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on which the symptoms appeared a false tooth had been provided, that soon after the operation intense pain resulted, that in her desire to conceal the fact of an artificial front grinder she had borne up against the pain, until the hysteria, epileptiform in reality, was the result.”
I insisted on instant removal of the new and offending cause, with the effect of entire and rapid subsidence of the symptoms.
Afterwards, at my suggestion, the new tooth was fixed with the plate simply.
This is not the only case in which I have had occasion to suspect the pivot of doing more than it was intended to do; and with great deference to the practical knowledge of my audience, who are much better able than myself to judge as to the manipulative advantages of pivot over plate, I, from the medical side of the question, pronounce the pivot a decided bore.
In a modified form I once saw similar results from the pressure of an amalgam stopping in a carious and irritable tooth. The symptoms were attended with a neuralgic face-ache, and were of frequent occurrence. At last it was thought best practice to remove the tooth altogether, after which there was no return either of pain or spasm.
The pressure excited by irregular and lapping teeth seems sometimes to exert a similar influence.
Lastly, a series of carious teeth, which may not in themselves ache, but which keep up constant irritation of gum, and retain a putridity of breath offensive to others and self-poisonous, stand amongst the common of the exciting local causes of dyspepsia, anæmia, and hysterical paroxysm. The author I have referred to above has seen even a condition approaching to epilepsy from this cause. · The treatment of the various kinds of hysterical disorder, either as developed in the teeth, or excited by them, is complicate, and is often of such nature, that the Dental practitioner has but spare opportunities of exerting his skill in its advancement.
The hysteric trismus, if it will not yield to simple measures, such as gentle force, or persuasion, or quiet mental diversion, will sometimes yield to a start, or sudden mental action. It is astonishing the effect of mental shock over spasmodic muscle. In the surgery of a medical friend, I one day saw a woman whose third finger was spasmodically closed and locked ; so it had been closed for two days. A young assistant, who thought that force was practice, like the young trumpeter who thinks that noise is music, had inserted a small rod under the arched finger, and was trying by main violence to wrench the crooked limb open. The more he tugged, the more intent was the mind of his patient on the fact, and the greater the resistance to be overcome. Ascertaining the nature of the case, I withdrew all forcible plans, and placing the face of the woman to the window, treated the matter lightly and got her tranquil. Behind her on
the wall was a cage containing a singing-bird, and while she was being attracted with something before her, I succeeded in setting open, noiselessly, the door of the cage. Then I returned to the stiff finger, and began to examine it gently. The plan contemplated succeeded. The little prisoner, his prison open, soon took advantage of his liberty, and hastened out, first on to the top of the cage, then suddenly to the closed window with great noise and flutter.
The patient, startled, was in an instant all attention to the bird, and at the same instant her finger, under my guiding will, was as straight as could be wished.
When her excitement was over, she would hardly believe that the finger was relieved, but seeing it so she must needs run her head against the notion, that now she could not close it. I bade her not try, explaining that a straight finger was better than a crooked one ; and sent her home laughing at her adventures.
It is just the same in hysteric trismus in its milder forms; a little persuasion, or a little diversion, and the rigid muscles are set free.
But if these means do not succeed, and friends are anxious, chloroform by inhalation is the remedy. This, carried to the third degree of Snow, is certain in its effects, and as far as I know is free from any unusual danger when administered by a prudent and experienced hand.
Hysterical tic is best treated, during the time of the paroxysm, by soothing remedies. Warmth is always useful, and the counter irritation from a sinapism is a simple and effectual measure. In hysteric pain of this description, galvanism seems of great efficacy. It acts here as it does in tooth extraction, as a grand foil, or to speak more definitely, as a diversion. It has all the properties of the mustard poultice without the mustard. I can quite believe that there is no intensity of hysteric pain which will not subside for the time under galvanism, while there is this advantage in the remedy, that it is a diagnostic, as well as a medicament. For if the pain is not relieved by the galvanism, the chances are as 99 to 100, that the pain is not hysterical, but of more profound signification.
The true hysterical toothache is ordinarily amenable to narcotic remedies. I have already shown to what advantage chloroform may be applied in its treatment. Counter-irritants are here again advisable--mustard or galvanism, between which there is so close a relationship. But the great art of the practitioner, in these cases, lies in making them out first, and in setting them free from serious interference afterwards. Where the pain is centric and emotional, a soothing impression made on the extremity of the nerve may, by conduction to the brain, relieve the suffering. But a painful impression, so conveyed, can only increase the suffering. Hence I warn the student practitioner, for the matured practitioner will anticipate me, that if he wishes to escape hysterical anathemas from gentlest voices, he will let the hysterically-pained tooth rest till the hysteria is gone, at all events. He will neither stop it, nor pivot it, nor extract it; nor give the patient cause to say of him one word more blameful than the old adage :
Our Doctor is a map of skill
It he does you no good, he does you no ill. The cases of hysteria which result from irritation in or about the teeth, require in the matter of treatment, a consideration the opposite of that which has gone before. In these cases the diseased local structure is the exciting cause of the general paroxysm, and it is therefore requisite that in so far as such local cause is removeable, that it be removed.
If then, in such case, the gum is an obstructing surface to a presenting tooth,-as in infancy so now,—the gum should be incised freely. If the gum is very hard and white, cartilaginous in fact, and if the crown of the tooth is not deep under the surface, it is best to remove a portion of the gum at the upper part altogether. The gum lancet and a free circular section suffices for this. But if the gum is soft, vascular, and tender, a straight or a crucial incision is to be preferred, and will be found sufficiently effective.
