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treme vessels. Solid substantial partly voluntary. In ordinary resfood is far better adapted to the piration, they act involuntarily, laxity of solids which I have de- and even without our knowledge. scribed.
But we can suspend their action Astringent medicines may be for a time, by the operation of used, such as the infusion of roses; the will; or we can increase it to small doses of alum; or any oth- a great extent, when desirous of ers, may be used, though they so doing are much less effective than is Now it is necessary to be accommonly imagined. The acetate quainted with the causes which of lead is perhaps more powerful, are capable of putting the respiand sufficiently safe, if the dose ratory muscles into action and be limited to two or three grains, which we shall find to be various. three or four times in twentyfour 1st. These muscles contract, hours, and continued only for a and by so doing expand the chest, few days. But even this is equi- as a law of the system, or, in other vocal, as hemorrhage, in so many words, because it is necessary to instances, after a time ceases do so. This is, in reality, all that spontaneously. Blistering the we know on the subject; and is, chest, is a means of counterirri- probably, all that Mr. Hunter tation, that may possibly be of meant, when he used the expressome advantage.
sion "stimulus of necessity. of the Diseases of the Respira 2d. The muscles of respiration tory Muscles.—You will recollect are incited to act by the will. that I arranged the organs of res- Hence we can suspend their acpiration under three general tion altogether for a time; or we heads : 1st, The airpassages ; 2d, can increase or diminish it, and The lungs themselves; and, 3d, this in regard either to the musThe muscles employed in this of- cles of inspiration or of expiration. fice, the chief of which are the It would be more correct, howediaphragm and intercostal muscles, ver, to say, that it is the result the muscles of inspiration: for er- only that is determined by the piration can take place in a great will, and not the means by which measure, independent of muscular this result is obtained. We have power, by the mere elasticity of no direct power of determining by the lungs, and that of the carti- the will the action of any muscle. lages and ligaments of the ribs. 3d. Mental emotion powerfully The diseases belonging to the two influences the action of these former heads, have been already muscles. In some emotions of discussed. We are now, there- mind, as fear and terror, respirafore, to attend to those of the tion is hurried ; in other states of third head, the respiratory muscles, mind, as in sadness, and when the the nature and actions of which mind is engaged in intense thinkyou must first understand.
ing, respiration becomes slower, It is by the action, that is, the and is sometimes almost suspendcontraction, of the diaphragm and ed for a time; while, in sudden intercostal muscles, that the chest and great grief, the diaphragm is is expanded, and inspiration per- convulsively affected ; as in sobformed. The action of these bing. In laughing, it appears to muscles is partly involuntary, and be the muscles of expiration chief
ly, the abdominal muscles, that airpassages, is capable of exciting are, as it were, convulsively af- irregular action in the muscles of fected.
respiration. Thus, when the nosThese facts show, that the trils are irritated, the act of muscles of respiration are under sneezing takes place ; which conthe influence of the brain ; which sists, first, in a full inspiration of is further proved by the effect air into the lungs, and then by a both of injury and disease. Some violent and involuntary effort on violent injuries of the brain de- the part of the expiratory musstroy life quickly, by interrupting cles, the abdominal muscles, the air altogether the action of the respi- is suddenly and forcibly expelled ratory muscles. Slighter injuries again through the nostrils, by may, of course, derange or disturb which the irritating cause is likethe function in different degrees. ly to be removed; and where the So, in some diseases, where the irritating cause is applied to any brain is in a state of oppression, part of the trachea or its ramifieither from arterial distension, or cations, coughing is excited, and the extravasation of blood or se- which is effected by the rapid and rum, respiration becomes slow nearly involuntary expulsion of and laborious. This we frequent. the air through the glottis. ly observe towards the end of in But sometimes irritation of the flammatory states of the brain, of mucous membrane appears to all kinds, whether in the form of produce permanent contraction, phrenitis or hydrocephalus; while, or spasm of the diaphragm; during in the earlier stages of the same which, respiration becomes exaffections, the muscles of respira- tremely constrained and difficult; tion are preternaturally excited, as natural respiration requires a and respiration quickened. constant alternation of contraction
Nor are the respiratory mus- and relaxation of this muscle. cles exempt from the influence of It is the diseased states to the spinal chord. Injuries, and, which the muscles of inspiration of course, diseases of the medulla more particularly are liable, that spinalis, that are situated as high we are now to consider. The or above where the nerves are abdominal muscles, which are the given off that supply the muscles muscles of expiration, have variof inspiration, interfere with the ous other functions to perform of performance of this function, and more importance ; for expiration this in a degree corresponding can take place in a considerable with the injury sustained, or the degree without their aid, as I benature and extent of the disease, fore stated to you.
