School Surgery. NOVEMBER, 1882. BY ALFRED CARPENTER, M.D. (LOND.), C.S.S. (CAMB.), Vice-President of the British Medical Association. THE IX. THE MOUTH AND THROAT. HERE are some affections of the mouth which are sometimes very troublesome, and cause much discomfort to children, and in consequence to teachers, such as Aphthous Ulcers, or Thrush, Cankers, Gumboils, Teething, Toothache, Relaxed Throat, producing hoarseness, Aphonia or loss of voice, Cough, Hooping Cough, Croup. These form a convenient section of complaints which may be considered together, and naturally follow quinsy. Aphtha are small round white ulcers, which look like particles of cream or curd lying upon, or as if inserted in, the mucous membrane. They are sometimes called Thrush, and old women tell us that they are fatal signs when they come on at the end of acute or exhausting diseases. These patches are of considerable interest to the microscopist; they consist of epithelial scales mixed with the isolated cells of a fungus, and with long filaments, which are rarely jointed. The scales are more or less opaque; intermingled with them are the multiplying bodies of vibrios, and bacteria. They are evidences of a defective vitality in the individual, which allows of the development of fungi in places where the ordinary healthy secretions usually have power to prevent their growth. Their presence indicates the necessity for the removal of decaying débris from the mouth and alimentary canal, and for disinfectants. The mouth may be washed frequently with a solution of chlorinated soda or a weak solution of Condy's fluid, and the places touched with a strong solution of borax in glycerine. Sometimes small ulcers form in the membrane, which is excessively painful when irritated by liquids or any food. These ulcers have raised edges, with bright red surroundings. They frequently form inside the lips and on the tip of the tongue, and should be gently touched with a solution of nitrate of silver (three grains to one dram of distilled water). If this is done two or three times on successive days, the pain will be at once removed, and the places will rapidly heal. VOJ II. PRICE 6D. Cankers, so-called, are owing to want of cleanliness, the presence of carious teeth, to disordered stomach in consequence of eating improper food, or continuing to feed either on that which is unwholesome or on a diet which is too exclusively animal. I have thought that the use of milk or meat which is the product of animals suffering from some feverish complaint has promoted the formation of aphthæ, but this point has not yet been conclusively proved. Gumboils frequently arise in connection with an aphthous condition, but there is always a decayed tooth which has some decomposing matter in its substance. The discharge from the inflamed part must be promoted by washing the mouth with warm water, and by holding the water in the mouth for a few minutes at a time. A soft fig, made quite hot in the oven, then cut in half, and the soft side applied over the boil, so as to avoid absolute pressure on the tender part, and kept in position as long as possible, will be the most comfortable way to apply a poultice. If the pain continues to be very acute the surgeon's lancet may be the best remedy, and after the inflammation has subsided the carious or necrosed tooth should be removed, if it continues to be tender to the touch. If the tongue is foul and the breath offensive it will be right to administer a simple aperient, such as a dose of Gregory's powder, or some fluid magnesia, or even an emetic, if the stomach is loaded with undigested food. Teething and Toothache.-Gumboils frequently accompany toothache. The acuteness of the pain of this agonising disorder is often relieved as soon as swelling takes place. When this is the case it indicates peri-dental inflammation, that is, an inflammation in the membrane covering the fang of the tooth. It is generally connected with some constitutional disorder, as a cold, or other disturbing cause. When there is acute pain on touching the tooth, warm fomentation in the mouth, and protection from outer cold, is the best treatment. The sufferer will find breathing through the nose (rather than the mouth) to be the best way to draw in air, for a draught of cold air impinging on the exposed nerve is a source of pain. Irritating applications, such as creosote or spirits of any kind, which are often used to allay pain, are of no service whatever. They only add to the mischief; although they may relieve pain for the moment, it is sure to return again more severely than before. Swelling of any kind near to a tooth 2 E should be treated tenderly with fomentations, and the use of liquid food until the boil has softened and discharged. If the tooth is hollow or carious, the pain sometimes may be relieved by picking out of the hollow tooth some small particle of decomposing food or some portion of hard matter which presses upon the exposed and inflamed nerve. Even by protecting the latter from the air by inserting a flake of cotton-wadding, soaked