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Extraction of a Tooth: Entire Unconsciousness of PainAuthor(s): Richard TurnerSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 9, No. 40 (Oct. 1, 1845), pp.604-605Published by: BMJStable URL: http://www.jstor.org/stable/25498840 .

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404 EXTRACTION OF A TOOTH WITHOUT PAtN.

though not rising satisfactorily. The vital powers were beginning to fail, the pulse between 130 and i40, and the extremities getting chilly, although there was a warm perspiration on the face; the tongue was

moist, and rather white, (as if mercurial.) The patient was perfeetly sensible, and very calm and tranquil. He had complained often of nausea and sickness, but

had not rejected, (as was stated to me,) food or

medicine.

On the first day after the blackberries were eaten

he vomited some of them, and diarrhea was most

troublesome, the bowels being purged nearly every

quarter of an hour; but since the morning of the 11th

no action could be procured from them, despite of the

several remedies which had been prescribed and taken

very frequently. Enemata had also been administered

in vain. Seeing that there was so little to be done, or

rather so little time to do what was proper in, I pre scribed saline aperients, in the effervescing form, every two hours, alternately with a pill of compound extract

of colocynth and croton oil; the blister to be kept on;

chicken broth to be given at intervals in small

quantities. On the 14th, at ten o'clock, I was less surprised than

grieved to find the patient more depressed, and that

the medicines and broth had almost instantly been

rejected from the stomach. The pulse was barelyidis

tinguishable, and the surface much lower in tempera

ture, notwithstanding the constant efforts to preserve the warnith of the whole body. A warm bath was

used, and ammonia prescribed; but the patientfittle fellow quickly sank, and died at one o'clock, appa

rently without pain. Examination twenty hours after death.-Marks of

decomposition going forward rapidly were visible

externally, particularly upon the abdomen. Within

the latter a vast quantity of turbid scrum was effused, and the entire reflections of the peritoneum exhibited

the most intense vascularity. The appendix vermi

formis of the caecum lay rather more anteriorly than

natural, and was somewhat directed to the left side. It was most conspicuous from the state of dark

ulceration which it was in, and from forming the

centre as it were of the inflammation existing during life. On more closely examining it, a perforation, surrounded by purulent matter, was found near to its

blind extremity, large enough for the passage of a

pea; and just above this a calculus, the size of a horse

bean, soft and pultaceous externally. The several

convolutions of intestine adjacent were glued together

by organized lymph, firmly adherent, and of the thick ness of chamois leather, and were of a dark black

colour. The cmcumn contained some healthy feculent matter in a liquid state, and the mucous membrane

internally was unaffected. No traces of the blackberries were met with.

In a few minutes after exposure to the air the con

cretion became harder, and rattled when shaken in the

saucer containing it. My esteemed friend, Dr. Prout, has kindly informed me that, "it contains a small

portion of a crystallizable fatty matter, which is pro

bably cholesterine. The bulk consists of inspissated mucus, with a considerable proportion of phosphate of

lime, and some carbonate of lime, the usual composi tion of all such deposits."

Just twenty years ago I witnessed a case, almost

precisely similar, in the practice of my friend and valued preceptor, Mr. Wickham, of Winchester. The

subject was a young collegian,'and the case is reported by Mr. Wickham, in one of the numbers 6f the London Medical and Physical Journal, for 1826. Dr. Prout tells me that a distinguished friend of his, the late Under Secretary for Ireland, died of a similar

cause, after a short but very severe illness. He has never himself met with an instance.

By some writers on calculous formations allusion is made to the various organs and cavities in which these

have been found, and I think the appendix vermifo.rmis has been specifically mentioned, but I cannot at this moment give the references. There can be very little doubt that the concretion forms in the intestines,

enters the appendix accidentally, wherein it becomes

impacted, producing such fearful effects asian extra

neous body, whereas, if it passed along the colon it would be wholly unperceived.

It may be perhaps as well to add, that I was facilitated in obtaining a post-mortem examination bytheobjection

of the registrar to receive the cause of death from

any other person than the medical attendant, under the recent regulation. The friends represented to him that the patient had been poisoned by blackberries, or something to this effect, and they were told by the

registrar, that if such were the case, a coroner's

inquest must be held. This at 6nce decided the

question in their minds, and they forthwith applied to me to open the body. I need scarcely remark on the extreme importance necessary, on the part of the

medical man, not only in giving a verbal opinion, but in signing a certificate of the cause of death in such a case. The ingesta into the stomach might have been here set down as the cause, had not the contrary been

proved by dissection.

I remain. Sir, Your obedient humble servant,

G. BURY.

Whetstone, September 19, 1845.

EXTRACTION OF A TOOTH: ENTIRE UNCON SCIOUSNESS OF. PAIN.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

SURGICAL JOURNAL. SIR,

It may be tlat sufficient space has already been

occupied in your Journal, on the subject of animal

magnetism, it being not one of the most practical subjects with which to engage the attention of your readers. If, however, you can find room for it, I have one more case for the profession.

