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ASSOCIATION OF SURGEONS PRACTISING DENTAL SURGERY.
576 the
’by enucleation
or
the
only
ecraseur, and the space between it andi
inch and three-quarters. The handI was introduced into the vagina, and pressure made on thee tumour, with a view to push it up out of the pelvis.i. Eventually this object was attained, and the forceps wass applied to the head, and delivery rapidly effected. Nc) l1aemorrhage followed. This was a case unmited for enucleation on account of the character of the growth. In suchi cases action should be taken early, and an effort made att repression before having recourse to more desperate measures -Dr. BARNES aid that the difficulties and dangers! associated with this complication varied with the seat ofF the tumour. When the growth projected into the cavity’ of the uterus the danger was very great; when situatedI in the lower segment of the uterus, enormous. In the latter case the tumour may be crushed, sphacelate, and giveI rise to pyaemia. There can be no doubt that fibroid tumoursi may atrophy ; they are occasionally expelled. Haemorrhage depends on the seat of the tumour.-Dr. BRAXTON HICKS said that not only small but large tumoursi opposing labour might be removed when situated in the lower segment of the uterus. He had removed successfully a mass as large as the foetal head. Some cases which appeared unpromising during early pregnancy improved during the course of gestation, so as not to give any trouble. When these conditions are met with during active labour they should be treated mechanically. - Dr. GODSON said that in a case under his care large masses were discharged and the tumour disappeared.-Dr. MURRAY had seen relief to the bowels brought about by pressing the* tumour from the pelvis by means of the band introduced into the rectum. -Dr. DE GORREQUER GRIFFITH had seen three cases of this complication: two without a bad sym-
pubes
was
an
-
’
,
ptom; the third complicated by post-partum haemorrhage. During gestation the tumour increased, but, afterwards diminished in size. - Dr. HAYES referred to a case in which death took place from haemorrhage before delivery. A fibroid, about the size of a Tangerine orange, which was easily enucleated after death, was found in the anterior wall of the cervix. The placenta was not prsevia.—Dr. Ems thought the best posture to effect reposition was the genu-pectoral. -After a few remarks from the President, Dr.PLATFAlE replied, saying that post-partum bsemorrbago occurred in some of these cases, but it did not appear to be so common as one would expect.
ASSOCIATION OF SURGEONS PRACTISING DENTAL SURGERY. A
of the Association was held on the 28th ultimo, S. Cartwright, F.R.C.S., President. Mr. CoLEMAN read a commumcation 11 On some Untoward Results of Immediate Torsion of the Teeth." Alluding to the supposed value of this operation in certain cases of dental irregularity, he showed how unsatisfactory the results might be when performed on imperfectly developed teeth. In certain cases development was entirely arrested, or absorption took place, and the tooth never descended to a level with its fellows, or even receded beyond the dental line, as occurred in a case the model of which he showed to the members present. These results he ascribed to the severance of the pulp-vessels by the operation.-Messrs. Cattlin, Edgelow, Srevenson, Gregson, and S. Cartwright joined in the discussion, there being a division of opinion as to the merits of the operation, though it was generally maintained that the operation was not justifiable before thirteen or fourteen years of age. Mr. S. J. A. SALTER then read a paper own some Reflex Symptoms and Results of Irritation of th e Dental Branches of the Fifth Nerve," and exhibited a seriesof specimens of dental and alveolar necrosis and exfoliation following the ernptive fevers-scarlet fever, measles, and small-pox. He said that a few isolated specimens of this condition, preserved in our hospital museums, had been attributed to mercury, but that that explanation was refuted by modern evidence. Mr. Salter considered that they are among the specific seque’se of the eruptive fevers; that the pulps and caps of the forming permanent teeth (members of the tegumentary system) are poisoned by the disease, die, and are shed in the only MEETING
in which they can be cast off-namely, by the necrosis and exfoliation of the capsule of bone which encases them, and to which the bone-necrosis is almost always strictly limited. Mr. Salter remarked that these cases usually occur in children about five years of age (a year or two more or less) when dental development is in its highest activity; that the morbid condition is usually symmetrical on both sides of the jaw; that the bone-necrosis is limited to the alveolar processes and capsules surrounding the teeth ; that he has never seen this condition excepting after eruptive fevers; and that he has had under his own care about
way
cases after scarlet fever, eight after measles, and four after small pox. Mr. T. W.B uNN read a paper On some Reflex Symptoms and Results of Irritation of the Dental Branches of the Fifth Nerve," in which he gave an account of certain cases confirmatory of the statements made by the President, Mr. Cartwright, in his communication" On Teething and its Complications" made to the Society on Nov. 22ad. The first case, which gave the keynote, as it were, to his subject, was a remarkable instance of delayed dentition in a woman between thirty and forty years of age, giving rise, by reflex irritation, to ulcer of the cornea. The ulcer, which obstinately resisted treatment, healed directly an upper bicuspid was cut.-The PRESIDENT gave several examples which had come under his notice of reflex action connected with the teeth, as also with other portions of the body, notably a remarkable case of double squint dependent upon curvature of the spine.-Mr. SALTER mentioned a case in which the iris had changed colour as a result of dental lesion.—Dr. WILTSHIRE ascribed ulceration of the cornea to the action of reflex nervous irritation on nutrition.-Mr. STEVENSON had seen good resulting from lancing the gums in cases of reflex disturbance. Mr. HAMILTON CARTWRIGHT showed a patient aged thirty, who had suffered from neuralgia for many years, her case presenting some peculiar points of interest. The trigeminal
eighteen
,
nerve
was
chiefly involved,
acute
pain being experienced
in the ear, eye, and supra-parietal region, whilst unilateral hyperaesthesia existed over the entire left side of the body from the head to the knee.
