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really exist, it was not likely to produce symptoms so violent,
as those present, however it might affect the sense of hearing.
After a little consideration, I gave my opinion, that there
was great reason to hope for a complete recovery, if she
would allow me to investigate the case more minutely. The
effect of hope was wonderful. She readily permitted me
to examine every tooth, and every part of her mouth very
particularly.
Her teeth were, generally, under the influence of caries,
and the disease had penetrated to the cavity in some of them.
They were all more or less encrusted with tartar, her gums
and the sockets of her teeth were in an inflamed state, and
bled at the slightest touch. The left under second large
grinder was carious and painful, and the opposite one was
also carious, and the crowns of the two upper second bicus-
pidali were nearly destroyed. There was but little room
for the dentes sapientiae, and knowing that in the warm and
changeable climate of America, their formation is frequently
hastened at a premature age, particularly in delicate and
irritable constitutions, I readily suspected that their preco-
cious formation, and the want of room for them to pass
through the gums in combination with the diseases of the
teeth, were the causes of the inflammation, and the pain in
#
the ears."
Mr. Koecker obtained consent, and performed such ope-
rations upon her teeth and mouth, as to render them perfect-
ly healthy, and in conclusion remarks,* " These measures
were followed by great improvement of the general health,
cessation of pain in the ears, as well as of the discharge
from them. The hearing was good, but not quite so acute

Koecker, page 161.