co^ffl'lc\fN"cflf^Kf'. I mil" I" " }^^g4069656 RK57 W25 1899 A compendotdental RECAP UIZ-COMPENDS Dental MiuPS^ WARREISr MORRIS' ANATOMY. SECOND EDITION. 79 J Illustrations, of which 214 are Colored. Human Anatomy. A Complete Systematic Treatise by Vari- ous Authors, Including Special Sections on Surgical and TopoeraDhical Anatomy, the Skin, and Vestigial and Henry Morris, m.a. and urgeon to Middlesex Hos- versity of London ; Mem- n of the Court of Exam- is, etc. Second Edition. ghly revised throughout. ;r part of which are Orig- Colors. Royal Octavo. 5.00; Leather, net, ^7.00 the editors and publishers 1 its value. The text has )arts rewritten ; the editor ing it a harmonious whole ; [i those used in the first n printed in colors, while een improved in several ^rrectness, and excellence liar treatise. The text is other text-book on particulars. Columbia ©nibers^itp in tf)e €\Xy^ of i^etu gork ^cfjool of Bental anb C^ral ^urgerp y^. 3^eferentE Hibrarp re those on surgical and topo- grapnicai anatomy, ana tne cnaprer on me nervous system is presented with great clearness and fullness. Tne ever-growing ])opularity of the book with teachers and students is an index of its value, and it may safely be recom- mended to all interested." From The Philadelphia Medical Journal. " Of all the text-books of moderate size on human anatomy in the English language, Morris' is undoubtedly the most up-to-date and accurate. . . . For the student, the surgeon, or for the general practitioner who desires to review his anatomy, Morris' is decidedly the book to buy." A Descriptive Circular of Morris^ ** Anatomy/* with Sample Pages and Colored Illustrations, will be sent free to any address. Tyson's Practice of Medicine 90 Illustrations, Several of which are in Colors. The Practice of Medicine. A Text-Book for Physicians and Students, with Special Reference to Diagnosis and Treat- ment. By James Tyson, m.d., Professor of Theory and Practice of Medicine and of Clinical Medicine in the Uni- versity of Pennsylvania; Physician to the University and to the Philadelphia Hospitals ; Fellow of the College of Physicians of Philadelphia ; Member of the Association of American Physicians, etc. Octavo. 1 184 pages. Ninety Illustrations. Cloth, net, $5.50; Sheep, net, $6.50 •^S" The sale of this work has been so large and rapid that we have had to reprint it a number of times. The author has taken advantage of these opportunities to revise and improve the book in many particulars. From The Therapeutic Gazette. " From the first to the last of this large volume of nearly 1 200 pages we find much to commend, almost nothing to criticise, and certainly nothing to contradict. " It is in the writing and preparation of a work of this character that Dr. Tyson stands pre-eminent. Those of the profession — and there are many at this time — who have been fortunate enough to have been his pupils during their medical student days, will remember that he brought to his lectures and to his writings an amount of industry and care which many other teachers failed to bring ; and those who know him best as an author and teacher have expected that his book on the Practice of Medicine, when it appeared, would be a credit to himself and would increase his reputation as a medical author. This belief has proved correct. . . . We look forward to using this vol- ume upon the ' Practice of Medicine ' more than any of the others which grace our library shelves, and they are many and all of them good."' From The North American Practitioner, Chicago. " The individuality of the writer is clearly manifest in the clear and practical manner in which diseases are described and their treatment expressed. . . . 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THE ILLUSTRATED DICTIONARY OF MEDICINE, BI- OLOGY, AND ALLIED SCIENCES, including the pro- nunciation, ACCENTUATION, DERIVATION, AND DEFINITION OF THE TERMS USED IN MEDICINE AND THOSE SCIENCES COLLATERAL TO IT: KIOLOGY (ZOOLOGY AND BOTANY), CHEMISTRY. DENTISTRY, PHARMA- COLOGY, MICROSCOPY, ETC. With many Useful Tables and numerous P'ine Illustrations. Large, Square Octavo. 1633 pages. Fourth Edition now ready. Full Sheep, or Half Dark-Green Leather, net, $10.00 ; With Thumb Index, net, $ll.OO; Half Russia, Thumb Index, «^/, ^12.00 THE STUDENT'S MEDICAL DICTIONARY, including all THE WORDS AND PHRASES GENERALLY USED IN MEDICINE, WITH THEIR PROPER PRONUNCIATION AND DEFINITIONS, BASED ON RECENT MEDICAL LITERATURE. W'ith Tables of the Bacilli, Micrococci, Leuko- mains, Ptomains, etc., of the Arteries, Muscles, Nerves, Ganglia, and Plexuses; Mineral Springs of the U. S., etc. Tenth Edition, com- pletely rewritten. Revised, Enlarged by over 200 pages, and set from new type. 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Containing all the Words, their Definition and Pronunciation, that the Student generally comes in contact with; also elaborate Tables of the Arteries, Muscles, Nerves, Bacilli, etc., etc.; a Dose List in both English and Metric Systems, etc., arranged in a most convenient form for reference and memorizing. New Edition, enlarged by 200 pages. 