Chapter 4

In another case, a young man, a clerk in a city bank, had for several years exhibited peculiarities in the keeping of his books. He was exceedingly exact in his accounts, but after the bank was closed always remained several hours, during which he ornamented each page of his day's work with arabesques in different-colored inks. He was very vain of this accomplishment, and was constantly in the habit of calling attention to the manner in which, as he supposed, he had beautified what would otherwise have been positively ugly. His fellow-clerks amused themselves at his expense, but his superior officers, knowing his value, never interfered with him in his amusement. Gradually, however, he conceived the idea that they were displeased with him, and at last the notion became so firmly rooted in his mind that he resigned his position, notwithstanding the protestations of the directors that his idea was erroneous. Delusions of various other kinds supervened, and he passed into a condition of chronic insanity, in which he still remains. In most of the cases occurring under this head the intellectual powers are not of a high order, though there may sometimes be a notable development of some talent, or even a great power for acquiring learning. Painters, sculptors, musicians, mathematicians, poets, and men of letters generally, not infrequently exhibit eccentricities of dress, conduct, manner, or ideas, which not only merely add to their notoriety, but often make them either the laughing-stocks of their fellow-men or objects of fear or disgust to all who are brought into contact with them.

IDIOSYNCRASY.--By idiosyncrasy we understand a peculiarity of constitution by which an individual is affected by external agents in a manner different from mankind in general. Thus, some persons cannot eat strawberries without a kind of urticaria appearing over the body; others are similarly affected by eating the striped bass; others, again, faint at the odor of certain flowers, or at the sight of blood; and some are attacked with cholera-morbus after eating shellfish--as crabs, lobsters, clams, or mussels. Many other instances might be advanced, some of them of a very curious character. These several conditions are called idiosyncrasies.

Bégin,[1] who defines idiosyncrasy as the predominance of an organ, a viscus, or a system of organs, has hardly, I think, fairly grasped the subject, though his definition has influenced many French writers on the question. It is something more than this--something inherent in the organization of the individual, of which we only see the manifestation when the proper cause is set in action. We cannot attempt to explain why one person should be severely mercurialized by one grain of blue mass, and another take daily ten times that quantity for a week without the least sign of the peculiar action of mercury being produced. We only know that such is the fact; and were we to search for the reason, with all the appliances which modern science could bring to our aid, we should be entirely unsuccessful. According to Bégin's idea, we should expect to see some remarkable development of the absorbent system in the one case, with slight development in the other; but, even were such the case, it would not explain the phenomena, for, when ten grains of the preparation in question are taken daily, scarcely a day elapses before mercury can be detected in the secretions, and yet hydrargyriasis is not produced; while when one grain is taken, and this condition follows, the most delicate chemical examination fails to discover mercury in any of the fluids or tissues of the body.

[Footnote 1: "Physiologic Pathologique," Paris, 1828, t.i., p. 44.]

Bégin's definition scarcely separates idiosyncrasy from temperament, whereas, according to what would appear to be sound reasoning, based upon an enlarged idea of the physiology of the subject, a very material difference exists.

Idiosyncrasies are often hereditary and often acquired. Two or more may exist in one person. Thus, there may be an idiosyncrasy connected with the digestive system, another with the circulatory system, another with the nervous system, and so on.

An idiosyncrasy may be of such a character as altogether to prevent an individual following a particular occupation. Thus, a person who faints at the sight of blood cannot be a surgeon; another, who is seized with nausea and vomiting when in the presence of insane persons, cannot be a superintendent of a lunatic asylum--not, at least, if he ever expects to see his patients. Idiosyncrasies may, however, be overcome, especially those of a mental character.

Millingen[1] cites the case of a man who fell into convulsions whenever he saw a spider. A waxen one was made, which equally terrified him. When he recovered, his error was pointed out to him. The wax figure was put into his hand without causing dread, and shortly the living insect no longer disturbed him.

[Footnote 1: "Curiosities of Medical Experience," London, 1837, vol. ii., p. 246.]

I knew a gentleman who could not eat soft crabs without experiencing an attack of diarrhea. As he was exceedingly fond of them, he persevered in eating them, and finally, after a long struggle, succeeded in conquering the trouble.

Individuals with idiosyncrasies soon find out their peculiarities, and are enabled to guard against any injurious result to which they would be subjected but for the teachings of experience.

