| Vol. II. | Brooklyn, N. Y., August, 1888. | No. 2. |
ORIGINAL ARTICLES.
PAIN, WITH SPECIAL REFERENCE TO ITS DENTAL RELATIONS.
BY WM. M. THALLON, M.D.
Read before the Brooklyn Dental Society, May 28, 1888.
Mr. President and Gentlemen:—Some months ago, when sitting in the operating-chair of your Chairman of the Committee on Subjects, he asked me if I would not read a paper before the Brooklyn Dental Society. In the helpless condition in which I then was, with literally a gag in my mouth, robbing me of the prerogative of free speech, and under the shadow of a formidable mallet, I somewhat timorously signified an assent. Under those circumstances I know of few men who would have had the moral and physical courage to have resisted such an appeal. When in the course of his further practices, he asked me what my subject would be, I promptly replied by mentioning the thing then most vivid in my mind: Facial Neuralgia.
I hardly realized my rashness and what I had undertaken, until I received your printed bulletin of subjects. But it has seemed to me on further thought that we might perhaps spend an hour profitably together in comparing notes about that borderland of facts and problems, which you touch on the one side as dentists and I on the other as physician. And I trust you will be lenient with me in your judgments if I go astray in my talk, and I pray you to remember that we doctors labor under great disadvantages compared with you dentists, contrasting the width and vagueness of our territory of research with the precision and accuracy of yours. I have again and again envied the exquisite dexterity and the certainty of adapting means to ends which I have seen exhibited by members of your profession, and vainly longed for the same in my own. But on the other hand, I think it may justly be urged that the dentists have not contributed as much to the general stock of knowledge, especially to the solution of disputed questions of pathology, such as the relation of micro-organisms to disease, as their unrivaled opportunities for observation would allow.
I shall therefore not hesitate, Mr. President, to somewhat dogmatically present my views on certain subjects, but I ask you to believe it is mainly because I hope the gentlemen present will honor them by frank and full discussion.
I shall also ask permission to change the subject of my remarks from the announced title to one of a little wider scope, namely, Pain, with special reference to its dental relations.
I presume the symptom of pain is the one for which the overwhelming number of your patients, as the majority of ours, apply to us for relief. And yet common as this sensation is both in ourselves and in others, it is very remarkable how little settled opinion is, as to its nature. If you have never had occasion to try and put into the form of a definition the idea of pain, and proceed to consult the authorities, you will be surprised that so many different views could be held of what at first seems so common and obvious as to be beyond dispute. As you proceed in your inquiries, the question instead of becoming simpler apparently becomes more complex, for as you think of the different forms of pain, and contrast, for instance, that of an inflamed rheumatic joint, with its definite structural changes and well-marked constitutional symptoms like fever, with an idiopathic neuralgia, pure and simple, often lacking in any outward manifestation other than the pain itself, you wonder if the pains resulting are not as different as the diseases producing them. But the common consciousness of mankind which has given the same name to the sensation produced, whether by an inflamed bowel or a carious tooth, is sure to be right in believing that there is essentially the same substratum in each. Now what is the nature of that substratum? It is evident that whatever else it is, pain is a disagreeable sensation, and the word sensation further obliges us to remember that it involves a central nervous system (in its simplest type a single cell), capable of feeling impulses, conveyed to it from without, or else generated within itself. Now, it is very evident that pain must consist either in some change in the nature of the impulses sent to our central cell, or else in some change in the condition of the receiving centre. So eminent an authority as Prof. Erb defines pain simply as an increase in the ordinary sensory stimulus, a heightening more or less intense of ordinary sensation. On the other hand, Anstie defines pain as a perturbation in the nervous system, especially of the central cells, involving a lowering of function, a diminution of ordinary sensation. It is very evident that both of these great authorities cannot be exclusively right, and I propose to see what light we could get on this subject from the abundant clinical evidence you have.