in some disinfectant and inserted very carefully, so as to avoid all pressure upon the nerve, we may save the little patient some suffering. If there is extending If there is extending decay in the tooth it may be arrested by active astringents or stimulating applications, such as creosote, camphor, or essential oils; but all these kinds of applications are of doubtful utility in the end. They relieve pain for the moment, but it is sure to come again. Soda will arrest fermentation for a time, and so may ease suffering when it arises from this cause. All these actions indicate decay in the teeth, and require the care of the dentist to arrest its extension. Loose teeth should always be removed, as they only cause irritation in the gums, and interfere with the formation of healthy saliva. They prevent the child from masticating his food properly, and lead him to swallow it uncomminuted, and thus throw a duty upon the stomach which it is not always able to perform. There is consequent indigestion, and with it an inability to do the mental task which the rules of the school require to be done. The child is then blamed improperly and unjustly. He knows that the fault is not altogether his own, and so a loose fang may be the first cause of mutiny and disorder among the scholars. These latter conditions, when they arise, are generally founded upon some concealed injustice in school-life as well as in the weightier arrangements of state government, and concerning which the actual governor is too often ignorant. There is a condition connected with teething which is not often thought of. We are generally inclined to think that teething ceases when swaddling clothes are put aside, and that the second set give no trouble on this head. This is not so; the second set of teeth often set up a considerable amount of nerve irritation when they come through the gums, especially if they have not followed the usual order, and have not at once taken the place of the milk-teeth which have preceded them in the gums. This is not quite so absolute in the case of those teeth which have a predecessor proper; but the canines or eye-teeth often produce headache, and cause an interference with eye-sight when they are about to pierce through the gums, producing a congestion in the conjunctival membrane. This condition is not ordinarily considered, but the frequency with which headache, and a tendency to cold in the eyes, as it is called, is associated with a canine tooth about to pierce the gums, satisfies me with the correctness of the association, and the necessity which exists in such cases to attend to the digestion and to the nervous system, rather than to the discharge from the eyes and nose, which is only an accompanying discomfort. The nerve disorder which attends upon cutting the wisdom-teeth is even more decided than that which accompanies canine dentition. The gums get swollen and hot, the secretion of saliva is lessened, the tenderness interferes with mastication, and food is swallowed in lumps, indigestion arises and still further complicates the case. If the patient be exposed to draught, or kept in a heated room until the skin acts freely and is then chilled by cold air, sore throat, or at least a relaxed throat, arises, cough sets in, perhaps bronchitis or some other feverish condition; the minor evil, which was the first cause, is lost sight of, and the major trouble treated. The gum irritation subsides when the disease which it has set up is gone, and solid food begins again to be taken, the gum is bitten upon and again crushed. There is a recurrence of the whole story, but the real offender is not thought of. I have seen convulsions of a serious character arise in cases of this kind, which have recurred, and in the end would have set up distinct epilepsy, but for the discovery that a wisdomtooth was at the root of the evil. The offending gum has been lanced, and the convulsive tendency has ceased at once. Wisdom-teeth are not to be neglected when they are being cut. They are the last to come, and generally they are the first to go, and we have a series of throat affections connected with their entrance into the mouth as well as with their removal therefrom. It is necessary for the schoolmaster to be aware of the fact that dyspepsia, headache, relaxed throat, cough, croup, and even convulsions may be simply dependent upon a decayed or cutting tooth. Fœtid breath very often indicates a number of decaying teeth in the mouth. If food is left for a few hours in a hollow tooth it is sure to become more or less putrid, and serious disorders or continued bad health may be produced by a small particle of decaying animal matter in a hollow tooth. Large schools should always have dental officers attached to them, who, by a periodical inspection of the teeth of the children will be able to avert decay, remove loose fangs before they produce general disorder, and this may be the means of stopping the progress of much dental mischief. It is not sufficiently known that the second set of teeth appear in the mouth before