Periscope of Medical and General Science in their Relations to Dentistry. [Volume: 2, Issue: 4, November, 1860, pp. 234-240]

236

THE DENTAL COSMOS.

auditory canal, or the upper portion of the anterior part of the external
ear, the pain must be, without question, (I hope I shall not be considered
as putting this too dogmatically,) the result of some irritation or diseased
condition or cause associated with the fifth cerebral nerve, and this gives
precision to further inquiry.
"Now, we know very well that there is often a simultaneous occurrence
of toothache and earache. The same nerve supplying the auditory canal
and the anterior portion of the ear supplies also the teeth; hence, in all
probability, this sympathetically associated influence. I think you may
take a further step in the other direction, and say that earache is often
accompanied with stiffness of the jaws, the fifth nerve supplying the
masticatory muscles which fix the jaw. So we know perfectly well that
disease affecting any part of the anterior third of the tongue is a very
common cause of pain in the auditory canal, the tongue and the auditory
canal being supplied by the fifth nerve. These auricular pains are pretty
constant in cases of malignant disease attacking the side of the tongue or
the part toward the apex. Local morbid conditions are sometimes induced
by irritating secretions resulting from the free nervous communication between the different parts which derive their sensibility from the fifth nerve.
"A professional friend had an enlarged gland below the external ear.
The real cause of this was not quite apparent, and so he requested me to
look at it. There was a slight discharge of morbid secretion in the
auditory canal. We argued the question together, and I said, 'Very likely
it may be the result of a decayed tooth. Irritation from it may be conveyed
to the auditory canal, and induce this morbid secretion; that morbid
secretion may produce slight excoriation, and that excoriation, aided by
lymphatic absorption, may explain the existence of the enlarged gland.'
The tooth was extracted, and all the other local morbid conditions disappeared, and there was no recurrence of these local symptoms.
"In order to show the practical application of the views I have just
advanced, I may mention a case that occurred last year. A gentleman,
aged sixty-three, came to consult me regarding an ulcer situated upon
the left side of his tongue. On examination, I there found an elongated,
very ugly-looking ulcer, nearly as large as a bitter almond, and of much
the same shape. The surrounding parts were swollen, hard, red, and
much inflamed, and a lymphatic gland was enlarged below the horizontal
ramus of the lower jaw on the same side. I saw in the mouth a rugged
tooth, with several projecting points upon it, opposite the ulcer. This
gentleman observed to me, 'Having suffered a good deal from earache on the left side for a long time, without experiencing any relief from medical treatment, it was thought that I must be gouty, and
I went to a surgeon who treats gouty affections of the ear. This
surgeon paid great attention to my ear, but certainly did not do it the
slightest degree of good. I accidentally mentioned to him that I had had
for some time past something the matter with my tongue. On seeing it,
he immediately began to apply caustic vigorously; moreover, not satisfied
with applying it himself, he gave it to my wife, that she might apply it at
home. I have gone on in this way from day to day until the pain in my
ear is very considerably increased, and the ulcer on my tongue is enlarging: so I have come to you for your opinion regarding my state; for, to
tell you the truth, I am afraid of a cancer in my tongue.' I thought I
saw the explanation of this patientis symptoms. The pain in the ear was
expressed by the fifth cerebral nerve, and there was a rugged tooth with