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continuing his ordinary practices. In this state, no symp-
toms of irritation have been at all discovered. The skin is
cool during the day, no pain is complained of, and no ac-
count has ever been given me of any nocturnal paroxysm of
fever. It would appear to be purely a state of asthenia we
:
are, however, by no means certain, that there was no con-
cealed irritation in the system. We were, of necessity,
obliged to depend, in a great measure, upon the reports of
nurses, and other females, and these were liable to overlook,
or mistake for mere weakness, the signs of an obscure dis-
ease. In this manner, commencing cases were frequently
not discovered, and nothing was done till the affection had
made further progress ; and this continued until the ascer-
tained existence of the epidemic in the house, combined with
the recollection of its former ravages, had excited an alarm
which led to the inspection of the mouths of all the children
in the institution.
The disease, in this form, must be within the curative pow-
ers of nature ; as, if this were not the case, we should hear
of more numerous unfavourable terminations. It has sel-
dom, however, if at all, been within my power to witness
this tendency ; and when not controlled by a particular
treatment, the cases have almost always remained stationary,
or increased in severity. Its first progress is, most gener-
ally, by extending to the edges of the gums round other
teeth ; frequently affecting a large portion of the dental arch-
es. A very early progress is, however, mostly effected down
the length of the tooth, in the direction of the socket, and,
in this way, the disease commits great and unsuspected rav-
ages. When it reaches, the edges of the bony socket, the
tooth begins to be loose, and when drawn, exhibits portions
of the fang, including parts which had been contained within
the alveolus, entirely denuded of their periosteum. Indeed,