the first set are shed. A child six years old will generally have twenty-four teeth whilst there are only twenty temporary. The extra four are the first permanent or six-year old molars. They are supposed to belong to the first set, and when they decay, which is often the case, it is thought to be of no consequence. These teeth often have slight decay in the enamel, which may be arrested if it is seen soon enough. They are the largest teeth in the mouth, and should never be removed unless absolutely necessary in consequence of complete destruction. They should be stopped if the decay is discovered early enough, and if stopping cannot be effected, a free application of disinfectants before and after food will assist to limit the ravages of the caries, and be the means of saving the tooth until the jawbone is properly developed. Parents should bear in mind, and dentists also, that the too early removal of a permanent tooth interferes with the regularity of the development of the jawbone, and sooner or later is followed by other changes. The deposit of so-called tartar upon the teeth is always a matter which requires attention. The deposit is various in its constituents: it consists of organic as well as inorganic matter; there is débris of food as well as débris of animal life; its presence depends upon a constitutional as well as a local If removed it often rapidly forms again. The cause must be corrected by an attention to the condition of the digestive organs, and a rapid cause. removal of the collected tartar, especially when, as is generally the case, it is accompanied by foetid breath. The varieties are numerous, but the majority can be easily remedied by the proper use of disinfectants. If there is any inflammation or sponginess of the gums, or tendency to hæmorrhage, each must be treated independently of the formation of the tartar; and it is probable that if the one condition is removed, the other will cease. Hæmorrhage, or bleeding from the gums, is sometimes an evidence of improper feeding; fruit and vegetables have been withheld, and a scorbutic tendency set up, which shows itself in loosening teeth and bleeding gums. The signs of mischief may be observed by the master, when the parents have not seen them, or have mistaken their significance. The state is one which can only be remedied by an alteration of diet, by a restoration of those kinds of food which nature requires. The aggregation of people in dense numbers, such as takes place in large cities, is a great impediment to the supply of the fresh fruit and vegetables; and yet such food is necessary for healthy digestion and a proper development of the second set of teeth. When a teacher observes the state mentioned, it would not be out of place for him to send a line to the parent, and suggest more fruit and vegetables, and less animal food or pastry for the child. The removal of a tooth is occasionally followed by considerable bleeding; when there is constitutional tendency, it will be good for the child to take lime-juice, as well as well-cooked green vegetables, so as to remove the tendency to hæmorrhage, and to obviate further evil. I am sometimes asked if tooth-powder is a necessary thing for a child to use, and how soon toothbrushes become necessary articles for use in the bed-room. It is wise to clean the teeth with some antiseptic powder, such as finely-levigated chalk or charcoal, whenever the teeth are decayed, but ordinarily with undecayed teeth too much friction with the brush is to be avoided. It would be best to wash the mouth out, and to gently clean the teeth at bedtime, so as to remove decaying food from between the teeth and out of the hollows before it has had time to decompose, rather than leaving it all night in the mouth, and so causing offensive breath. This is the principal use which renders a toothbrush an advantage, which does not arise from the friction which is so often advised. You will not keep the teeth white by brushing them severely, but you may assist in doing so by removing decaying food from between them, and keeping the digestive organs in good order. founded and fully equipped. It was a beautiful summer morning, but the assembled pupils had evidently little heart for their accustomed play. The wheels of amusement moved heavily, and, except with the youngest, there seemed to be a prevailing consciousness of something wrong, something that ought not to be. Gloom was falling unnecessarily on sunny hearts. Two years had passed since many a manly tone had faltered as pastors, true to their cherished principles, closed their last services in the church they loved; and bitter tears had bedewed many a mother's cheek as she left the manse endeared by the tenderest associations of sorrow and joy, while distress had quivered on young lips as children left behind them their gardens and their play-fields. These changes had become inevitable, but the formal discipline might have been averted, which extended to the common school the gloom of the church and the manse. It engraved on young minds recollections of these inexplicable changes; but with many of the more advanced pupils it deepened the consciousness that Christian men could make heaviest and most enduring sacrifices for what they conscientiously held to be sacred principles. 