Idiosyncrasies may be temporary only--that is, due to an existing condition of the organism, which, whether natural or morbid, is of a transitory character. Such, for instance, are those due to dentition, the commencement or the cessation of the menstrual function, pregnancy, etc. These are frequently of a serious character, and require careful watching, especially as they may lead to derangement of the mind. Thus, a lady, Mrs. X, was at one time under my professional care, who, at the beginning of her first pregnancy, acquired an overpowering aversion to a half-breed Indian woman who was employed in the house as a servant. Whenever this woman came near her she was at once seized with violent trembling, which ended in a few minutes with vomiting and great mental and physical prostration, lasting several hours. Her husband would have sent the woman away, but Mrs. X insisted on her remaining, as she was a good servant, in order that she might overcome what she regarded as an unreasonable prejudice. The effort was, however, too much for her, for upon one occasion when the woman entered Mrs. X's apartment rather unexpectedly, the latter became greatly excited, and, jumping from an open window in her fright, broke her arm, and otherwise injured herself so severely that she was for several weeks confined to her bed. During this period, and for some time afterward, she was almost constantly subject to hallucinations, in which the Indian woman played a prominent part. Even after her recovery the mere thought of the woman would sometimes bring on a paroxysm of trembling, and it was not till after her confinement that the antipathy disappeared.

Millingen[1] remarks that certain antipathies, which in reality are idiosyncrasies, appear to depend upon peculiarities of the senses. Rather, however, they are due to peculiarities of the ideational and emotional centers. The organ of sense, in any one case, shows no evidence of disorder; neither does the perceptive ganglion, which simply takes cognizance of the image brought to it. It is higher up that the idiosyncrasy has its seat. In this way we are to explain the following cases collected by Millingen:

[Footnote 1: _Op cit_., p. 246.]

"Amatus Lusitanus relates the case of a monk who fainted when he beheld a rose, and never quitted his cell when that flower was blooming. Scaliger mentions one of his relatives who experienced a similar horror when seeing a lily. Zimmermann tells us of a lady who could not endure the feeling of silk and satin, and shuddered when touching the velvety skin of a peach. Boyle records the case of a man who felt a natural abhorrence to honey; without his knowledge some honey was introduced in a plaster applied to his foot, and the accidents that resulted compelled his attendants to withdraw it. A young man was known to faint whenever he heard the servant sweeping. Hippocrates mentions one Nicanor, who swooned whenever he heard a flute; even Shakespeare has alluded to the effects of the bagpipes. Julia, daughter of Frederick, King of Naples, could not taste I meat without serious accidents. Boyle fainted when he heard the splashing of water; Scaliger turned pale at the sight of water-cresses; Erasmus experienced febrile symptoms when smelling fish; the Duke d'Epernon swooned on beholding a leveret, although a hare did not produce the same effect; Tycho Brahe fainted at the sight of a fox; Henry III. of France at that of a cat; and Marshal d'Albret at a pig. The horror that whole families entertain of cheese is generally known."

He also cites the case of a clergyman who fainted whenever a certain verse in Jeremiah was read, and of another who experienced an alarming vertigo and dizziness whenever a great height or dizzy precipice was described. In such instances the power of association of ideas is probably the most influential agent in bringing about the climax. There is an obvious relation between the warnings given by the prophet in the one case, and the well-known sensation produced by looking down from a great height in the other, and the effects which followed.

Our dislikes to certain individuals are often of the nature of idiosyncrasies, which we can not explain. Martial says:

"Non amo te, Sabidi, nec possum dicere quare; Hoc tantum possum dicere, non amo te;"

or, in our English version:

"I do not like you, Doctor Fell, The reason why I can not tell; But this I know, and that full I do not like you, Doctor Fell."

Some conditions often called idiosyncrasies appear to be, and doubtless are, due to disordered intellect. But they should not be confounded with those which are inherent in the individual and real in character. Thus, they are frequently merely imaginary, there being no foundation for them except in the perverted mind of the subject; at other times they are induced by a morbid attention being directed continually to some one or more organs or functions. The protean forms under which hypochondria appears, and the still more varied manifestations of hysteria, are rather due to the reaction ensuing between mental disorder on the one part, and functional disorder on the other, than to that quasi normal peculiarity of organization recognized as idiosyncrasy.

