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treme vessels. Solid substantial food is far better adapted to the laxity of solids which I have de

scribed.

Astringent medicines may be used, such as the infusion of roses; small doses of alum; or any others, may be used, though they are much less effective than is commonly imagined. The acetate of lead is perhaps more powerful, and sufficiently safe, if the dose be limited to two or three grains, three or four times in twentyfour hours, and continued only for a few days. But even this is equivocal, as hemorrhage, in so many instances, after a time ceases spontaneously. Blistering the chest, is a means of counterirritation, that may possibly be of some advantage.

Of the Diseases of the Respiratory Muscles.-You will recollect that I arranged the organs of respiration under three general heads 1st, The airpassages; 2d, The lungs themselves; and, 3d, The muscles employed in this office, the chief of which are the diaphragm and intercostal muscles, the muscles of inspiration: for expiration can take place in a great measure, independent of muscular power, by the mere elasticity of the lungs, and that of the cartilages and ligaments of the ribs. The diseases belonging to the two former heads, have been already discussed. We are now, therefore, to attend to those of the third head, the respiratory muscles, the nature and actions of which you must first understand.

It is by the action, that is, the contraction, of the diaphragm and intercostal muscles, that the chest is expanded, and inspiration performed. The action of these muscles is partly involuntary, and

partly voluntary. In ordinary respiration, they act involuntarily, and even without our knowledge. But we can suspend their action for a time, by the operation of the will; or we can increase it to a great extent, when desirous of so doing.

Now it is necessary to be acquainted with the causes which are capable of putting the respiratory muscles into action and which we shall find to be various.

1st. These muscles contract, and by so doing expand the chest, as a law of the system, or, in other words, because it is necessary to do so. This is, in reality, all that we know on the subject; and is, probably, all that Mr. Hunter meant, when he used the expression "stimulus of necessity."

2d. The muscles of respiration are incited to act by the will. Hence we can suspend their action altogether for a time; or we can increase or diminish it, and this in regard either to the muscles of inspiration or of expiration. It would be more correct, however, to say, that it is the result only that is determined by the will, and not the means by which this result is obtained. We have no direct power of determining by the will the action of any muscle.

3d. Mental emotion powerfully influences the action of these muscles. In some emotions of mind, as fear and terror, respiration is hurried; in other states of mind, as in sadness, and when the mind is engaged in intense thinking, respiration becomes slower, and is sometimes almost suspended for a time; while, in sudden and great grief, the diaphragm is convulsively affected; as in sobbing. In laughing, it appears to be the muscles of expiration chief

ly, the abdominal muscles, that are, as it were, convulsively affected.

These facts show, that the muscles of respiration are under the influence of the brain; which is further proved by the effect both of injury and disease. Some violent injuries of the brain destroy life quickly, by interrupting altogether the action of the respiratory muscles. Slighter injuries may, of course, derange or disturb the function in different degrees. So, in some diseases, where the brain is in a state of oppression, either from arterial distension, or the extravasation of blood or serum, respiration becomes slow and laborious. This we frequently observe towards the end of inflammatory states of the brain, of all kinds, whether in the form of phrenitis or hydrocephalus; while, in the earlier stages of the same affections, the muscles of respiration are preternaturally excited, and respiration quickened.

Nor are the respiratory muscles exempt from the influence of the spinal chord. Injuries, and, of course, diseases of the medulla spinalis, that are situated as high or above where the nerves are given off that supply the muscles of inspiration, interfere with the performance of this function, and this in a degree corresponding with the injury sustained, or the nature and extent of the disease.

It follows, as a necessary consequence of what I have now stated, that injuries or diseases of any of the nerves that convey the influence of the brain, or spinal chord, to the muscles of respiration, may also impede or disturb this function.

Again, irritation of any part of the mucous membrane lining the

airpassages, is capable of exciting irregular action in the muscles of respiration. Thus, when the nostrils are irritated, the act of sneezing takes place; which consists, first, in a full inspiration of air into the lungs, and then by a violent and involuntary effort on the part of the expiratory muscles, the abdominal muscles, the air is suddenly and forcibly expelled again through the nostrils, by which the irritating cause is likely to be removed; and where the irritating cause is applied to any part of the trachea or its ramifications, coughing is excited, and which is effected by the rapid and nearly involuntary expulsion of the air through the glottis.