'As Mr. Stow stood that morning among his students, masters, and brother directors, a slightly deeper flush than usual was all that indicated his disappointment. He accepted the new conditions of labour and resolutely strung himself to new exertion. Other hearts there are burdened with their own sorrows-one is taking a last look at the young currant-bush which he was permitted to plant on the border of the playground, and another has left a tear glistening on her favourite flower. 'But the signal for preparation to leave gathers into the large hall all stragglers. Thrilling is that song of praise, and deeply impressive that voice of prayer, as the goodness of the Lord is acknowledged and His guidance sought. 'The assembly moves from the building, directors, teachers, fifty students, 700 pupils, and at last the quiet old Janitor with his wife, locking the door and joining the procession, left a seminary, lately instinct with life, tenantless and silent. The The whole fabric is completely deserted; the joy of youthful voices thrills no listener, and the sunbeams, all the day pouring into empty halls, beating on the floor, and at last creeping slowly on the walls into twilight, only made the desolation greater. procession-headed by Mr. Stow and Mr. Nathaniel Stevenson, a beloved companion and fellow-labourer in every good cause-having threaded its course through a multitude lining the streets, passes into the extemporised canvas-covered school. When the new seminary had been opened with praise and prayer, appropriate and hopeful addresses were delivered, but not a complaint was uttered, nor was there any special allusion to the circumstances in which they were placed. Every person will admit," said Mr. Stow, "that the buildings of the institution are not the institution itself; even this temporary building, embodying as it does all the trainers, students, and children, will exhibit the system as it existed ten years previous to the erection of the edifice which we have now left; it was then the Glasgow Normal Seminary, and such it must continue to be!"' The tents were the abcde of the Normal Seminary until August, 1845, when the new building was formally opened, and the work continued still under Mr. Stow's personal superintendence, and under more favourable outward circumstances. The Free Church had been led to accept the responsibility of many schools whose masters and mistresses had been dismissed, and in Edinburgh as well as in Glasgow a Normal College had to be formed for the preparation of teachers for their work. By the exertions of the Rev. Dr. James Buchanan, the Glasgow Seminary was erected at a cost of £10,000, of which sum £3,000 was a grant from Government. Students in the Scotch Colleges are not resident as in England. The new 'Seminary,' therefore, consisted only of four large halls for the model practising schools, with class-rooms, students' rooms, library, and museum, etc., with, of course, spacious playgrounds, in connection with the four schools. Since the retirement, in 1840, of the Rev. Robert Cunningham, from the Rectorship, financial difficulties had prevented the appointment of a successor. On the entrance upon the new premises, however, Mr. Robert Hislop, who had for several years been the head master of the senior school, was chosen as the Rector. 'His exact scholarship, his thoughtful appreciation of Bible training, his deep sympathy, as a teacher, with Mr. Stow's views, and the command which his Christian character gave him over the students, invested his appointment with public value.' Every one who reads this sketch will be acquainted with the Minutes of Privy Council of 1846,' but comparatively few can remember the surprise with which they were received, and the earnestness with which they were discussed in all parts of the country. As 'the result of one of the most benevolent, unfettered, and exact investigations of modern times made into the details of public instruction through individual enterprise,' they especially challenged the attention of all practical educationists. Mr. Stow's ardent Christian philanthropy was ready to accept any means of usefulness which these Minutes seemed to promise, and he sought to secure for Scotland such modifications as were more adapted to the long-established arrangements of that country. In this effort he was not sufficiently supported, and the 'Minutes' were therefore made applicable to England and Scotland alike. Monitors were to be superseded by pupil-teachers; Queen's Scholarships were offered; salaries were to be augmented by a direct grant from the Government, and according to a scale of nine degrees of merit ; retiring allowances were promised; and in other details the Minutes framed by Sir James Kay Shuttleworth encouraged many, who, like Mr. Stow, were struggling hard against ignorance