the convulsion is preceded by fever, and in a third class it alternates with some other of the general manifestations of the dental irritation. Thus the muscular affection may alternate with diarrhoeal flux. Diarrhoea has stopped, and convulsion occurs; or, what is more common still, the muscular malady runs side by side with the other constitutional disorders. In prolonged diarrhoea from tooth irritation, convulsion is almost inevitably the ultimate attendant.

The force of the muscular disturbance will vary in almost every case, and even in the same case in different paroxysms; moreover, in the same paroxysm the mode and position of the convulsion may vary. That which commenced as a squint may terminate in epileptic form seizure, or that which commenced in a general convulsion may terminate in spasm of one muscle or set of muscles.

Dr Ashburner gives the clearest case I know as illustrating the above facts. He thus writes:

"I attended a fine boy from the cutting of the first incisor tooth to the completion of the dentition of twenty teeth. He was the last child of a family in which all the children had afforded examples of abnormal dentition. This boy was of a nervous temperament, with black hair and eyes. Every tooth had come forward with a want of biliary secretion. Nothing could exceed the care observed by the watchful mother, as to the diet of this infant; yet, whenever an effort at developing a tooth took place she was always aware from the deficiency of bile in the evacuations that he was to have a slight fever, sometimes with a catarrh and cough, always with twitchings of the face and fingers, and starting and moaning during sleep, and a catch in fetching a deep sigh. With the appearance of the first four molares the spasms were more severe. The thumb of the right hand was thrust into the palm, and the fingers clenched upon it; the toes were drawn down; the face was distorted. These spasms relaxed and reappeared. I found, on these occasions, that the tooth was always abnormal in its progress; seldom observing its turn, and never its time. The gum-lancet freely used always cured these spasms. On the last occasion I was sent for in great haste, for the spasms had been continued into an epileptic fit, from which I speedily and effectually relieved my little patient by cutting through the capsule of the coming tooth."

A question has sometimes been raised whether epilepsy, in the truest sense of that term, ever results from dentition. The author I have just quoted inclines to the affirmative of this view, but I cannot think it tenable.

There are at the same time certain cases where a strong predisposition to epilepsy is first lighted up to actual demonstration of the disorder by the irritation of dentition. I have met with one clear illustration of this kind, and with another case in which

suspicion of the same relationship was prominent, but these are very rare exceptions, and must be received with extreme caution.

In ordinary convulsive or spasmodic paroxysms from dentition all the evidences of epilepsy may be presented. This I grant; but such attack is not true epilepsy, but epileptiform convulsion, a simulation very intimate, but a simulation after all.

In dentition the epileptiform attack is most marked when that serious spasmodic complication-laryngismus, is induced. Dentition in such examples may set up a fatal paroxysm. I will sketch an example which led to a coroner's inquiry.

A gentleman who had removed from Physic into the Church, or I had rather said into the Chapel, for he was at the time I name a nonconformist minister, was on a visit with a friend, a member of whose family was ill from teething. Our ex-doctor, with the old professional duties still haunting him, examined the gums of the sick child and ordered one to be lanced. The gums were all irritable, but one more so than others, so it must be lanced. The operator, a druggist in a little town, lanced freely, as it was stated at the inquest, a different gum to that to which the direction referred. The child was taken home, and in the evening, while sitting on its father's knee with a portion of bread crust in its mouth, at which it was biting with its irritable gums, as babies only know how to bite, fell back with a scream in the father's arms. To use his own expression, it never breathed again, but it showed evidence of continuous life for nearly three minutes, by the violent epileptic form of convulsions into which it was cast.

Another medical man was summoned, but he being from home, some time was lost in coming after me, who lived at a longer distance. When I arrived all convulsion had ceased in death. I opened the windpipe, and endeavoured to restore life by artificial respiration, but it was of no avail.

As I say, the case gave rise to an inquest, and the druggist was accused of malapraxis for not dividing the gum as he had been directed. He was acquitted, and I think fairly; the error was one easily made, and the incision was by no means sufficient to give rise to the result.

The convulsive or spasmodic seizures of the first dentition sometimes extend to the period of the second dentition, and we have already seen in a foregoing lecture that the cutting of the wisdom teeth is occasionally followed by the same results in severe forms. I have not time to dwell further on these topics

than to note that in cases where the deciduous teeth are much decayed, where the permanent set are pushing forward, and where these meet obstruction either to their evolution or to that development of the jaw which befits it as the basis of the permanent set-that in such instances convulsion, frequently recurring, may be the fact; may be attributed to worms, may be attributed to temper, and may not be understood in regard to cause, till nature

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does slowly that which the observant practitioner might do with one movement of the forceps.

As I remarked at the beginning of this lecture, the effects of the irritation of dentition mainly attestify themselves through the body by the medium of the nervous system, not by the blood. I take this as a general thesis, admitting, as I believe, of demonstrative proof. And on this I would throw overboard all notion of the origin in tooth irritation of active diseases having their source in the circulating fluid, such diseases, for instance, as hydrocephalus and pneumonia, both of which, by extreme advocates of an extreme view, have, with many others, been traced back to dentition as their cause.

In the list of diseases already given we have surveyed all disorders which without doubt may have a dental origin. It were well, therefore, to rest content with the certainties, and so will we rest.