But sometimes irritation of the

mucous membrane appears to produce permanent contraction, or spasm of the diaphragm; during which, respiration becomes extremely constrained and difficult; as natural respiration requires a constant alternation of contraction and relaxation of this muscle.

It is the diseased states to which the muscles of inspiration more particularly are liable, that we are now to consider. The abdominal muscles, which are the muscles of expiration, have various other functions to perform of more importance; for expiration can take place in a considerable degree without their aid, as I before stated to you.

The diaphragm and intercostal muscles, the muscles of inspiraration, are liable, like all other structures, to inflammation; and, like muscles in general, to disordered action without inflammation.

Inflammation of the diaphragm is properly named diaphragmitis. It was formerly called paraphrenitis, and is so designated in most

of the older writers; on the supposition of its being generally attended with active delirium. One sees, however, no particular reason for this inflammation, more than others, giving rise to delirium; nor does it accord with modern observation. The term paraphrenitis, therefore, is now generally laid aside. The diaphragm, or midriff, consists of a double membrane, the upper being an extension from the pleura, the lower, a continuation of the peritoneum. Between these, is interposed the muscular structure. Now any one of these parts may be attacked by inflammation, distinct from the rest; though, in practice, the distinction may be difficult. When the pleura generally is inflamed, the inflammation may, and no doubt often does, extend to the covering of the diaphragm; which would probably, in addition to the ordinary signs of pleurisy, give rise to pain in the direction of the diaphragm, increased on deep inspiration. If the peritoneal covering were the part inflamed, we might expect to feel pain in the abdominal cavity. In either case, the muscular part of the structure might be affected so as to disturb its action, and that either spasmodically or convulsively. That the muscle itself of the diaphragm is liable singly to inflammation, can hardly be doubted, from analogy; but it is not likely that we should be able to distinguish such a case in actual practice. Such minute distinctions, however, if they could be made, would be of no practical utility; the treatment being in all cases the same; namely, the common antiphlogistic treatment, modified as in other inflammations, by the different circum

stances I have so repeatedly pointed out to you.

The diseases of the diaphragm that take place independent of inflammation, are spasm, and convulsion or hiccough, as it is termed.

Spasm in this muscle occurs as a symptom of tetanus; and probably in many other cases of disease, as a secondary affection. It is characterized by pain, extending across the body at the margin of the chest; and by straitened respiration. Such cases in practice require only attention to the primary disease.

A spasmodic affection of the diaphragm, combined, perhaps, with a similar affection of the intercostal muscles, sometimes takes place spasmodically, and constitutes one variety of asthma; as I shall soon have occasion to notice.

A convulsive action of the diaphragm is termed hiccough, and is sometimes a sign of inflammation in this organ; when, of course, it will be accompanied with the usual characters. It frequently occurs, likewise, as a symptom of other diseases; particularly, inflammation in the abdomen; also, in brain affections, as in fevers, in which it every now and then appears. It is produced likewise by repletion simply, or a disordered state of the stomach; and it may be occasioned by irritation or distension of the lower part of the esophagus. When hiccoughing takes place as a symptom of inflammation, either in the brain or elsewhere, it is usually considered an unfavorable sign; but it is by no means a necessarily fatal one.

In the treatment of hiccough regard must be always had to the cause, and particularly when it

arises from inflammation, as the means that are calculated to put an immediate stop to the convulsive action, such as antispasmodics and opiates, may not be the best adapted, or even admissible, with respect to the inflammation out of which it arises.

of solicitude as to its event, from which there are but few individuals even with stout hearts and strong nerves, who do not shrink, and rather for a time nurse up the evil that they dread to cure, seeking a temporary ease in the popular palliatives of the day, which too frequently serve only to protract the suffering that they profess to relieve.