It follows, as a necessary con The diaphragm and intercostal sequence of what I have now muscles, the muscles of inspirastated, that injuries or diseases of ration, are liable, like all other any of the nerves that convey the structures, to inflammation ; and, influence of the brain, or spinal like muscles in general, to disorchord, to the muscles of respira- dered action without inflammation. tion, may also impede or disturb Inflammation of the diaphragm this function. Again, irritation of any part of it was formerly called paraphren
is properly named diaphragmélis. the mucous membrane lining the itis, and is so designated in daost
of the older writers ; on the sup- stances I have so repeatedly position of its being generally at- pointed out to you. tended with active delirium. One The diseases of the diaphragm sees, however, no particular rea- that take place independent of inson for this inflammation, more flammation, are spasm, and convulthan others, giving rise to deliri- sion or hiccough, as it is terined. um; nor does it accord with mo Spasm in this muscle occurs as dern observation. The term pa- a symptom of tetanus; and probaraphrenitis, therefore, is now gen- bly in many other cases of disease, erally laid aside. The diaphragm, as a secondary affection. It is or midriff, consists of a double characterized by pain, extending membrane, the upper being an across the body at the margin of extension from the pleura, the the chest ; and by straitened reslower, a continuation of the peri- piration. Such cases in practice toneum. Between these, is in- require only attention to the priterposed the muscular structure. mary disease. Now any one of these parts may A spasmodic affection of be attacked by inflammation, disa diaphragm, combined, perhaps, tinct from the rest ; though, in with a similar affection of the inpractice, the distinction may be tercostal muscles, sometimes difficult. When the pleura gen- takes place spasmodically, and erally is inflamed, the inflamma- constitutes one variety of asthma; tion may, and no doubt often does, as I shall soon have occasion to extend to the covering of the dia- notice. phragm ; which would probably, A convulsive action of the diain addition to the ordinary signs of phragm is termed hiccough, and is pleurisy, give rise to pain in the sometimes a sign of intlammation direction of the diaphragm, in- in this organ; when, of course, it creased on deep inspiration. If will be accompanied with the the peritoneal covering were the usual characters. It frequently part inflamed, we might expect to occurs, likewise, as a symptom feel pain in the abdominal cavity. of other diseases ; particularly, In either case, the muscular part inflammation in the abdomen; alof the structure might be affect. so, in brain affections, as in feed so as to disturb its action, and vers, in which it every now and that either spasmodically or con- then appears. It is produced likevulsively. That the muscle itself wise by repletion simply, or a of the diaphragm is liable singly disordered state of the stomach ; to inflammation, can hardly be and it may be occasioned by irridoubted, from analogy ; but it is tation or distension of the lower not likely that we should be able part of the æsophagus. When to distinguish such a case in actu- hiccoughing takes place as a sympal practice. Such minute dis- tom of inflammation, either in the tinctions, however, if they could brain or elsewhere, it is usually be made, would be of no practi- considered an unfavorable sign; cal utility ; the treatment being but it is by no means a necessarily in all cases the same ; namely, fatal one. the common antiphlogistic treat In the treatment of hiccough ment, modified as in other inflam- regard must be always had to the mations, by the different circum- cause, and particularly when it
arises from inflammation, as the of solicitude as to its event, from means that are calculated to put which there are but few individuals an immediate stop to the convul- even with stout hearts and strong sive action, such as antispasmodics nerves, who do not shrink, and and opiates, may not be the best rather for a time nurse up the evil adapted, or even admissible, with that they dread to cure, seeking a respect to the inflammation out temporary ease in the popular of which it arises.
