« ForrigeFortsett »
III.- The Natural History and Diseases of the Human Teeth : by Josepu
Fox, M. R.C.S., &c. &c. First American, from the third London edition. Remodelled, with an Introduction and numerous Additions, hy CHAPIN A. Harris, M.D., D.D.S., &c. Large 8vo., pp. 430, illustrated with 30 plates. Philadelphia : Barrington & Haswell ; 1846. It is the duty of the physician to familiarize himself with every depart. ment of knowledge that has any bearing on the practice of his profes. sion; and he will often have it in his power to obtain most satisfactory results in practice, and to advance his reputation, by attention to things which are regarded by some as not of sufficient importance to deserie their notice. Almost every man in our profession who makes any pretensions at all, aims at the performance of something great and dreadful; nothing less than capital operations will do them; and it is to be feared, that so strong is this passion, that good limbs are often sacrificed, be. cause bad ones do not offer. Every one wishes to tie the carotidia, bubclavians, or iliacs, and the only reason they can give is, that nearly all those thus operated on, die. The fact is, that it is merely fiom vanity; from a desire to do something that the vulgar will stare and wonder at; and we too often lose sight of the fact, that the mere ope. rator in surgery holds the same position in regard to the scientific physician, that the operative mechanic does to the skilful engineer or architect. Many young physicians thus devote themselves to the study of diseases and operations, which they rarely have occasion to see; and, perhaps, will hardly have the opportunity once in a lite-time of performing operations to which they have devoted so much attention. How much better to attend closely to the study of those things which we are to meet with at every step, and which are in reality most interesting, as they call most frequently and imperatively for relief. Singularity and rareness are too generally regarded as giving cases their principal interest ; whereas, the very circumstance of their being common, and of daily occurrence, should be a sufficient reason to induce us to give them our especial attention.
In connection with the subject of the work we are now noticing, there are many points which are generally regarded, erroneously, as of but trifling importance, but which are of the utmost consequence in their hygienic and therapeutic relations. The physiology and pathology of the teeth ; dentition, and its various concomitant lesions; the compli. cated relations of the dental system to the bony and soft parts with which it is connected'; its relations to the digestive functions; and, in fact, the reciprocal relations existing between the dental system and other portions of the economy, are all matters of the gravest moment to the practioner, and not unfrequently the chance of life or death is to be decided by the knowledge or ignorance of the physician respecting somo of these points.
This, however, is not all. Our physicians are very often referred to in regard to the teeth, in reference to points which do not involve the life of the subject, but which often deeply affect the happiness of the individual, by destroying or jeopardizing health. How often do we see decayed, deciduous teeth torn from young jaws, thus affecting the form.
ative cells, or sacks, which contain, and should perfect the permanent teeth that are to replace those removed, and which will now arise chalky and ready for decay, from absence of the enamel, which the torn sack has not completed! How often, from injudicious interference, do we find the permanent teeth arising crooked and jagged; thus, perhaps, forming for a life-time, standing monuments of the ignorance of some physician respecting the physiology of dentition !
The natural history of the teeth, their structure, the history of their development in their normal state, and of their deviations from this standard, are subjects of sufficient interest to repay any one for the time spent in reading a good account of them; and no physician can understand either the pathology of the teeth themselves, or the symptomatic lesions which are so frequently met with in connection with those of the dental system, without a good knowledge of the physiology of this sys. tem. All the methods of preventing and curing irregularities and deformities of the teeth, and the whole theory and practice upon the diseases of the teeth, should be founded entirely upon this basis.
The work of Dr. Fox was first published in 1803; and notwithstand. ing the rapid progress of dental surgery from that to the present time, it has still occupied a high place in this department of medical literature. Two other editions were subsequently brought out; the third appearing in London in 1833. The present work is on the basis of this last London edition, and the additions by Dr. Harris have brought it up to the state of the science at the present day. It is a work calculated to be of incalculable advantage to the physician, as well as the dentist; for there are so many diseases, especially those of childhood, having intimate relations with the state of the dental apparatus, that this kind of knowledge is as important to the general practitioner as to the dental surgeon, and even more so, as the diseases requiring the attention of the physician to be directed to this system, often involve the general health or life of patients, whilst the dentist deals principally with those producing only deformity or inconvenience.
We will conclude, by recommending this work to the attention of physicians, as one to which they may often make reference with great advantage and satisfaction.
W. M. C.
IV.-A Compendium of Lectures on the Theory and Practice of Medicine,
delivered by Professor CHAPMAN, in the University of Pennsylvania. Prepared, with permission, from Dr. Chapman's manuscripts, and published with his approbation; by N. D. BENEDICT, M. D., &c. Philadelphia : Lea & Blanchard; 1846. 8vo.: pp. 258.