Reviews
and
Notices of Books.
on Gout and Rheumatic Gout. By A. B. GAREOD M.D., F.R.S. Third Edition. London: Longmans. 1876.
A Treatise
DR. GARRon’s well-known treatise on Gout is one of the works of which English medical literature is justly proud, for it contains the fullest extant account of the disease from the pen of the discoverer of the real pathology of the affection. It is hardly necessary to remind our readers of the general characters of the work, which are a very accurate and careful description of the symptoms of the disease, the original" discussion of its pathology, and a copious account of the principles of its treatment. The present edition has evidently been subjected to a thorough and careful revision, and a good deal of new material has been incorporated into the old texture. Among the additions must be specially mentioned the notes which Dr. Charcot appended to the French translation, and which have been introduced or referred to in the present edition. A little inconsistency is here and there to be noted between theory and phraseology, which is worth the attention of the author when the work comes to another edition. For instance, Dr. Garrod believes that the relation between the deposit of urate of soda in the joints and gouty inflammation is causal, that the presence of the urate is the cause of the inflammation. He urges many reasons for this view, and amongst them the fact that inflammation appears to destroy the urate of soda, since it cannot be found in the blood near the seat of active inflammation ; but he almost invariably phrases the sequence in the statement that 11 the gouty inflammation
’by enucleation
or
the
only
ecraseur, and the space between it andi
inch and three-quarters. The handI was introduced into the vagina, and pressure made on thee tumour, with a view to push it up out of the pelvis.i. Eventually this object was attained, and the forceps wass applied to the head, and delivery rapidly effected. Nc) l1aemorrhage followed. This was a case unmited for enucleation on account of the character of the growth. In suchi cases action should be taken early, and an effort made att repression before having recourse to more desperate measures -Dr. BARNES aid that the difficulties and dangers! associated with this complication varied with the seat ofF the tumour. When the growth projected into the cavity’ of the uterus the danger was very great; when situatedI in the lower segment of the uterus, enormous. In the latter case the tumour may be crushed, sphacelate, and giveI rise to pyaemia. There can be no doubt that fibroid tumoursi may atrophy ; they are occasionally expelled. Haemorrhage depends on the seat of the tumour.-Dr. BRAXTON HICKS said that not only small but large tumoursi opposing labour might be removed when situated in the lower segment of the uterus. He had removed successfully a mass as large as the foetal head. Some cases which appeared unpromising during early pregnancy improved during the course of gestation, so as not to give any trouble. When these conditions are met with during active labour they should be treated mechanically. - Dr. GODSON said that in a case under his care large masses were discharged and the tumour disappeared.-Dr. MURRAY had seen relief to the bowels brought about by pressing the* tumour from the pelvis by means of the band introduced into the rectum. -Dr. DE GORREQUER GRIFFITH had seen three cases of this complication: two without a bad sym-
pubes
was
an
-
’
,
ptom; the third complicated by post-partum haemorrhage. During gestation the tumour increased, but, afterwards diminished in size. - Dr. HAYES referred to a case in which death took place from haemorrhage before delivery. A fibroid, about the size of a Tangerine orange, which was easily enucleated after death, was found in the anterior wall of the cervix. The placenta was not prsevia.—Dr. Ems thought the best posture to effect reposition was the genu-pectoral. -After a few remarks from the President, Dr.PLATFAlE replied, saying that post-partum bsemorrbago occurred in some of these cases, but it did not appear to be so common as one would expect.
