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SWELLING OF THE DENTAL PULP. 839

gation has again dispelled this idea, and now it seems to me fairly well
settled that it is the condition of the patient that determines this form
of pain, rather than the particular form of disease of the dental pulp
by which it is excited. It appears, however, that neuralgia rarely
results from acute affections of the pulp.
Swelling (that is apparent) is uniformly absent in the diseases of the
dental pulp. In diseases of the peridental membrane swelling occurs
uniformly, either in slight degree or extensively. Especially is there
apt to be some swelling and tenderness of the lymphatics of the angles
of the neck. This does not occur in any of the diseases of the dental
pulp. The only instances in which I have noted exceptions to this rule
have been in inflammations of the pulp in children, in teeth of which
the roots were not yet fully developed, and consequently were still Avide
open at the apex. But even in these cases it is of rare occurrence. This
fact is to be explained by the consideration of the anatomy of the parts,
together with the theory of oedema and the cause of the swelling of the
lymphatics in inflammatory diseases. In regard to the latter, it seems
that in inflammations the tissue-changes are imperfectly performed,
resulting in the formation of abnormal waste products which are taken
up by the lymphatics. These cause swelling and tenderness of the first
lymphatic glands at which they arrive in their course toward the central
parts of the body. This being the case, it is clear that different inflam-
mations will differ as to the amount of swelling they will cause in these
glands, those of a septic character usually causing the most, for the
reason, perhaps, that the poisonous products of micro-organisms are
added to that produced by the abnormal tissue-changes. Thus a com-
mon " canker sore " on the mucous membrane will often cause more
trouble to the glands in the angles of the neck, than an alveolar abscess.
Th« principal reason why we have no lymphatic swellings in connection
with inflammations of the dental pulp is probably to be found in the
fact that the pulp has no lymphatics ; therefore the altered products of
inflammation are not removed by that system of vessels.
The absence of oedema in inflammations of the dental pulp is evi-
dently owing to the confinement of the organ in its dentinal chamber,
together with the absence of areolae in its tissue. These two causes com-
bine primarily to prevent the escape of the serum of the blood from
the vessels, and secondarily to prevent its infiltrating the surrounding
tissues. It cannot pass through the dentine, and in the normal condi-
tion the apical foramen is too narrow to allow of much escape by that
route, especially as inflammation is for the most part confined to the
bulb of the pulp at some distance from the apical foramen. For these
reasons, anv effusions that occur in the pulp are necessarily removed by
the veins, if removed at all, and therefore do not cause swelling of con-
tiguous parts. Ordinarily, the effusions must be very slight, for the
sim])le reason that there is no space for their accommodation. That
sioeUinfi of the pulp occurs, however, must be plain to every one who has
noticed its protrusion into a cavity of decay through an orifice exposing
its tissue.
In widespread diffusive inflammation or hyperemia of the pulp there
may be some effusion into the apical space, causing the tooth to be