64mo. Full Limp Leather, (iilt Edges, net, $1.00 ; Thuml) Index, tret, $1.25 Full descriptive circulars and sample pages sent free upon application. 95,000 COPIES OF GOULD'S DICTIONARIES HAVE BEEN SOLD. DENTAL PATHOLOGY AND DENTAL MEDICINE. WARREN. Frotn The Southern Clinic. "We know of no series of books issued by any house that so fully meets our approval as these ? Quiz-Compends ?. They are well arranged, full, and con- cise, and are really the best line of text-books that could be found for either student or practitioner." BLAKISTON'S ?QUIZ=COMPENDS? The Best Series of Manuals for the Use of Students. Price of each, Cloth, $0.80 net. Interleaved, for taking Notes, $1.25 net. ie®°"These Compends are based on the most popular text-books and the lectures of prominent professors, and are kept constantly revised, so that they may thoroughly repre- sent the present state of the subjects upon which they treat. 1 i>^>. ^ X!^ a = a e z <*-t o u O o -^ fn c3 O X! v^ o S3 ca u u STRUCTURE OF THE TEETH. 15 root portion of the dentine. Its special use is, by being inter- mediate in the density of its structure, to form a union of the soft tissue of the root membrane with the dentine, thus aiding the pulp in nourishing the tooth, and preserving, in a measure, the vitality of the tooth after the pulp may have been de- vitalized. Fig. 5. — Represents Vertical Sections of the Upper Cuspid and Molar Teeth, showing the Relation and Relative Thick- ness OF THE Hard Dental Tissues; also Size, Shape, and Location of the Pulp Chamber. E. Enamel. C. Cement. D. Dentine. P. Pulp cavity. The pulp is enclosed by the dentine, and represents the shape of the tooth in a diminished size. It is composed of nerve, vein, artery, and formative tissue. This body is the mere shrunken condition to which the tooth germ, or dental papilla, is reduced, after it has normally accomplished the work of dentification. 1 6 DENTAL PATHOLOGY AND DENTAL MEDICINE. The pulp is exquisitely sensitive and highly vascular; it is of a reddish-gray color and is enveloped in an exceedingly delicate membrane, which is continuous with the peridental membrane and is adherent to the wall of the pulp cavity. The pulp is divided into two portions — the crown or body, which occupies the crown cavity, and the extremities, which occupy the root canal. In advanced age this body often undergoes considerable change; the size is sometimes much diminished, while again it is found as a shriveled and nearly insensitive mass. This degeneration is due to the irritation and shock to which the teeth are liable at this time of life, owing to their worn and abraded condition. If the irritation is mild and constant, and the patient of a calcic diathesis, a further deposit of lime salts is made, and the pulp diminished in size in consequence. But where the irritation is more severe it is apt to cause con- gestion and death of the pulp. • The pericemental membrane is, as the name implies, the membrane which surrounds or invests the roots of the teeth. It is a richly vascular, fibrous structure, and is the nutrient organ of the cemenlum. It is also the organ of touch in the tooth, as through the nerves of this membrane every impres- sion upon the tooth is reported to the brain. It serves, too, to unite the tooth to the alveolus by its continuation through- out the alveolar cavities or sockets, and is connected at the dental foramen with the pulp, as previously indicated. The peridental membrane also serves as a cushion, per- mitting a certain passive motion by which the teeth are pro- tected from injury by blows and concussions which they are apt to receive during the performance of their peculiar function of tearing and grinding during the process of mastication. ANATOMY OF THE TEETH. 1 7 ANATOMY OF THE TEETH. Anatomically, the teeth are divided into three parts, the crown, neck, and root, the crown being that portion which projects freely into the mouth ; the neck is surrounded by the gums, and the root is that portion covered by the alveolar process of the jaw and by which the whole tooth is held securely m position. In old age the gums recede, exposing the neck, and a part of the root is sometimes exposed in con- sequence of atrophy of the alveolar process. The temporary denture consists of twenty teeth, divided into three groups — the incisors, cuspids, and molars. The relative position and number these groups bear to one another is expressed in the following formula: — M2 Ml C I2 Ii I Ij I2 C Ml M2. M2 Ml C I2 Ii I Ii lo C Ml M^. In the temporary teeth the proportion of the length to the width is marked, they being somewhat shorter than their suc- cessors, the permanent teeth. The color of the temporary teeth is of a milky or bluish white, while that of the per- manent presents a yellowish appearance. In determining between the temporary and permanent teeth the observer