reference to this matter, Mr Hunter states, at p. 121 of his treatise, “ As far as my experience has taught me, to cut the gum down to the teeth, appears the only method of cure. It acts, either by taking off the tension upon the gum arising NEW SERIES.—NO. YI. JUNE 1855.
from the growth of the tooth, or by preventing the ulceration which must otherwise take place.
“ It often happens, particularly when the operation is performed early in the disease, that the gum will re-unite over the tooth; in this case the same symptoms will be produced, and they must be relieved by the same method.
“I have performed the operation above ten times upon the same teeth where the disease had recurred so often, and every time with the absolute removal of the symptoms.” Here then, it is evident, that the scarification did not act by assisting the tooth in its efforts to make a way through the gum-nor by relieving the gum from the pressure of the tooth-as in either way the tooth would have been so far advanced before it could produce such symptoms, as to appear through the gums immediately upon their being cut; but the true rationale of the advantage derived from this practice, lay in the scarification acting as a local depletive, or as a means of counter irritation, and as such it would still be indicated for the alleviation of these symptoms, until they were removed by the exit of some of the teeth, or an increase in the size of the jaw. On such principles it would be equally efficacious in relieving the vessels, to make an incision, not upon the alveolar ridge, but somewhat laterally; and in doing so, there would be less risk of injuring the sacs of the advancing teeth—an occurrence which, although considered by some as of little importance, cannot but exercise an injurious influence. And only in those cases where either the local appearances positively indicate incisions in that particular situation, or where the tooth is elevating and stretching the mucous membrane, would it at all be preferable to cut down upon the crown of the enclosed tooth. At all events, whatever benefits might result from any method of treatment, they cannot be justifiably attributed to the fact of its having rendered the penetration of the gums or alveoli more easy for the tooth to effect, but merely as affording relief, in the meantime, to irritation temporarily present, and in expectation of an extra amount of space being shortly gained within the jaw by the evolution of some of the teeth in their natural order, and the accompanying increase of the maxillæ in size.
ARTICLE V.- Case of Fatal Injury to the Orbit with a Walking
stick. By PATRICK JAMIESON, Surgeon, Peterhead.
I was called, in great haste, on the morning of Tuesday, February 13, 1855, at half-past ten o'clock, to see James Grant, a tinsmith, who had met with a severe accident. I found him sitting in a chair, his head reclining on the shoulder of a bystander. He was very pale, faint, and exhausted ; had been retching; right eyelids much swollen, tense, protruding, and discoloured, but without any abrasion of cuticle, or other external mark of injury, with the exception of a
semilunar incised wound, parallel to the transverse diameter of the orbit, about an inch long, upon the central and external part of the lower lid, the convexity being downwards. The edges of the wound were in apposition, and no blood was issuing from it; but from out the closed eyelids blood continued to trickle down the cheek. From the swelling and tension of the parts, and the intolerable pain when touched, it was found impracticable to separate the eyelids, so as to admit of a satisfactory examination of the eye and its appendages, but enough was accomplished in this respect to afford a partial front view of the eyeball, and inner surface of the lower lid. The former was pushed upwards, forwards, and slightly inwards from its natural position, bulging out from close beneath the superciliary ridge of the frontal bone. It was fixed, embedded in blood-gorged, torn appendages, but it retained its spherical shape; had a glazed or sodden aspect, pupil fully dilated; the inner surface of lower lid was lacerated and congested. I did not think it necessary to run the risk of farther injury, by probing the wound to ascertain its true direction and depth, it being abundantly evident that the weapon, whatever it was, had entered the orbit through the wound in the lower lid, pushed the eyeball upwards and forwards, and, passing behind it, had probably reached as far as the roof of the orbit.
The patient was quite conscious, answered questions readily, distinctly, and without hesitation ; swallowed a glass of wine, and retained it; his pulse was 52, regular, compressible. He could stand, but not walk, complaining of inability to move his limbs, from their being numbed or “ dozened.” It was observable that the left leg was more affected than the other; the upper extremities presented nothing remarkable in this respect. He was placed in bed, had bottles of hot water to his legs and feet, leeches to his right temple and brow, warm fomentations to the eye.
Three P. M.--Eyelids dark purple, swelling and discoloration extending to temple and brow. Complains of the weight of the fomenting cloths occasioning increased pain, and removes them with his own hand. Pulse 48, feeble, oppressed ; breathing slow, regular ; no stertor; skin moderately warm : in other respects the same.
Nine P. M.-Eyelids quite black; their distension increased, separated half an inch by protrusion of eyeball, which is fixed and glazed, but retains its natural shape; sclerotic, ædematous, and highly congested; no apparent structural change can be observed : hæmorrhage has ceased. He has been restless the last hour, frequently changing his position; continually moves his right hand over the injured eye; complains of great pain in his eye and head; wanders a little in his mind at times, and has more than once attempted to get out of bed. Pulse 54, full, sluggish; skin hot; micturition free; was bled from the arm to six ounces.