The mere circumstance that a work appears from the pen of the distinguished Professor Chapman, is, of itself, a sufficient recommendation to most of the members of the profession in this country; and even his sanction or approbation conveys a great influence, as emanating from an authority from which we tremble to differ. But in examining a book, the question will always arise, as to what useful end is intended to be
attained by its publication ; and when this question arises in reference to the present work, it will, in all probability, be difficult to obtain a satisfactory answer.
So great, however, is our respect for the talents and opinions of Pro. fessor Chapman, that we should feel guilty of a high degree of presumption in attempting to criticise any thing written or sanctioned by him; and as we have not been able to detect any thing in the book at all commensurate with our opinions of the learned professor's abilities, we will say no more about it, for fear of being regarded as assuming - the same ungracious attitude as that in which that notable critic, Gil Blas, was placed, by his friendly comments on the archbishop's homily.
W. M. C.
V.-An Essay on the Pathology and Treatment of Trismus Nascentium,
or Lock-Jaw of Infants. By J. MARION Sims, M. D., of Montgo." mery, Ala. Lea & Blanchard ; 1846. This is a republication of an article which appeared in the April number, 1846, of the American Journal of the Medical Sciences. The author has been led to present it to the profession, in a separate publi. cation, from the value and importance which he attaches to the subject. Concerning the importance of the subject, we believe every practitioner in the South and South-West will agree with him.
The following extract will show how the author came by the pecu. liar views which he entertains of this disease.
***“My friend, Dr. Vickers, visited the little sufferer with me this morning. Many experiments were performed to demonstrate, before the Doctor, the reflex action of the excito-motor system, and its exceedingly delicate impressibility to the gentlest touch. To show the great rigidity of the frame, I caught hold of the feet, and raised the whole body without flexing the thighs on the pelvis. At last, I run my hand under the head, for the purpose of elevating the body in the same way, when I immediately detected a remarkable irregularity in the feeling of the bones. It had lain, during the whole of its illness, exactly in one position all the time, the weight of the head resting wholly on the os occipiis. Its pulse was now uncountable; respiration more frequent than I had ever seen it before under any circumstances; it was breathing 120 times in a minute, and looked as if it could not possibly live an hour. I raised it up, to examine the head more particularly, and set it on my knee, or rather leaned it against the knee, for the tonic rigidity of the muscles prevented the flexure of tħe thighs to a sufficient degree for the sitting posture. After holding it so for some ten or twelve minutes, what was my surprise to find a rapid amelioration of all its bad symptoms! True, the tonic rigidity remained the same, but the clonic spasms became less frequent and less intense; the whole expression was less disturbed; and the respiration fell, in this short space of time, from 120 down to 70 in a minute. I now felt convinced that position had a great deal to do in the production of this disease. On examining the head, I discovered that the fontanelles were open and very large, particularly the anterior; that the bones were loosely attached by their commissures; and that the os occipitis was pushed in on the brain, being overlapped for a quarter of an inch or more along the whole course of the lambdoidal suture, by the edges of the ossa parietalia. I had the child laid on its side, so as to take the weight of the body from the os occipitis. It died about sundown, on Friday, 25th July, having been sick about ninety-six hours.
" Through the kindness of Mr. Stickney, and with the consent of the mother, a post-mortem examination was made the next morning at 10 o'clock. I am indebted to iny friend, Dr. Ames, for the following notes, made at the time.
“No emaciation; countenance tranquil; slight cadaveric discoloration of back.
5 · Head.-Anterior fontanelle large, triangular; coronal suture open in its full extent; sagittal same, open to ossa nasi; parietal bones overlap the frontal slightly; the occipital for the fourth of an inch along the whole of the lambdoidal commissure; gentle pressure on the occipital bone projects the brain forwards, producing a considerable fullness of the anterior fontanelle.
“ • Brain.-Superficial vessels full of black blood, particularly posteriorly. Interior of the brain natural in appearance.
Spine.-Coagulum of blood occupying the spine in its whole length, enreloping perfectly the medulla spinalis ; thicker as it approaches the brain. Spinal reins full of black blood.
" • Thoracic and abdominal viscera healthy; nothing unnatural about the appearance of the umbilicus.'"
The extract below will inform our readers of the view which the author takes of the pathology and etiology of this “insatiable babykiller.”