The diseases to which the intercostal muscles are liable, are either inflammation or spasm. Inflammation here may be of the By these remarks it is not to be rheumatic kind, and will then understood that I object to the use probably be accompanied with of any probable means for the purrheumatism in other parts. A pose of allaying the pain, and therestate of spasm in these muscles, by enabling a carious tooth to regives rise to those intolerable main "a quiet tenant in its accusstitches in the side, as they are tomed house;" but I do object to called, which are often induced that random, useless, and worse by violent muscular exertion. It than useless range of inefficient takes place also in many cases of prescriptions, from "simple water pleurisy, and is the cause of those temporary aggravations of pain that occur in this disease. While endeavoring to relieve the spasmodic affection in these cases, you are to be careful not to employ means that will aggravate the inflammation itself. It is necessary I should observe to you, that most of the slight pains in the side that are frequently attributed to spasm, are in reality cases of inflammation, and should be treated as such.

For the Medical Intelligencer.

Practical Remarks on the Extraction of Teeth, and on the Duty of the Dentist in relation to this Operation. By T. W. PARSONS, M.D., Surgeon Dentist.

THERE is no common surgical operation among us of more frequent necessity, and none that is generally attended with more dread on the part of the patient, than that of the extraction of the teeth,—an operation in regard to which none are so insensible as not to feel some degree

up to liquid fire," all professing to be as excellent as they are numerous, and against many of which it were well if no higher objection could be urged than that of their total inefficacy; and here it may be of service to notice some of the injurious effects frequently resulting from the indiscriminate use of articles taken into the mouth as remedial applications to decayed teeth, since to this too common practice I am well convinced that many of the diseases of the teeth and gums are properly to be referred. Cases are of every day occurrence in the practice of the dentist, in which extensive caries has been induced in several teeth by the imprudent application to them of various saline and caustic substances;-pearlash, sal sodae, cayenne pepper steeped in brandy, elixir vitriol, several of the mineral acids, and various concentrated caustics and essential oils, are among the popular remedies of the present day. Any of these substances, when applied to the cari

ous cavity of a tooth, cannot be made to confine its action to this tooth alone,-by the very moisture of the mouth it will either be dissolved or so mixed with the saliva that it must inevitably be brought into contact with the other teeth; and the fact that it is so, is very apparent by the taste of the article, which is always very perceptible in the mouth,-hence the adjoining teeth, however sound, cannot fail to be injured.

The use of strong spirituous liquors held in the mouth for the purpose, as it is commonly expressed, of "lulling the pain" of an aching tooth, is no less pernicious than it is common. From this absurd and useless practice a high degree of inflammation is induced in the gums and membrane covering the fangs of the teeth, the pain of which, when superadded to that of the carious tooth, is usually so severe as to render its extraction inevitable. · Under these circumstances, the operation itself is also unavoidably much more painful, as the sensibility of the parts concerned is greatly increased in consequence of their being at the time in a state of high inflammatory action. I frequently notice the gums extensively blistered, and highly irritable and painful to the slightest touch for a long time, from the use of stimulating liquors held in the mouth, and I can declare, in the most unqualified manner, that I have never known an instance in which they have contributed in the least, except for the moment, to relieve the pain of a carious tooth; and I have no doubt that the experience of every dentist will on this subject be in perfect accordance with my own.

Affections of the gums are often so intimately connected with those of the teeth, that when they are

diseased, we cannot expect, nor do we find the teeth in a healthy state,

these to a considerable extent participate in the diseases of the gums, and vice versa. This is a fact which seems generally not to have been sufficiently attended to; but it is truly no less the duty of the dentist to direct his treatment so as to promote a sound and healthy condition of the gums, than it is to remove the tartar, or perform any other necessary operation on the teeth. I am well convinced that from a failure on the part of the dentist to insist on a course of treatment particularly directed to promote a healthy condition of the gums, that the success of many of the operations on the teeth have sometimes fallen into disrepute, and the confidence of many individuals in the resources of the dental art, has been hereby much weakened, if not entirely destroyed.

The immense number of substances that have at one time or another been applied as remedies for the toothache, is truly astonishing; and as if the products of the vast kingdom of nature were insufficient for this purpose, recourse has often been had to some of the potent influences of the magic art, and it is doubtless true, that amulets, charms and incantations, with their imaginary influences, have sometimes succeeded, at least, in appeasing for a time the enemy they could not vanquish. As if the favorite panacea for toothache, like the long sought philosophers' stone, still remained to be discovered, we find even at this time, not only the public prints frequently announcing remedy after remedy for this formi dable foe, but almost every individual we meet has a favorite one, peculiarly his own, from the philosopher, the virtue of whose specific

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