palliatives of the day, which too The diseases to which the in- frequently serve only to protract tercostal muscles are liable, are the suffering that they profess to either inflammation or spasm. Iu- relieve. flammation 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 up to liquid fire,” all professing to temporary aggravations of pain be as excellent as they are numethat occur in this disease. While rous, and against many of which it endeavoring to relieve the spas- were well if no higher objection modic affection in these cases, could be urged than that of their you are to be careful not to em- total inefficacy; and here it may ploy means that will aggravate be of service to notice some of the the inflammation itself. It is ne- injurious effects frequently resultcessary I should observe to you, ing from the indiscriminate use of that most of the slight pains in the articles taken into the mouth as side that are frequently attribut- remedial applications to decayed ed to spasm, are in reality cases teeth, since to this too common of inflammation, and should be practice I am well convinced that treated as such.
many of the diseases of the teeth
and gums are properly to be referFor the Medical Intelligencer. red. Cases are of every day ocPractical Remarks on the Extrac- currence in the practice of the den
tion of Teeth, and on the Duty tist, in which extensive caries has of the Dentist in relation to this been induced in several teeth by the Operation. By T. W. Parsons, imprudent application to them of M.D., Surgeon Dentist.
various saline and caustic subThere is no common surgical ope- stances ;-pearlash, sal sodae, cayration among us of more frequent enne pepper steeped in brandy, necessity, and none that is generally elixir vitriol, several of the mineral attended with more dread on the acids, and various concentrated part of the patient, than that of the caustics and essential oils, are extraction of the teeth,—an opera- among the popular remedies of the tion in regard to which none are so present day. Any of these subinsensible as not to feel some degree stances, when applied to the cari.
ous cavity of a tooth, cannot be diseased, we cannot expect, nor do made to confine its action to this we find the teeth in a healthy state, tooth alone, by the very moisture —these to a considerable extent of the mouth it will either be dis- participate in the diseases of the solved or so mixed with the saliva gums, and vice versa. This is a that it must inevitably be brought fact which seems generally not to into contact with the other teeth ; have been sufficiently attended to ; and the fact that it is so, is very but it is truly no less the duty of apparent by the taste of the arti- the dentist to direct his treatment cle, which is always very percepti- so as to promote a sound and healthy ble in the mouth, hence the ad- condition of the gums, than it is to joining teeth, however sound, can- remove the tartar, or perform any not fail to be injured.
other necessary operation on the The use of strong spirituous li- teeth. I am well convinced that quors held in the mouth for the from a failure on the part of the purpose, as it is commonly express- dentist to insist on a course of treated, of " lulling the pain" of an ach- ment particularly directed to proing tooth, is no less pernicious than mote a healthy condition of the it is common. From this absurd gums, that the success of many of and useless practice a high degree the operations on the teeth have of inflammation is induced in the sometimes fallen into disrepute, and gums and membrane covering the the confidence of many individuals fangs of the teeth, the pain of which, in the resources of the dental art, when superadded to that of the ca- has been hereby much weakened, rious tooth, is usually so severe as if not entirely destroyed. to render its extraction inevitable. The immense number of sub
Under these circumstances, the stances that have at one time or anoperation itself is also unavoidably other been applied as remedies for much more painful, as the sensibi. the toothache, is truly astonishing ; lity of the parts concerned is great- and as if the products of the vast ly increased in consequence of their kingdom of nature were insufficient being at the time in a state of high for this purpose, recourse has often inflammatory action. I frequently been had to some of the potent innotice the gums extensively blister- fluences of the magic art, and it is ed, and highly irritable and painful doubtless true, that amulets,charms to the slightest touch for a long and incantations, with their imagitime, from the use of stimulating nary influences, have sometimes liquors held in the mouth, and succeeded, at least, in appeasing can declare, in the most unqualified for a time the enemy they could manner, that I have never known not vanquish. As if the favorite an instance in which they have con- panacea for toothache, like the tributed in the least, except for the long sought philosophers' stone, still moment, to relieve the pain of a remained to be discovered, we find carious tooth ; and I have no doubt even at this time, not only the pubthat the experience of every den- lic prints frequently announcing retist will on this subject be in per- medy after remedy for this formisect accordance with my own.
dable foe, but almost every indiviAffections of the gums are often dual we meet has a favorite one, 80 intimately connected with those peculiarly his own, from the philoof the teeth, that when they are sopher, the virtue of whose specific