“Curling, in his admirable • Treatise on Tetanus,' tells us, that · Dr. Goëlis, of Vienna, in the examination of children who have died of this disease in the Foundling Hospital of that city, found an appearance of increased vascularity in the substance of and in the membranes enveloping the upper part of the spinal marrow;" and that Dr. Thompson, of Philadelphia, had also observed the same thing.
“M. Billard (Stewart's edition, page 490), says, that he 'found, on dissection, nothing more (!) than an effusion of a quantity of coagulated blood in the spine. This blood was effused between the two laminæ of the tunica arach noidea, and filled the whole of the medullary canal from the medulla oblongata to the sacral region.' And after finding this morbid appearance and no other, he gravely asks the question, "Were the symptoms of tetanus to be ascribed to this hemorrhage of the spine ? What more did he want to account for the distressing symptoms and fatal termination of the disease than this · hemorrhage of the spine ?' * Did ever cause and effect stand more intimately connected ? Is not the presence of this effusion a sufficient explanation of all the phenomena of the disease? Are not the tetanic spasms the very result that we would reasonably and almost invariably calculate on finding in ó spinal hemorrhage ?' I think so. And, as the real character of this affection has evaded the efforts of all pathological inquirers-Goëlis, Thompson and Billard being the only writers that I can find who agree on any single point relating to it,— and as my observations are wholly corroborative of theirs, I must here insist that the true seat of the disease is the spinal canal ; that its morbid anatomy consists, first in a congestion, and then in a rupture of the minute reins and capillaries of the medulla spinalis; that this is the special and pathognomonic feature of the disease, while every other alleged cause and explanation of symptoms are but mere coincidences.
“ The next question that naturally arises is, what produces this venous congestion and capillary rupture, this effusion of coagulated blood, this spinal
. apoplexy, if I might be allowed to apply a term significant of the abnormal appearance? I answer, that a simple and ample explanation may be found in the anatomical peculiarities of the foetal cranium, and spinal circulation, in connection with the imprudent and careless habit in mothers and nurses of allowing infants to remain too long in one position. The imperfect ossification of the cranial bones is essential to the production of the disease, while the position of the child is its accidental or exciting cause."
The rest of the argument consists in showing, from the anatomy of the veins of the spinal marrow and cerebellum, how congestion, and consequently effusion of blood on the spinal cord, must or may ensue from continued pressure on the occiput.
We have read this paper with a great deal of interest, and we think the arguments of the author exceedingly plausible, but we cannot agree with him that compression of the occiput is the main or sole cause of trismus nascentium. If such were the case, how comes it that this disease is in many places endemic? How comes it that it is so rare in England, and so frequent in Scotland and Ireland ? How explain, that although it " occurs very rarely, if at all, on the main-land of Iceland, it is eminently disastrous in Heimaey, one of a group of islands consisting entirely of lava, situated on the southern coast”?* Upon this hypothe. sis, how account for the singular facts mentioned before the PhysicoMedical Society of New Orleans, by Drs. Axson and Lindsay, as pub. lished in this journal ? Dr. Axson expressly stated, that "there was nothing peculiar in the location of the plantation” on which, he had been toid, “ only four or six children had been raised, all the others born on the place having died of trismus. On an adjoining place,” he goes on to say, “ distant about a mile and a half, and owned by a bro. ther of the proprietor of the first place, this disease was rare, and many young and vigorous children were found. The same midwife officiated on both places. She was an old black woman, with all the requisite pretensions to such an office ;' &c. Besides, the habits of negroes and the poorer classes of whites are, in this respect, pretty much the same all the world over. Thousands of new-born childien are laid on their backs every day. In certain regions we find this disease prevail. ing, whilst others are exempt from it.
In our opinion, nothing whatever is known concerning the remote, or rather the efficient causes of tetanus. One man may have a limb wrenched off by machinery, and recover, without a single symptom of the disease ; — the scratch of a pin may bring it on in another.
But though we think thus, we are thankful to the author for putting his views before the public; and we have reason to believe they will be of much practical value. Why we think so, will appear from what follows.
The writer of this notice was called, February 14th, 1845, to see the child of a gentleman residing in New Orleans. It was the third day from the birth of the child, and the father informed us that the labor had been a protracted one,- that the child, soon after birth, had been seized with convulsions, which had been continued at intervals of from one to three hours up to the moment of our visit. We were also told, that the physician who had been in attendance had retired, giving up the case as hopeless. The child's bowels had been evacuated, and it was a well-formed, stout infant.
Upon examination, we found the patient extremely drowsy, as if suffering from cerebral congestion : we found, also, the pupils considerably dilated. There were no tonic spasms-nothing, in short, characteristic of tetanus. During the examination, a convulsion came on, which
Curling on Tetanus.