In the treatment of different diseases resulting from dentition, the art of the dental practitioner, though limited in its applica tion, includes in the majority of cases the key to success. In all instances, where the symptoms I have described attend the first dentition, the primary point of practice is to examine the gums, and freely and boldly to set every irritable gum at liberty by the lancet. I cannot but agree with Mr Fox that the operation of lancing the gums is often neglected in dentition from a timidity which is as weak as it is culpable. The operation gives but little temporary pain (for the gum is not richly supplied with nerves) and the evil consequences resulting from it are comparatively The friends of patients often request that the operation shall be deferred for the tooth to present itself more prominently, under the impression that if the gum should heal again the cicatrix will offer great opposition afterwards; this I believe to be a delusion. I have frequently incised gums and given much relief by dividing congested vessels, and these gums have healed up, and teeth have made way again without any greater resistance than in gums undivided. Indeed, the new and annealing matter possesses less resistance as a structure than the original gum substance.

none.

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Different practitioners have different ways of making the incision. Some incise the molars with a crucial cut and the others with a straight incision. I think the single incision is in all cases the most practicable, and equally efficient. incision in the line of the tooth for the molars, and an oblique incision across the bodies of the smaller teeth, answers every purpose.

In

The only cases where hesitation is required as to the propriety of the operation are cases where the hæmorrhagic diathesis is unmistakably present. Here the operation is unadvisable. such instances, if the gum is very resistant, the destruction of its upper part may be greatly expedited by touching the resisting

portion with the caustic point.

I have done this on two or

three occasions with excellent results.

In those examples which have been before us where deciduous teeth stand in the way of the free evolution of the temporary set, there can be but one line of practice, viz. complete removal of all the obstacles by extraction. The shedding teeth have served their office, and are better away altogether.

The special treatment of the various forms of skin disease resulting from dentition belongs almost purely to the medical man, but there are one or two general rules which cannot be too widely known. These are-1st: That a proper hygiene should always be enforced. Pure air, milk diet, and cleanliness are the grand necessaries, to which may be added, as the case may demand it, an occasional alterative, or a tonic, as iron or quinine. Above all things, friction or stimulation of the skin of the affected part should be avoided. The parts kept clean by gentle washing, treated with the simplest ointment, and protected from the hands of the child, ordinarily, nay, I think I may say always, recover of themselves, when the prime source of irritation is removed and the constitutional degeneracy is restored.

The diarrhoea of dentition is frequently a very troublesome symptom to meet, and can only be scientifically encountered by removal of the dental irritation, and by attention to the same hygienic measures already recorded. When the flux is persistent, however, an astringent tonic may be administered with advantage. I generally prescribe with most benefit, in such cases, small doses-say the fourth of a grain dose-of quinine, with ten or twenty minims of the tincture of catechu, with water. This repeated three or four times in the day really meets the requirement, and beats out of the field chalk, opium, and other remedies of that class, to which custom gives so much preference.

In the convulsive affection the main chance of treatment, again, lies in searching for the source of irritation, and relieving it. It is good practice even during a convulsive paroxysm to pass the finger round the mouth, and if an unyielding gum be felt, then and there to incise it. The immediate danger in convulsion being * laryngeal spasm and obstruction to the entrance of air by the windpipe, the immediate treatment consists in supplying pure air freely, and taking every measure to ensure respiration. When there is no doubt of laryngismus, the treatment must be prompt and decisive. If respiration seem to have ceased, tracheotomy and artificial respiration are pre-eminently demanded. If the symptoms are not so severe the spasm may almost always be controlled by the administration of chloroform, which to children. may be given with uncommon safety. In a case in which I had the opinion of my late friend Dr Snow I kept a child for no less than forty-eight hours under the influence of chloroform and ether. The effect was magical. The irritation was subdued,

the spasmodic state ultimately relaxed, and the child, it may be said without exaggeration, was saved from death by the influence of these benign remedies.

The late hour warns me that my remarks on the influence of the diseases of infancy on Dentition must be concluded in a sentence. I am relieved on this score, from the feeling of omission, by the fact that this topic has already been discussed in the first and fifth lecture of this course.

*

In the first lecture, taking up the great point here brought into our argument, the effects of the eruptive diseases in producing dental atrophy and caries, I explained, as it will be remembered, that, with the exception of small-pox, I could not accept it proved that any one of the eruptive diseases produced the effects so often attributed to them. I urged then, that before any conclusion could be drawn from the cases which have been cited against the eruptive maladies, that before the charge could be sustained, the poisons of mercury and syphilis must be excluded as the causes of the modification of dental structure; and I adduced the further fact, that many children pass through the eruptive disease during the first dentition, and yet present afterwards a permanent set having neither spot nor blemish. Thence I inferred that the connection of atrophy of teeth and carious tendency, stand in relation to the eruptive fevers, not as effect to a cause, but as coincidences to a fact.

Further researches and further thought serve only to confirm me in that opinion.

In this lecture, Mr President, such a breadth of subject has been opened to me-such a volume of important truths-that I have had to sustain supreme difficulties in disposing of the materials before me. The lecture would afford scope for a distinct course, with each section as a text instead of a reading. But if I have succeeded in placing before you the richness of the subject, by shading forth its merest outlines, my object is attained, and I am content.