and vice, to hope for the most favourable results to the country. Monitors were little used in Scotland, though in the schools founded by both Lancaster and Bell they were an important part of the 'system.' In his four 'departments' Mr. Stow dispensed with the aid of monitors in intellectual training. Children of nearly the same age were 'trained' together, and in large numbers. He demanded the best teachers for a'l grades; and he considered fifty to sixty or, at the outside, eighty children quite enough for one teacher. From want of funds this number has often been exceeded, and many trainers' have managed schools without assistance, even when the children have not been of nearly the same age.' But Mr. Stow always urged that in order to effective teaching, the numbers should be small, and he resisted the employment of inexperienced apprentices.' On every ground he demanded even for the youngest classes highly qualified teachers and carefully-trained assistants. The effect of the operation of the Minutes' on the Glasgow Normal Seminary was distressing to Mr. Stow in the conversion of that institution into a teaching college. Many a University student had entered the Seminary for the one object of learning the theory and methods of education; but by the introduction of Queen's Scholars, the former class of students began to decline in numbers as they were excluded from the Government grants, and very shortly the principal part of the time and energy of the staff and students was devoted to the necessary preparation for the inevitable Christmas examination. Mr. Stow urged that separate colleges should be adapted to the completion of such education as the Government might demand from Queen's Scholars, and that all students who were duly qualified should subsequently pass to the Training College, and there learn the best methods of applying their knowledge for the purposes of instruction. the arrangement of uniting instruction and training be continued in the same institution,' he added, then THREE YEARS, at the least, ought to be the minimum course, viz., two years in the preparatory college, and one year afterwards exclusively confined to the practical or normal as a separate department.' "If It will be thus seen that Mr. Stow attached the highest importance to the training of the teachers, who, during their professional career, necessarily have the making or the marring' of so many minds, and the formation to a large extent of the moral character. He sought to secure men and women of sterling piety, and of considerable mental culture, and to give them a' practical preparation for the important work of communication and moral training, which was our original object in establishing the first Normal Seminary in this country, and without which all the theoretical knowledge that the students may acquire will not enable them to communicate it in a natural and efficient manner to the pupils who may eventually be placed under their charge.' 'Our experience during twenty years up to 1847, when we added a college to the Normal Department, was this, that six months' exclusive practical attention of well-educated young men to the normal, made better trainers and teachers of schools than the present course of two years does, or can do, with the college and normal combined' Mr. Stow always affirmed that for the development of the child's intellectual faculties it was of far greater importance how he was taught, than what he was taught. Hence the anxiety manifest in the extracts quoted above for a proper equipment and skill on the part of the trainers. There is accumulating evidence that the opinion of practical educationists is now more in accord with these views of Mr. Stow. In June, 1851, Mr. Robert Hislop resigned the rectorship of the Normal Seminary to enter upon another sphere of public usefulness, and again, for a period of six months, Mr. Stow had to bear the chief burden of the institution. Mr. Thomas Morrison, M.A., whose scholarship and success as a teacher had attracted the attention of the directors, was appointed rector in February, 1852, and Mr. Stow found in him a cheerful, energetic, and highly talented coadjutor.' Dr. Morrison still ably presides over the Free Church College. For several years the work of the Normal Seminary Institution was carried on without any changes of importance. The Minutes of 1846' and their supplements were confessedly conferring 'immense educational advantages' upon the country. The desire to have education placed on a national basis, however, led to the introduction of measures into Parliament which only 'secured ecclesiastical contests and merited rejection.' Mr. Stow naturally shunned controversy, but in some vigorously written pamphlets and letters he maintained the principles of Bibletraining. He never attempted to mix religion with the multiplication table,' but he desired liberty to appeal to the Word of God at any hour of the day, and 'whether the classes were at arithmetic, at grammar, or in the play-ground,' to bring that Word to bear on lying, swearing, dishonesty, or