ON THE GENERAL OR SYMPATHETIC SYMPTOMS OF DENTITION. 1 invulsione These symptoms comprise convulsions, certain diseases of the skin, which are termed in the vernacular, feux de dents, slight inflammation.. of the conjunctiva, and inflammation of the intestine. The convulsions sympathetic of dentition do not at all differ from the Cimeti convulsions which are observed in the other periods of infancy; they aud pass off quite as rapidly, and like them are in no way dependent on an Intestines In + appreciable organic affection of the brain. They must be related to If the children die, which has been more than once observed, no change is discovered in the brain; if it presents traces of an inflammation, the convulsions ought then to be considered as symptomatic convulsions. These convulsions should be treated in the manner we have pointed out at the end of the chapter devoted to essential convulsions. Eczematous, impetiginous, or simple erethematous eruptions are often rules observed in the bodies of young children who are teething. These eruptions present themselves on the body, or on the limbs, and on the head; they have been designated feux de dents. It has not been correla demonstrated that between this morbid manifestation and dentition Eruations there exists anything more than a coincidence, and by no means in ive wit relation, of causality. In fact, these eruptions do not always appear at the period of the inflammation of the gums, and do not disappear with it; neither are they reproduced at the time of each irruption of the teeth. It is then difficult to establish a positive correlation between them and the dental evolution. rutition The mucous membranes are especially the seat of the sympathetic ed symptoms of dentition. The conjunctiva is rather frequently inflamed at the period of the eruption of the canines and of the molars; but the inflammation is very soon dissipated under the influence of emollientel remedies. When it assumes a more serious character, it must be treated by antiphlogistics and topical astringents. The influence of the dental irruption upon the diseases of the alimentary canal is completely established; it is demonstrated by numerous observations. There are children which constantly experience diarrhoea at the period of the eruption of each of their teeth. The a relation between these two phenomena rests, then, on the firmest foundation. teething, is Sympa The irritation of the bowels, which is the result of teething, is often very slight; it only lasts a few days, and ceases in order to reappear at a later period on a similar occcasion. It does not appear to be connected with an alteration of the intestine, for it is not in general accompanied by fever; its termination is nearly always favourable. In some circumstances, however, it presents all the characters of acute entero-colitis, and depends upon inflammation of the mucous membrane. Suturestolites The diarrhoea of dentition is, then, most frequently idiopathic; it is perhaps the result of a simple acceleration of the peristaltic movement of the intestines, occasioned by the general nervous state of the children. It is, probably, a nervous diarrhoea. In fact, if fear, cold, or some acute moral emotion can provoke diarrhoea, and this is incontestable, it is not impossible that the pain of dentition, and the nervous Tagitation which is the consequence of it, may determine the same result. af by the appropriate means. First, it very much weakens the children; Whatever may be the nature of this diarrhoea, it must be treated afterwards, it may persist in a permanent manner, and then it is evident that it is symptomatic of an intestinal alteration. Further in the chapter devoted to the study of diarrhoea, will be found the series of means by the aid of which we may remedy this disease. APHORISMS. 220. The first teeth should appear from the lower jaw, between the sixth and eighth month. 221. The first teeth appear very late and very slowly in rickety children. 222. The median inferior incisors, then the median superior, then the superior lateral, and after the inferior lateral, appear successively by groups in their respective alveoli. 223. After the irruption of the incisor teeth, that of the first small molar teeth commences. 224. The canine teeth always appear after the first molar teeth. 225. After the irruption of the canine teeth, the process commences which should prepare the evolution of four new molars which complete the set of teeth of childhood. 226. A short period of arrest, a veritable period of repose, always exists between the appearance of each group of the teeth of early childhood. 227. The teeth of early childhood are twenty in number, and are called caducous, in consequence of their premature decay between the seventh and eighth year. 228. The caducous teeth are replaced, on their decay, by new permanent teeth. 229. A third dentition is observed, but it is an exceedingly rare phenomenon. 230. Good or bad teeth is an hereditary circumstance in families. 231. Short teeth, of a yellowish white colour, are the strongest, the most lasting, and indicate a good constitution. 232. White and long teeth are soft and readily decay. 233. Teeth with a bluish tint indicate a feeble constitution, and are frequently met with amongst phthisical subjects. 234. The irruption of the teeth very often engenders local symptoms of simple, ulcerous, or apthous stomatitis, and general sympathetic phenomena, developed on the skin, mucous membrane, and nervous system. 235. The ulcerous stomatitis caused by dentition should be carefully treated, in order to avoid the formation of glandular enlargements of the neck. 236. The diarrhoea of dentition should be arrested as soon as it becomes very abundant. 237. It is in the highest degree unreasonable to acquiesce in the popular adage, which, everywhere and always, accords immunity to the accidents of the first dentition. CHAPTER IV. ON PHARYNGITIS. Inflammation of the pharynx is a very rare circumstance in infants and children at the breast. There are scarcely any examples of it in the various treatises on medicine. I have discovered a very curious one which appears worthy of mention here. It relates to the development of an abscess in the posterior wall of the pharynx, and it has been published by M. Besserer. This is the substance of it: the case will be afterwards given at full length. A child, four months old, was seized with fever, hoarse and frequent cough, obstruction to the respiration, and difficulty of deglutition. At the end of forty-eight hours the child was unable to drink, the anxiety was considerable, and the finger introduced into the back of the throat discovered a tumour projecting in front of the vertebral column. On the tenth day the tumour had acquired a considerable volume, but it could not be well examined, as every attempt at this kind brought on attacks