ASSOCIATION OF SURGEONS PRACTISING DENTAL SURGERY. A
of the Association was held on the 28th ultimo, S. Cartwright, F.R.C.S., President. Mr. CoLEMAN read a commumcation 11 On some Untoward Results of Immediate Torsion of the Teeth." Alluding to the supposed value of this operation in certain cases of dental irregularity, he showed how unsatisfactory the results might be when performed on imperfectly developed teeth. In certain cases development was entirely arrested, or absorption took place, and the tooth never descended to a level with its fellows, or even receded beyond the dental line, as occurred in a case the model of which he showed to the members present. These results he ascribed to the severance of the pulp-vessels by the operation.-Messrs. Cattlin, Edgelow, Srevenson, Gregson, and S. Cartwright joined in the discussion, there being a division of opinion as to the merits of the operation, though it was generally maintained that the operation was not justifiable before thirteen or fourteen years of age. Mr. S. J. A. SALTER then read a paper own some Reflex Symptoms and Results of Irritation of th e Dental Branches of the Fifth Nerve," and exhibited a seriesof specimens of dental and alveolar necrosis and exfoliation following the ernptive fevers-scarlet fever, measles, and small-pox. He said that a few isolated specimens of this condition, preserved in our hospital museums, had been attributed to mercury, but that that explanation was refuted by modern evidence. Mr. Salter considered that they are among the specific seque’se of the eruptive fevers; that the pulps and caps of the forming permanent teeth (members of the tegumentary system) are poisoned by the disease, die, and are shed in the only MEETING
in which they can be cast off-namely, by the necrosis and exfoliation of the capsule of bone which encases them, and to which the bone-necrosis is almost always strictly limited. Mr. Salter remarked that these cases usually occur in children about five years of age (a year or two more or less) when dental development is in its highest activity; that the morbid condition is usually symmetrical on both sides of the jaw; that the bone-necrosis is limited to the alveolar processes and capsules surrounding the teeth ; that he has never seen this condition excepting after eruptive fevers; and that he has had under his own care about
way
cases after scarlet fever, eight after measles, and four after small pox. Mr. T. W.B uNN read a paper On some Reflex Symptoms and Results of Irritation of the Dental Branches of the Fifth Nerve," in which he gave an account of certain cases confirmatory of the statements made by the President, Mr. Cartwright, in his communication" On Teething and its Complications" made to the Society on Nov. 22ad. The first case, which gave the keynote, as it were, to his subject, was a remarkable instance of delayed dentition in a woman between thirty and forty years of age, giving rise, by reflex irritation, to ulcer of the cornea. The ulcer, which obstinately resisted treatment, healed directly an upper bicuspid was cut.-The PRESIDENT gave several examples which had come under his notice of reflex action connected with the teeth, as also with other portions of the body, notably a remarkable case of double squint dependent upon curvature of the spine.-Mr. SALTER mentioned a case in which the iris had changed colour as a result of dental lesion.—Dr. WILTSHIRE ascribed ulceration of the cornea to the action of reflex nervous irritation on nutrition.-Mr. STEVENSON had seen good resulting from lancing the gums in cases of reflex disturbance. Mr. HAMILTON CARTWRIGHT showed a patient aged thirty, who had suffered from neuralgia for many years, her case presenting some peculiar points of interest. The trigeminal
eighteen
,
nerve
was
chiefly involved,
acute
pain being experienced
in the ear, eye, and supra-parietal region, whilst unilateral hyperaesthesia existed over the entire left side of the body from the head to the knee.
Reviews
and
Notices of Books.
on Gout and Rheumatic Gout. By A. B. GAREOD M.D., F.R.S. Third Edition. London: Longmans. 1876.
A Treatise
DR. GARRon’s well-known treatise on Gout is one of the works of which English medical literature is justly proud, for it contains the fullest extant account of the disease from the pen of the discoverer of the real pathology of the affection. It is hardly necessary to remind our readers of the general characters of the work, which are a very accurate and careful description of the symptoms of the disease, the original" discussion of its pathology, and a copious account of the principles of its treatment. The present edition has evidently been subjected to a thorough and careful revision, and a good deal of new material has been incorporated into the old texture. Among the additions must be specially mentioned the notes which Dr. Charcot appended to the French translation, and which have been introduced or referred to in the present edition. A little inconsistency is here and there to be noted between theory and phraseology, which is worth the attention of the author when the work comes to another edition. For instance, Dr. Garrod believes that the relation between the deposit of urate of soda in the joints and gouty inflammation is causal, that the presence of the urate is the cause of the inflammation. He urges many reasons for this view, and amongst them the fact that inflammation appears to destroy the urate of soda, since it cannot be found in the blood near the seat of active inflammation ; but he almost invariably phrases the sequence in the statement that 11 the gouty inflammation