[31] [In congenital cataract there can be no valid reason for postponing the removal of the opaque lens even to as late a period as that mentioned in the text. The operation is perfectly simple, unattended with risk, and may be performed within six or eight weeks after birth.—ED.]
[32] [This must, I suppose, be a typographical error. The author can certainly not mean that the instrument should be introduced at the centre of the cornea, as would inevitably happen if we were to carry out his directions. The proper point is the lower and outer part of the cornea, about a line anterior to its junction with the sclerotic coat.—ED.]
[33] See Elements of Pathological Anatomy, vol. i., p. 489, for description of this fascia.
[34] Boston Medical and Surgical Journal, Dec. 29th, 1841.
[35] [This opinion is certainly erroneous. That the obstruction occasionally exists in the situation adverted to, cannot be doubted, but that it does so constantly, or even generally, is not true. When the lining membrane of the antrum is inflamed, it does not follow that it must be so throughout its entire extent; most commonly, indeed, there is reason to believe that the morbid action is circumscribed, and hence when matter forms it may readily, in many cases, find its way into the nose. It is only where the whole of the mucous lining is involved, or that portion of it which covers the inner wall of the antrum, that the edges of the communicating aperture will be likely to be so much thickened as to produce complete obstruction. It is difficult to conceive how Mr. Liston could have committed such an error.—ED.]
[36] [These abscesses are sometimes acute, the suppuration occurring as a consequence of active inflammation. They are seated in the submucous cellular substance, and often acquire a large size; at first there is merely soreness in the throat and pain in swallowing, but when matter begins to be poured out difficulty of breathing is superadded, from the pressure which it exerts upon the epiglottis and mouth of the larynx, and if it be not speedily evacuated the patient may die from suffocation. As soon as fluctuation is recognised, or even before, if there be much swelling and difficulty of respiration, relief should be afforded by a free incision, made with a sharp-pointed bistoury with the back towards the tongue, which is to be depressed with the forefinger of the left hand.—ED.]
[37] [There is no subject of greater importance to the country practitioner than the extraction of the teeth; an operation which, from his insulated situation, he is constantly obliged to perform. Like the operation of venesection, it may be executed well or indifferently, and precisely as he does the one or the other will be the measure of his standing with his patients. The following observations in relation to this subject are condensed mainly from the excellent work of Mr. Bell, “The Anatomy, Physiology, and Diseases of the Teeth,” which should be in the hands of every physician in the country.
Mr. Bell thinks that the separation of the gum from the teeth, as a preliminary measure, is unnecessary; a view in which I must entirely disagree with him. That it materially facilitates the removal of the organ from its socket, ample experience has long since convinced me. The operation may be performed with a gum-lancet, or, what I have always preferred, a sharp penknife, which should be passed completely round the neck of the tooth, down to the alveolar margin of the jawbone. In the removal of the first teeth in children the previous separation of the gum is unnecessary.
The incisors of the upper jaw will require the use only of a small pair of straight forceps, the application of which is extremely simple. As the roots of these teeth are conical, and generally perfectly round, they will require merely a slight rotation, when they may be drawn downwards in the direction of the socket. The forceps should be placed as high on the root as the alveolar process will admit, and pressed so firmly as to prevent the blades from slipping, while at the same time care is taken not to crush the tooth.
The extraction of the lower incisors is effected in a very different manner. The roots of these teeth being very much flattened laterally, it is obvious that they cannot be dislodged upon the principle of simple rotation in the socket. When the tooth is even, or nearly so, with the others on each side of it, the best instrument will be the hawk’s-bill forceps, of very small size, and with narrow blades. The instrument being fixed as low on the neck of the tooth as possible, a gentle but firm movement is to be made forwards, so as just to separate the organ from the back part of the alveolar cavity, and then, continuously with this motion, the tooth is at once to be raised out of the socket.