Thus, upon one occasion I was consulted in the case of a lady who it was said had an idiosyncrasy that prevented her drinking water. Every time she took the smallest quantity of this liquid into her stomach it was at once rejected, with many evident signs of nausea and pain. The patient was strongly hysterical, and I soon made up my mind that either the case was one of simple hysterical vomiting, or that the alleged inability was assumed. The latter turned out to be the truth. I found that she drank in private all the water she wanted, and that what she drank publicly she threw up by tickling the fauces with her finger-nail when no one was looking.

The idiosyncrasies of individuals are not matters for ridicule, however absurd they may appear to be. On the contrary, they deserve, and should receive, the careful consideration of the physician, for much is to be learned from them, both in preventing and in treating diseases. In psychiatrical medicine they are especially to be inquired for. It is not safe to disregard them, as they may influence materially the character of mental derangement, and may be brought in as efficient agents in the treatment.--_N.Y. Medical Journal_.

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PYORRHEA ALVEOLARIS.

[Footnote: Abstract from a paper lately read before the Southern Dental Association, Baltimore, Md.]

By Dr. J. M. RIGGS, of Hartford, Conn.

A gentleman, a physician, aged thirty-two years, strong and vigorous, with no lack of nerve-energy, calls to have his teeth attended to, with the disease in the first stage throughout the mouth. Upon examination, he observes upon the gum of one of the lower cuspids a dark purplish ring encircling the neck, from one-sixty-fourth to one sixteenth of an inch in depth; the tooth _in situ_ is white and clean. With the aid of the mouth and hand mirror he shows the condition to the patient, and, taking up an excavator, endeavors to pass it down between the tooth and gum, on the labial surface. After it gets down a little way the instrument meets with an obstruction, over which, calling the patient's attention to the fact, he carefully guides the instrument until it drops down on the tooth-substance beyond it; then, turning the instrument and pressing it upward, he breaks off a portion of the concretion; which proves to be what is ordinarily called lime-salts, or tartar. That is the cause of the purple ring on the gum, which is merely the outward manifestation of the disease. Take it off thoroughly, polish the surface of the tooth, and in three days' time the gum will show a perfectly healthy color. The condition described is the first stage of the disease, and the treatment given is all that is required for a cure of the case at this time. But take the same man and let him go for ten years without the simple operation detailed. The disease spreads, and causes inflammation of the process, and, finally, its absorption--sometimes on the labial surface for one half or two-thirds the length of the tooth. It runs its course, the tartar accumulating, all the time following up the line of attack. At the end of ten years what has become of the line of tartar? Sometimes it will be found extending clear around the tooth. Sometimes it will not be found at all; it has done its work--the tooth is loose, but the concretion is gone, in whole or in part. In this case the patient wants the tooth out, but, he asks, what has become of the tartar? The answer is that the natural acids found in the oral cavity have dissolved it, and it has passed into the stomach or out of the mouth in the saliva. But the tooth is so loose that it is a torment to the man; it lies in its socket, entirely loose, almost ready to drop over. It hurts so that he cannot bear the pain. The tooth is taken out. There is no tartar on it, or very little; there is a little speck near the point that looks like a foreign body; but the point of the tooth--the apex--is as sharp as a needle. After the disease has done its work of separating the tooth from its socket, the destroying agent begins to absorb the tooth at the point, irregularly, causing the sharpness described. Now, because no tartar is found upon the tooth, does that argue that it has never been there? Not at all; the loosened tooth shows simply that it has been there and has been absorbed. The speaker has never seen a tooth in that condition on the point of which he could not show patches or specks; we may not see the tartar, but it certainly once existed there, and has accomplished its work.

Now suppose we find a patient with all the teeth loosened; he has neuralgia pains in the face, for which medicine seems to furnish no remedy; he has also catarrh, and the malar and nasal bones are all affected. In the third and fourth stages a low inflammatory action pervades all the bones of the face, accompanied by neuralgic pains, extending to the brain itself. In such a case the disease of the teeth intensifies the catarrh. A medical man called upon him for treatment for pyorrhea alveolaris; the patient was also afflicted with catarrh. He cured the pyorrhea alveolaris, and cured the catarrh, too, at the same time.