When any foreign body in a carious tooth is the cause of local irritation, the point of practice naturally is, to remove that cause, whatever it may be; and if this cannot be removed alone, to remove the tooth altogether.
When several carious teeth exist, and produce, with foetid breath, a constant irritability and excitement to hysterical passion, there can be but one line of treatment in ordinary cases, and that is to remove all the sources of irritation. Palliative measures, in shape of warranted washes, and guaranteed denti. frices, are warranted shams. Let me be understood, I do not say that, under certain circumstances, as where gums are spongy, the operation may not be prudently put off for a season; and I do not say but that under such conditions, an astringent wash, or an antiseptic wash, may be advisable, and the very best tempo. rary measure. Not at all, I mean simply that in these cases, the medical side of the Dental art teaches from experience that extraction, where practicable, is the true practice.
These, then, are the principles of local practice in such disorders of the Dental organs as are allied to hysteria. But as the hysteric condition is based on something beyond the local mischief; as there can be no hysteric ache or pain, without a predisposing condition or hysterical diathesis ; as no local mischief can induce hysteric convulsion in the absence of such diathesis; so it is clear that the true and basic treatment of hysteria must be directed to the removal of those systemic or constitutional derangements which supply the diathesis.
Here in treatment there are some general rules which every one can understand, which often effect more than physic, and without which all physic is of little avail. These rules are hygienic, and as such are necessarily simple. The first item in the prescription is--pure air; the second exercise of body; the third mental rest, if mind is over-done ; the fourth a diet of rigid simplicity; the fifth cleanliness; and the sixth regularity in times of action and sleep. What, say you, a panacea these for all the evils flesh is heir to, and Physic and Dentistry going in solemn procession to their burials ? Even so! but the risk is little of the burials ; not because the rules are bad—but because the general practice of the rules is too remote in the future to affect the present generation in the least.
The medical treatment to be adopted in the instances cited, turns, in every case, on the cause which seems to lie nearest to the root of the evil. I could not here enter into detail. If the primary cause be a flux from mucous surface, astringent remedies, as the mineral acids, with quinine or iron, may be the indication. If the cause is an impaired digestion, stomachics or purgatives may be indicated. If anæmia seem the basic evil, iron may be the all-efficient remedy.
Suffice it for me now to rest content on what has been inculcated in the natural treatment of those classes of the hysterical phenomena where the teeth are concerned, and in relation to the management of the Dental structures during the hysterical diathesis.
One of two short recapitulations may recall and fix on the mind the points of chief interest.
1. Hysteria, as a constitutional malady, has its origin in a degraded nutrition.
2. Its phenomena are all developed through the agency of the nervous centres.
3. The phenomena, stripped of all accidental and extraneous appearances, are made up of two elementary changes-exalted sensibility-exalted irritability, i. e. pain, and muscular convul. sion.
4. The muscular irritability may be special or general. Dif. fering in degree; it may be a simple twitch, a powerful convulsion, a spasm.
5. The pain, common to all sensitive structures, may take the course of muscle, nerve, or membrane.
6. The diathesis being furnished, the reflection of pain from a nervous centre may extend to any local spot; or the diathesis still being present, a locally diseased spot may prove the point of irritation, from which, by reflection through the nerve centre, muscles, and sets of muscles, may be stimulated into abnormal contraction.
7. In relation to the teeth, and parts surrounding, hysteria may give rise to trismus, spasm, tic, and centric odontalgia.
8. On the other hand, local diseases of the teeth may, by reflex action, set up, when the hysterical diathesis is present, the acute hysterical paroxysm.
9. The special treatment in the first of these cases is sedative purely. In the second, removal of the irritating body is the one and the rational measure.
If, Mr President, in this Lecture I have called attention to matters which, to many practitioners, both in Medicine and Dentistry, are novel as systemized facts, and as taught facts, I make no apology, for the facts are in nature, and are to be learned in the study of nature. The more reason, therefore, that they should be both learned and taught.
MONTHLY MEETING, TUESDAY, JANUARY 4.
THE PRESIDENT IN THE CHAIR. The following gentlemen were duly elected Members and Associates, namely
MEMBER: James Lee Pike, Esq., Dumfries, Scotland.
The usual routine business having been disposed of, the President, in the unavoidable absence of the Author, read the annexed paper on “ Intense Cold, or Congelation, as a Means of producing Insensibility in Surgical Operations,” by Dr JAMES ARNOTT : · It may be useful to introduce the subject of Dental Anæsthesia from Congelation, with a few observations on the subject of anæsthesia in operations generally. The advantage will thereby be better seen of substituting, on all occasions where it is practicable, local means of producing insensibility of only a small portion of the body for measures which powerfully affect the whole system ; the advantages, in other words, of substituting, whenever we can, local for general anesthesia.
More than a hundred years have elapsed since a minute account was given, in the Philosophical Transactions,' of the insensibility caused in dogs by immersing them in the mephitic vapour of the Grotto del Cane, near Naples. Dr Hickman recommended the inhalation of this vapour, or carbonic acid, in order to render operations painless, about · seventy years afterwards, but not until Sir H. Davy had suggested
nitrous oxide gas for the same purpose. The fear, however, of inju