any act of meanness that might occur. The particular schemes which he opposed need not now be named. While he required freedom for the teacher, he equally insisted upon the advantage and necessity of confining religious exercises-praise, prayer, and the Bible lesson to a fixed hour. His one contention was : 'Scriptural school-training is my only hope for the permanent elevation of the masses.' The Social Science Congress was held in Glasgow in 1860, and under the presidency of Sir James KayShuttleworth, a resolution was passed to appoint a committee to consider the whole question of education, with a view to instituting a national system. committee failed, and legislation was attempted without the investigation upon which so much stress had been laid. The Mr. Stow made his last public effort at this Congress, by reading a paper on Moral Training' in the Educational section. The purpose of this devoted philanthropist was to show the advantages that would result from the universal adoption of the system which had been found to be so effective, especially in the more neglected districts of large towns. The two greatest British educationists of the age, Sir James Kay-Shuttleworth and David Stow, were associated on this occasion. They lived for the same great end, the physical, social, and moral welfare of the people.' They both sought to secure that end through the same agency, the common school. They both embodied their conceptions in practical forms, and, notwithstanding unreasoning opposition, contributed more than all other men of their time to change the educational aspect of Britain.' Mr. Stow's personal appearance was not such as to attract special attention. His stature was rather under the average height and on 'Change' he would not be specially distinguished from other first-class Glasgow merchants. His frank and open countenance seemed to challenge confidence, whilst shrewd intelligence and habitual caution could be read in his face, which, nevertheless, bore a most cheerful expression, with a genial humour ever manifest around his radiant eye. His emotions were readily interpreted by the easily controlled tones of a pleasant voice, as well as by the responsive play of his features. In the various benevolent enterprises to which he devoted his life, and especially in his Sabbath-evening school, his ready sympathies had been much exercised, and he had acquired a power of voice and gesture which made his manner a helpful expositor of his instruction. In this respect he was an example to all teachers, who often have to attract and sustain the attention of weary children, or 'picture out in words' novel or complex conceptions. His enthusiasm was contagious, and as his unselfish labours were persistently pursued, the esteem of those who were trained under him merged into a desire to obtain more of his spirit and to imitate his example. Their character could be hardly formed on a better model, for in every respect Mr. Stow was a Christian gentleman. He was fortunate in securing for his Normal Seminary a staff of teachers of similar character and culture, and probably not a single student was ever known to leave the institution but with a feeling of regret at being removed from its ennobling atmosphere. Every student trained by Mr. Stow respected and loved him. The earnestness, the enthusiasm, the self-sacrificing devotedness of his life, won their admiration; while his courtesy and his personal interest in them all invariably gained their affections. In the year 1850 a few friends resolved to present Mr. Stow with some expression of their regard for him as a Christian friend, and of their estimate of his labours as an educationist; but, their purpose being made known, others wished to join in the testimonial, which thus necessarily assumed a public character. Teachers sent contributions even from distant lands. The presentation took place in 1851, at a meeting presided over by Henry Armstrong, Esq., the Inspector of Wesleyan Schools, and which was attended by many distinguished educationists. The chairman, in the course of his address, said: 'There are some men whom we are bound to honour, because God has honoured them, and separated them from the mass of their fellows by placing them in prominent positions, as the representatives of some great principle, and the instruments of some great work— men living before their age, labouring not only without sympathy or any just appreciation, but borne down by an amount of toil of which the world at large knows but little, whilst their actions and motives have been misunderstood. He held it as a fixed principle that no man had ever lived for the good of others, and had become a blessing to his species, since the Lord Jesus honoured humanity by clothing Himself with it, but by the denial of himself, taking up his cross and following his Master.' An appropriate address was read by Mr. Caughie and given to Mr. Stow, and a marble bust resting on a beautifully proportioned column was uncovered and presented. On the pedestal was inscribed :— |