will be aided by the relative size and color, and by remembering that the former are somewhat loose, and have a marked depression at the neck, just at the union of the enamel and cementum. The permanent denture consists of thirty-two teeth, which are divided into four groups, namely : incisors (cut- ting), cuspids (tearing), bicuspids (crushing), and molars (grinding), according to the following formula : — M3 M2 Ml BC2 BCi C I2 Ii I Ii I2 C BCi BC2 Ml M, M3. M3 M2 Ml BC2 BCi C I2 Ii i Ii I2 C BCi BC2 Ml M2' Mg. i8 DENTAL PATHOLOGY AND DENTAL MEDICINE. The relation between the permanent and temporary teeth is shown in the accompanying diagram, Fig. 6. The anterior twenty teeth, namely, the incisors, cus- pids, and bicuspids, each have one root, except the first upper bicuspid, which in about eighty per cent, has two roots, one labial and one palatine. The roots of the upper incisors are rounded ; those of the bicuspids are flattened laterally. The 3 3 CpQsQoQ^^ Fig. 6.* — The Figures i, 2, 3, etc., Indicate the Groups of Teeth AND THE Order of their Appearance. roots of the lower incisors are the most flattened, while the root of the cuspid combines partially the roundness of the incisor and the flatness of the bicuspid. The upper molars have three roots each, two buccal and one palatine, which are usually of a round shape. While the lower molars have but two roots, one anterior and one posterior, these are laterally *" Disease of the Digestive Organs in Infancy and Childhood," 2d ed. By Dr. Louis Starr. ANATOMY OF THE TEETH. 19 flattened, and extend from the buccal to the lingual surface of the tooth. The roots of the third molar or wisdom tooth are subject to the same rules as those of other molars, but they are subject to a great number of exceptions. The crowns of the teeth present several surfaces for examination, which are named according to their position and use. Those of the incisors and cuspids presenting toward the lips are called labial surfaces ; while the same outer surfaces of the bicuspids and molars are called buccal, Fig. 7. — The median line is shown at M, labial surface at L, cutting edge at C, palatal surface at P, and approximal surfaces at A, of typical superior central incisors. being next to the cheeks, and the opposite or inner surfaces of all the teeth, that portion presenting toward the tongue, are called the lingual surfaces. Some, however, use the term *' palatine surfaces " for tliose of the upper jaw and "lingual" for those of the lower. While this is not necessary, it seems perfectly proper. Those surfaces of the teeth that lie adjacent or next to the adjoining teeth are called proximate or proximal ; these are more closely defined or divided by the terms mesial d.\^d. distal. They are so n„amed by their relative position to the central or 20 DENTAL PATHOLOGY AND DENTAL MEDICINE. median line of the face. Those proximate surfaces which face toward the median line are called mesial surfaces ; and the opposite, or those most distant from this line, are called the distal suj-faces. These several surfaces are clearly shown in Figs. 7, 8, and 9. The cutting edges of the anterior teeth and the grinding Fig. 8. — The Several Surfaces OF A Superior Cuspid Tooth. L indicates the labial, P, the palatal, and A, the approximal surfaces. Fig. 9. — TheThreeRoots,Neck, AND Crown of a Superior Molar Tooth, Presenting Both the Buccal and Ap- proximal Aspect. The masticating surface is indicated at M. surfaces of the bicuspids and molars are called the occluding surfaces. The Normal Articulation. In the upper jaw the arch is larger than in the lower, especially in the anterior portion of it. The upper and lower teeth, therefore, do not meet perpendicularly in articulating; the lower incisors and cuspids articulate on the palatine sur- faces of the corresponding teeth in the upper jaw. The cusps of the lower bicuspids and molars articulate in the grooves and furrows of the upper, and the teeth are so arranged in size and position that each tooth in the upper jaw when ANATOMY OF THE TEETH. 21 articulating occludes with two of the lower teeth. This is illustrated in Fig. lo. Fig. io. Primary Dentition. First dentition takes place, normally, in the order given in the following formula : — Central incisors, 5th to 7th month. Lateral " 9th to nth " First molars, 12th to 14th " Cuspids, 14th to i8th " Second molars, i8th to 25th " Marked Exceptions. — Some children are born with a few teeth erupted, and there are cases reported where the entire temporary set have been erupted at birth ; there are also cases on record of adults vv^ho have been edentulous from birth. But, as indicated, these are rare exceptions. The force which causes the teeth to emerge is called vital force, and 2 2 DENTAL PATHOLOCxY AND DENTAL MEDICINE. operates by growth, developing first the neck, then proceed- ing gradually to the apical end of the root. Lesions Incident to First Dentition. Though the eruptive process of dentition is a