On the 25th of August, A. B., a cook in a gentleman's family, came to me to have a tooth extracted. On

looking at it, I found it not much diseased, but the

gum inflamed; I therefore recommended lancing the

gum, hoping that would relieve it. This I did freely in all directions around the tooth, it standing by itself.

On using warn water, to encourage bleeding, and

cleanse the moutlh, she said it made it ache more, and

thought she had better have it out. Accordingly I pro ceeded with the forceps to extract, (it was an upper

bicuspid.) At first she just placed her hand on mine, when I requested her to hold on the chair; she put

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THE NEW LUNACY ACT.6

down her hands, and I removed the tooth, not without

Considerable lateral movement, and a rather hard pull. I was about to give her water to wash her mouth

with, when I found her head fall toward my shoulder, her hands hanging by her side, and her mouth open,

taking no notice when I spoke; in this state she remained a sensible time,-from one to two minutes

perhaps,-and as I was about to alter her position, she

quietly opened her eyes, with. a little kind of winking, very much as I have seen them, when the hand of a

mesmeriser was rapidly passed across, (to undo the

spell, I believe.) After she had cleansed her mouth, I

asked her if it hurt as much as she expected, and she said "I knew nothing about it." Let it be observed, that this was altogether different from those cases

which I have several times witnessed, where the patient screams out with pain, and faints away. Now, I cer

tainly did not think of magnetizing this patient, though if she had heard something about it, and I had tried,

perhaps I might, unpractised as I am in the art, (should I say science ) I feel quite persuaded the patient knew nothing of animal magnetism, and equally sure that it did not for a moment occur to me, till she said she knew not when the tooth came out.

Mr. Newnham, in answer to a correspondent in the

Journal, (March 12th,) says, " I never before witnessed an operation performed where there was entire uncon

sciousness of pain;" nor did I, till tile case I have here narrated presented itself.

I submit the case as one not "' borne with stoical

apathy, heroic fortitude, jocular levity of expression, or apparent indifference to suffering," but one in which there was entire unconsciousness of pain; and that, too,

withoutany magnetizing process having been consciously gone through.

I am, Sir,

Yours faithfully, RICHARD TURNER, M.R.C.S., &c.

Tonbridge Wells, Sept. 19, 1845.

PROVINCIAL

j tble cal & *urgical Sournal. WEDNESDAY, OCTOBER 1, 1815.

Of all evils in a country in which the authority of State enactments or laws is recognized, that of

hasty and ill-digested legislation is most to be

deprecated. The legal fiction that the subjects of such a State are bound to know that which the

highest physical and intellectual endowments, with

time and means also to devote them entirely to the

object, can never enable them to attain to a know

ledge of, or comprehend, is fraught with injustice and moral wrong. In very many instances the con straint is thrown, not so much upon the will and

disposition of the individual, as upon his powers both of body and mind, and responsibilities are

forced upon him, which however well disposed he might be to discharge them, are neither known to him, nor indeed from their oppressive numerical

extent, obscurity, and uncertainty, can ever be conle so.

It may be objected that the evil complained of is

inseparable from all legislation, and especially so in a highly civilized community, where the interests to be protected are numerous and complicated, and

oftentimes opposing; but if this be so, it should

surely render the necessity for caution and careful

deliberation, in each progressive step, whether of

so-called amendment, or new enactment, which may be proposed, only so much the mote apparent.

Looking to the general tone of society in this

country, it may safely be advanced, that there is

much respect for the laws, and a desire, for the

most part, amongst the respectable portion of the

community of all classes, to support and obey them.

It is no light evil then, by such hasty and unadvised

attempts at legislation, as each session of parlia ment gives origin to, either to weaken these

feelings, to do violence to the conscientious prin

ciple by which they are regulated, or to render

them nugatory, by the impossibility of carrying them out.

W e have been led to make these observations

by a survey of the new Lunacy Act; and although

many of its provisions are of real value, and reflect

much credit upon the philanthropic nobleman to

whom it owes its origin, we are compelled to say there are other parts of the measure which bear

the marks of imperfect acquaintance with many branches of the subject, and which, if carried into

operation, will, it is to be feared, lead to serious

inconvenience, and indeed tend materially to injure the very class of persons for whose benefit the Act

is mainly intended.

It is not, however, intended on the present occa

sion, to do more than allude to this part of the subject,

although a few words might suffice to show that

tlie close restrictions attempted to be enforced, must, if carried out, ultimately have the effect of increas

ing the number of incurable lunatics. The evil of

which we are now complaining is, that from a

want of due consideration in some of the details, much injustice is inflicted upon those on whose

judicious services the restoration of the sufferers

under this most severe of earthly afflictions so

greatly depends, while so little are the bearings of

thle Act likely to be understood or appreciated, that

although the discussions on it are fresh in the

recollection of all who have felt an interest in tile

question, we will undertake to say that, without

the slightest intention or wish to evade its provisions, the greater number of lunatics who have been

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