DENTAL FISTULA. 331 



while controlling the progress of operation by passing one hand into 

 the animal's mouth. 



The tooth having been removed the opening was cleansed with 

 warm carbolic solution, and plugged with gauze. That evening the 

 temperature was normal. 



Next day the dressing was renewed. The animal ate freely and 

 seemed to have suffered little from the operation. Temperature 39'2° C. 

 Discharge was less abundant, but breathing was still noisy. 



The same treatment was continued on the following days. The 

 wound showed no special feature. 



On the i8th discharge had ceased. The external wound was 

 clean, and there were no splinters or necrosis. 



Treatment was continued until the 25th. Swelling of the face had 

 gradually diminished, the alveolar cavity rapidly filled up, and the 

 abnormal breathing disappeared. 



DENTAL FISTULA. 



34. Eight-year-old entire horse suffering from dental fistula. 

 Brought for examination on the 19th January, 1899. 



History. — The disease had first appeared nearly two years before. 

 At that time the horse showed a slowly increasing enlargement over 

 the anterior portion of the left upper maxilla, which was several times 

 unsuccessfully blistered and once punctured. On the last occasion 

 pus escaped, but the enlargement continued and the wound became 

 fistulous. 



Condition on Examination. — Opposite the roots of the second and 

 third molars, and at its junction with the cheek, the left side of the 

 face showed a swelling measuring three and a quarter inches in 

 diameter, the centre of which was pierced by a fistula discharging 

 greyish, putrid pus. A probe entered for a distance of one and a half 

 inches, and at that point appeared to be checked by contact with the 

 root of a molar tooth. 



External manipulation of the parts produced little pain, but the 

 introduction of a probe into the fistulous tract caused the animal to 

 struggle violently. 



The left line of molars showed nothing abnormal, no caries or 

 tumour, no fistula or gingivitis ; and the buccal cavity was perfectly 

 sweet. 



The long duration of disease, the fistula formation and other 

 attributes of the swelling, the character of the pus, and the absence 

 of lesions within the mouth pointed to the existence of alveolitis 

 confined to the space around the root of the tooth, or of caries of this 

 root. 



Treatment. — On the 21st January the animal was cast on the right 

 side by means of Daviau's table ; the maxilla trephined over the root 

 of the second molar (which was found to be separated from its alveolus 

 and the point of origin of the fistula) and the tooth punched out with 

 the usual precautions. 



After operation the wound was cleansed and the alveolar cavity 

 plugged with cotton wool surrounded by layers of gauze. 



