1857 The Lancet  
81 at the hour mentioned. The pupils were contracted, but not completely so; he was a. little exhausted, and did not speak with his usual firmness of voice; I quickly procured the assistance of my friend, Mr. Robarts, of Great Coram-street, and' in our presence, at eight o'clock, he spontaneously vomited a. quantity of fluidfrom the.stomach, which contained the greater part of the laudanum, the smell of which was unmistakable, and. the bitterness as great as when it was swallowed the night
more » ... owed the night before. The name of the druggist who scid the laudanum Was ascertained, the stoppered vial which had contained by measurement twelve fluid drachms was sent to him, and we learnt, on clear evidence, the laudaom was-a pure and genuine article, and-had'been purchased at the time: stated by our patient.. We then gave him a breakfast-cupful of strong coffee, which was rejected in about a quarter of an hour, with much mucus. The coffee was repeated in twenty minutes, but' only a portion-of it was taken, and he remained quiet. His pupils< were now mere dilated than they were, and no constitutional disturbance was manifest. He was,perhaps, in,.the slightest degree drowsy. We left him at nine o'clock, in-charge of a careful nurse:—Ten A.M.: I'saw him again; he had been -perf6etly,-qniet; his pulse was 60, full, regular, and strong; pupils slightly contracted; drowsiness a little more marked; his ideas not easily collected; skin somewhat hot. He had taken nothing since previous visit. His ltwere all along of a-healthy pink colour, and the tongue was clean. As he felt, squeamish,--I prescribed an emetic of twenty grains of sulphate of zinc to be taken at=once.-Four P.M. : As before, quiet and calm ; skin clammy, but warm; pulse 60, full and regular. Still nauseated, but had' not mmited, even after the emetic. -Half-past eight P.M.: Saw him with my friend, Dr. Lagan. Skinnier and warm;pulse as before; rational and calm; pupilsa-little . contracted. He had some liausea after wakening from adoze, in which he-snored loudly; and vomited freely, which was encouraged by draughts of warm water. The egesta were a mixture of coffee and water, and smelt Vua He had dozed occasionally during the last four hours" but had not actually slept. He felt very languid and weak. July 17th.-Ten A.M.: Perfectly recovered in.every respect, but disposed to vagaries; had slept well the greater part of & p o u n d ; the night. Pulse 58, not so full, softer, and more natural; pupils natural-Eight P.M.: Feels giddy on attempting-to get up. From this period he had no. more -uneasiness, and got quite convalescent. For nine: hour8!tne twelveadraohms of--laudanum remained inactive in the stomach, without any symptoms of poisoning; vomiting then ensued, whicli-vaaa'followed by-perfect:recarery;. The case is, solely. remarkable from the fact of no ,symptoms of sor setting, in, which I should have ultimately looked for as in Dr. Christison's case, had: not, vomiting occurred. Watch. ing was still, however, necessary. In the oourae of; my. experience, an iastance occurred under my care) ia which three dtattima of,the tincture pMorMb fatal, although remedies were actively employed in a sailor, the subject of eahausting suppu ration of the knee-joint. In the-present instance any patient. was a healty and very temperate man, of remarkable age, audnot in the habit of using:opium at all. This case is only equalled by the one of"the student deacribed by Dr. Taylor,* who swal. loved four ou=.3 of laudauum at nine o'clock in the evening, went to bed" and slept till, six, the. next morning, when he vomitted freely, and recovered. Guildford-street, Bussell-square; July, 1857. Off the Operation in general.-The affécted tooth being carefully examined, its cavity is to., be well-dried out and cleaned,-; a soft napkin is them introduced; to protect the mouth, from the possibility of' contact with the instrument, the platinum-,Isat. of Which is, passed' into the cavity of' the tooth, is then heated, and" from its brilliancy, gives a clear and distinct. light, and the tooth-pulp is lightly touched, with; that heated with and the whole or particular portion of it required is destroyed. If, the operatbr-preferit; he may have" the. wire * Taylor on Poisons, 1848, p. 597. heated before introduction into the mouth, but my own practice is generally to apply the wire before doing this and' then permitting of incandescence to take place in the mouth, which gives a light whioh ia not seen by the. patient, and so well ihuminates the interior of the tooth, as to permit the tooth-pulp or diseased membrane to be seen very distinctly and clearly. There is some caution to be observed in the use of this agents, which it will be as well to mention, and thatia, to avoid burning or otherwise injuring the solid part of the tooth; particular attention and care should be paid to this.point. This will not happen unless the application is prolonged,. which will very rarely. indeed be required, if special care be o&served toBave the wire at a white heat. This is .the more nacessary, to produee speedy destruction ofthe part, to be touched, which is effected .almost instantly. In one istance under my care, that of a: lady f6r whom I nipped off the crown of an incisor tooth for the purpose-of , fixing some artificial teeth, and so exposed the: pulp of that tooth, I applied the electric cautery at barely heat owing to feebleness of the acid ; the consequence of this was, that the dental pulp became attached to the end of the wire, and was actually drawn; omt entirely. This has been preserved. It gave some sligbt -pain for the moment, tlat nothing in comparison to the pointed. steel or silver wire used by most dentists. This perhaps unimportant accident, I think would not have occurred, had the cautery been at a white heat xs it would then have completely-. carbonized, or destroyed the part with which it came into contact. The effect of the operation is..the rapid destruction of the pulps of the decayed and condemned tooth:; not the whole of the pulp for that is not always, necessary, but that portion of it especially which is exposed. If this is: done with a lights steady hand, no subsequent inflammation is produced upon the substance of the tooth, or in the cavity. If there should be any marked sensitiveness in the tooth, independent of the pulp, the slightest application of the cautery to it .will prove effectual in completely removing it. In the large number of case in in which I have employed the electric cautery I have never ItnoMt any bad effects produced on the tooth, . and this I attribute to the care with which it has been applied. I am, however, quite prepared to believe that a want. of attention in this respect would not only prove injurious to the tooth; but even in many instances cause its.. destruction. It would be only under such circumstances that the operation could be attended with or followed'by severe pain.-:
doi:10.1016/s0140-6736(02)38745-2 fatcat:xo5vcnwvrneszeszm3pc5hrbje