of suffocation. It was thought to be croup; and the child died. There was nothing wrong in the larynx, but there was, in front of the vertebral column, behind the posterior wall of the pharynx, an abscess as large as a hen's egg, enclosing half a cupful of pus, which a small incision would have easily liberated. Case. Abscess of the posterior wall of the pharynx, in a child four months old. A child four months old, born of scrofulous parents, presented 21st November, 1840, the following symptoms: moderate fever; hot, dry skin; easy, moist, unfrequent cough; mucous rales, particularly in the larynx and trachea. The buccal cavity and the back of the throat were filled with filamentous and viscous mucosities. The It's table posterior wall of the throat appeared to be covered with a false membrane. The The base of the tongue was enlarged and covered with a white layer. loud, and there is much mucosity in the back of the throat. The finger introduced into the mouth, discovers the posterior wall of the pharynx projecting and swollen. The child is very much agitated and in a state of great anxiety; it would not take the breast, and allowed the small quantity of milk given it to eull drink to run from the mouth. A fresh emetic was administered and three leeches applied to the neck. After vomiting had taken place there was a little improvement; calomel was then given in the dose of half a grain every two hours, and the application of a blister prescribed. The symptoms remained stationary until the 1st of December; only the child grew weaker. They suddenly and violently Gully returned in the night of the first to the second. A certain sound was, moreover, detected which appeared to be that of a membrane ruptured by the effort, after having for a long time obstructed respiration. Every attempt to examine the teul larynx brought on attacks of suffocation. M. Besserer, believing it to be a case of croup, prescribed the sulphate of copper. In the evening the child was found with the head strongly thrown back, the face pale, covered with a cold sweat, Aand in a state of extreme agony. The finger introduced into the back of the throat discovered a firm tumour which did not manifestly appear to narrow it. This manœuvre rendered the respiration more easy, as did also pressure on the sides of the larynx, carrying this organ forwards, Bleedings, emetics, &c., were followed by a slight amelioration; but the next day the attacks became more violent, and the child died in the night. On the examination of the neck after death, it was discovered that the larynx, the epiglottis, and the trachea, were white, exsanguine, and covered by a viscid mucus. The posterior wall of the pharynx which was not at all covered by false membrane, as it was believed to have been observed to be during life, was white, swollen, and very thick; it formed the anterior wall of an abscess as large as a hen's egg. This abscess formed exclusively by the cellular tissue, rested on the bodies of the first, second, third, and fourth cervical vertebræ, and contained half a cupful of thick, flocculent, greenish yellow pus. The vertebræ did not present any traces of disease.-(Gein. und Westf. Correspondenzbl. No. 22, 1844.) [Abscess between the spine and the pharynx is occasionally observed, in which case surgical interference is as effectual as it appears to be essential from the symptoms, and not alone from the fact of certain fatal results from mechanical pressure on, and interference with, vital organs, but also from the situation of the abscess being particularly favourable to extensive diffusion. Dr. O'Ferrall has seen, in one case, a spontaneous opening occur: the abscess was high up, and matter passed through the nose. The abscess should be opened with a straight bistoury, with the cutting part short, as the density of the covering renders the plunges of a trochar unsafe.-P.H.B.] CYNANCHE PAROTIDEA. [Cynanche parotidea, or mumps, consists of inflammation of the parotid, sublingual, and submaxillary glands, occasionally associated with that of the tonsils. It is more fequently met with as an epidemic, although it occasionally occurs as a sporadic affection. It usually commences with the ordinary symptoms of slight fever or catarrh, which are followed, in from twelve to twenty-four hours, by pain and stiffness of the neck and the lower part of the jaw. Swelling is then loot observed about the angle of the jaw; sometimes confined to one side, sometimes Pain & Shilling in may be averaged at eight or ten days. Evanson and Maunsell (On Diseases of 11 Children) state, that the swelling of mumps, at times but very rarely, will proceed to suppuration, and may cause immediate death, by discharging its contents into the larynx, if it burst internally, or lead to great deformity when it opens externally. West believes that suppuration is oftener met with in infants and young children Purotis you Swilling than those who are approaching the period of puberty; but that, on the other hand, ay be metastatis of the disease from the parotid to the mamma, the testicle, or the brain, of all of which instances are recorded by different writers, appears to be rare in proportion to the tender age of the patient. The treatment of this disease bery girat is very simple; mild antiphlogistic medicines, and the application of warmth, being Rarely all that is required, local depletion being neither necessary nor useful. M. Rilliet has published a very interesting account (Gazette Medicale, 1850) of Steppuratio an epidemic visitation of mumps, which prevailed there from March, 1848, to May, 1849. In the majority of cases there were no premonitory symptoms, those of May & Can a local character being the first intimation of illness the patient received. The Fruste. Generally tumefaction of the parotidean and mastoidean regions continued increasing from four to six days, and, after remaining stationary, then rapidly diminished, so as to have disappeared by from the seventh to the tenth day, the submaxillary gland continuing hard and swollen, in several cases, long after the resolution of the parotidean tumour. The frequent cases were those in which the tumefaction was of medium size only; but in some it was enormous, extending almost to the external on the li extremity of the clavicle. In such, and in subjects predisposed to neuralgia, the pain was severe and even violent, but in the other cases, moderate-it being usually, th= spontaneous, but also augmented by pressure and every movement of the jaw, which right in indeed was sometimes as immoveable as in tetanus. In some cases, when the blu twelve hours to three or four days, to the opposite side, one gland being almost dys⋅ always more swollen than the other. The accompanying constitutional irritation was not prolonged beyond forty-eight hours, save in very bad cases. A feeling of great lassitude and debility accom |