Another case.--A lady called in great distress. Nearly all her teeth were affected, and the discharge was most offensive and abundant; if she lay on her side in bed, the pillow would be covered with large splotches of the discharge in the morning; if she lay on her back, the mass was swallowed, and the result was that the whole alimentary canal was demoralized by the pus, blood, and vitiated secretions. When she arose she wanted no breakfast, only two or three cups of strong coffee and some crackers. She was nearly blind, could only see a great light, and was totally unable to see to read. He told her that the trouble with her sight was caused by the diseased condition of the teeth; that unless that was remedied, she might live three months, but she would die suddenly. He treated three or four teeth at a time at each sitting. This consumed three weeks. The teeth became firm, her appetite returned, her sight was restored, and she was able to walk a mile or two without disturbance. He was called to Brooklyn, where they had a live society, and an infirmary for the treatment of dental diseases, at which members of the society were delegated to attend from day to day. He was invited to give a clinic upon pyorrhea alveolaris, and he told them of this patient, whom he showed to some fifteen members. The woman was apparently in fair health. It was not loss of nerve-energy which started the disease in this case, but the disease caused the loss of appetite and the vitiated condition of the whole alimentary canal. Her physician would have sent this woman to the grave, not recognizing the disease and its management.

He maintains that it is not lack of nervous energy that causes this disease, but the disease will lead to loss of nerve-energy. That small purple ring on the gum of the cuspid in the case first mentioned would eventually have led to the loss of the whole set, if left to work its way unopposed. He had tried in these remarks to controvert the old ideas, and to present the cause of the disease and its treatment as he sees it. You may see it differently; if so, give us your information, in order that we may correct our views, if wrong.

One gentleman says he finds it is only those who are strong and vigorous who have this disease. The speaker finds some cases of this kind; he also finds consumptives who have not a trace of it, but he would take the strongest man in the room and cause a beautiful case of pyorrhea alveolaris in his mouth in three weeks, with a fine cotton thread tied around one of the lower front teeth at the line of the gum. The thread will work its way under the gum, and the gum will become inflamed; it will work its way down between the gum and the tooth, and in the meantime the flour and the particles of food will also work down under the loose gum, finding a rallying-point on the thread; the mass will become impregnated with lime-salts, and will then begin to harden, and in a very short time you will have an excellent example of the disease under discussion. Patients suffering from salivation fall an easy prey to this disease, due to the action of the drug on the glands and the hard and soft tissues of the mouth, the gums in such cases affording a ready pocket under their edges for the deposits.

When you find a tooth with the characteristic concretion of tartar upon it, the first principle of surgery demands that you clean that tooth thoroughly. Go down beyond the line of the disease, go around the tooth thoroughly, and break up the diseased tissue, and apply tincture of myrrh, and in three days you will notice a marked improvement for the better, and if the patient takes proper care of the teeth the disease will not return. Practitioners should watch the teeth of the young people under their care, and see that the mouth is kept scrupulously clean and healthy.

In reply to a question, Dr. Riggs stated that whenever absorption goes on irregularly, unless the inflammatory action is extreme, it will sometimes absorb one or two bone-cells, and then skip one or two, and these last, being isolated, naturally die, or become necrosed to some extent. In treating this disease you must break up the line of disintegrated tissue. You must, as it were, transfer your eyesight to the end of the instrument, so that when you strike dead bone you will know it. Live bone will feel smooth and greasy.

It requires some years of experience to treat this disease properly, because you have not your eyesight to aid you, but must depend absolutely upon the sense of touch. With experience, however, you will learn to give a great deal of relief in one of the most annoying conditions to which the teeth are subject. The reason the profession are not familiar with the treatment of this disease is, they fail to recognize it until it reaches its third or fourth stage, and then they treat it by depletion and therapeutic remedies. Some treat it by stippling in acids underneath the gum, thinking thereby to dissolve away not only the tartar, but the necrosed bone. Another writer takes off patches of the diseased tissue, and another a strip of the gum, from wisdom-tooth to wisdom-tooth. This treatment he could only characterize as simply barbarous. The treatment of this disease is purely surgical. Any therapeutic treatment is to alleviate the pain and soreness immediately after the operation.

Dr. W. N. Morrison, St. Louis, referring to the method of treating pyorrhea alveolaris described by Dr. Riggs, said he cheerfully bore testimony to the importance of loosening the scales of tartar, and teaching patients the value of cleanness of the mouth. In his experience he had found that all instruments will occasionally fail to dislodge the deposit. In such cases he used as an assistant a little ring of para gum about an eighth of an inch wide. This was sprung on the tooth at the edge of the gum. If this is done and the ring allowed to remain a few hours, you will see an entirely new revelation, and you will readily be able to get at the tooth to clean it. He had found it advisable to give patients practical showing how the brush should be used.

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SULPHUR AS A PRESERVATIVE AGAINST MARSH FEVER.