Wednesday, February 14th.- Passed, on the whole, a quiet night ; is quite collected; articulation distinct; pulse 50, regular, compressible; is drowsy, and not readily roused; dullness of hearing perceptible; breathing slow, oppressed, and stertorous; left side completely paralysed; converses with those around him, and takes whatever is offered him.
Nine P. M.—Has had frequent shivering fits throughout the day, so severe as to alarm the attendants. The last one at 4 P. M., which seemed to threaten speedy dissolution: the symptoms of disorganisation of the brain have increased in intensity, but he is still quite conscious, and converses when roused; does not complain so much of pain, as of a feeling that his head would burst.
Thursday, February 15th, 8 A.N.- Moribund; the patient continued to converse with his attendants till between five and six o'clock, A.M., gradually passing into a comatose state, and died at eleven A.M., about forty-eight hours after receiving the injury.
Post Mortem appearances twenty-four hours after death. The body, being uncovered, presented the appearance of a fine healthy subject. There was no injury on any part of the body except in the right orbit. The right eyelid was much swollen and discoloured. The eyeball protruded, so that the iris was perceptible, notwithstanding the distended condition of the eyelid. An ichorous and bloody fluid issued from between the eyelids and ran over the cheek; while manipulating and dissecting out the eyeball, a thick, dark brown, semi-Auid substance proceeded from the orbit. The eyeball was entire. The sclerotic coat was entirely vascular. The back part of the roof of the orbit was fractured.
The scalp was reflected, and the upper portion of the cranium sawn off in the usual way. The superficial blood-vessels of the brain were highly vascular. On removing the brain, an irregular radiate fracture was found on the base of the skull, at the junction of the orbital process of the frontal bone with the small wing of the sphenoid, to the outside, and, for the most part, in front of the optic foramen. All the fractured pieces were nearly in apposition. A sanious purulent fluid lay on the fracture, and could not be removed by sponging or otherwise, so that the dura mater, at this part, did not admit of being accurately observed. The dissecting knife picked away several loose pieces of bone. The direction of the wound seemed to be a line drawn from the middle of the lower margin of the orbit to the optic foramen. A quantity of thick, dark, red fluid lay on the seat of the fracture, and a similar deposit was observed on the corresponding part of the anterior lobe of the brain. Into this part of the brain the finger could be pushed without using any force, the substance of the brain having apparently participated in the puriform degeneration. There were no coagula of blood in the brain. On laying open the ventricles, they were found more or less filled with the same Auid already mentioned. The mouth, nasal ! sages, pharynx, and larynx, were not examined.
The chest, externally, was well arched. The lungs and heart, with their investing membranes, were healthy. A slight deposit of a flocculent substance was seen on the apex of the heart, the result, probably, of a former slight inflammation.
The stomach contained about a breakfast-cupful of a dark brown semi-fluid substance, smelling strongly of beer. The coats of the stomach were healthy, and indicated that digestion was going on at time of death. Liver and intestines healthy. The right kidney was highly vascular, but otherwise healthy. Left kidney not examined. Bladder healthy, filled with urine, but not distended.
The writer had not an opportunity of seeing particularly what injury was done to the soft parts of the orbit, as the eyeball was removed for more careful dissection.
Remarks.—The instrument which inflicted the wound was a walking-stick, not by any means a stout one, but armed with a small iron ferrule, having a knob at the extremity, about the size of a large pea. It was thus enabled to inflict a penetrating, instead of a contused wound.
The symptoms of disturbance of the brain's functions on the second day, indicated clearly, that either the optic nerve, or the roof of the orbit had been injured ; but the continued consciousness of the patient precluded the idea that the substance of the brain had been penetrated.
It is interesting, in this case, to observe, the gradual sequence of the symptoms of compression,—the appearance of paralysis on the first day—its persistence and increase of intensity on the second
-the drowsiness on the second day-and, finally, the coma on the morning of the third ; and although these and similar symptoms increased as the case progressed, the pulse never gave indication that reaction was impending, or had come on.
ARTICLE VI.- Case of Tape-worm which resisted treatment until
the source of the disease was removed. By R. W. CRIGHTON,
M.D., Edinburgh. In December 1853, I was consulted by J. B., æt. 40, a calicoprinter, on account of tape-worm, with which he had been troubled for six or seven years. On inquiring as to what means he had employed for his relief, I was much struck at the long list of medical practitioners under whose care he had been, but without obtaining respite for any length of time from his distressing complaint.
He stated that the remedies employed had generally been successful in bringing away portions of the parasite, but that after a greater or less time, never exceeding a few weeks, his symptoms. itching, pain, etc., had invariably returned.
The observations of Dr Nelson on the development of Tania