physiological action, it is very often attended by serious irritation. During early childhood the tissues are all softer, more vascular and sensitive, the nervous system predominating. Hence it is that the system at the period of first dentition is so susceptible to nervous impressions. In infancy, too, the system is less capable of combating diseases, and a large portion of the alarmingly great mortality of this period is traceable to the irritation caused by dental evolution. The indications of the eruption of the teeth are, first, an increased flow of saliva — a healthy manifestation, as it tends to keep the mouth moist and cool. This " drooling " is due to the irritation of the trifacial or fifth pair of nerves, which is sensory to the teeth and nutrient to the salivary glands. When the irritation becomes more pronounced, the secretions are somewhat checked and the mouth becomes hot and dry, the cheeks unusually red, eruptions appear upon the face, and, indeed, sometimes over" the whole body; with ulcera- tions upon the tongue and mucous membrane of the mouth and inflammation of the gum over the advancing tooth or teeth. A condition quite opposite to the above in appearance is a w/ii/e and hardened gum overlying the advancing tooth or teeth. This offers a greater resistance than the inflamed condition and is often neglected, especially by physicians, owing to the absence of any appearance of congestion. The child becomes wakeful, peevish, and cross, loses his appetite, and if relief is not then given this may be followed by persistent nausea, diarrhoea, and spasms or convulsions. Treatment. — The first thing is to remove the irritation ANATOMY OF THE TEETH. 23 by freely lancing the gums over the advancing teeth. The manner of doing this is admirably and fully shown in the ac- companying illustration (Fig. ii), which is taken from a paper by the late Dr. James W. White, in the ''American System of Dentistry." If the convulsive stage is reached, the patient's feet should be placed in hot mustard water, and cold cloths applied to the head, or the entire body put in a warm bath ; Fig. II. such measures cause muscular relaxation and have a soothing effect upon the nervous system. Decalcification of the Temporary Teeth. The temporary teeth must be removed before the permanent can erupt in their normal position; this takes place normally, by the absorption or decalcification of the roots. This process usually commences at the apex of the root, on the side nearest to the successional tooth ; this, however, is not invariably the case. Absorption may coaimence at several and distinct points, sometimes on the labial side — that most distant from the succeeding tooth. 24 DENTAL PATHOLOGY AND DENTAL MEDICINE. The cause and manner in which the roots of the temporary teetli are absorbed has been the subject of much and careful study by such advanced investigators in the domain of dental science as Tomes, Peirce, Bodeker, Abbot, and others. It was thought for a long while that the pressure caused by the advance of the permanent teeth was the sole cause for the decalcification of the primary teeth ; but it is now generally conceded that // is simply the result of a physiological action and not a mechanical force. The fact that the decalcification of the deciduous teeth is sometimes successfully accomplished in the absence of the corresponding permanent teeth adds much to the evidence that their presence and pressure is not essential. Prof. Peirce, in the '' Transactions of the American Dental Association," says : '' The several conditions which are always present and essential are readily recognized, but the part each plays is not easily ascertained. The place of its commence- ment, at the end of the root, the retention of pulp vitality, and the presence of a vascular papilla in close proximity to the absorbing surface, with the fact that the surface of this papilla is rich in giant-cells, termed ' osteoclasts,'' are evidently essential accompaniments, and the absence of any one of them would certainly militate against the completion of the process." And in another place the same writer says: ''That the organ has served its purpose, and that the nourishment which had previously been appropriated by it is diverted or relegated to its successors, is probably the most plausible explanation we can give of this interesting physiological process." Decalcification of the deciduous teeth commences in the central incisors at about the fourth year; in the lateral incisors in the fifth year ; in the first molars the seventh year, the second molars the eighth year, and the cuspids the ANATOMY OF THE TEETH. 25 ninth year. After decalcification commences in a tooth, it .takes about three years for it to accomplish its work. (See Fig. 12.) Second Dentition. In a harmonious development of the teeth and jaws, the indications of the time approaching for the development of the permanent teeth are the expanding of the alveolar ridge and the spreading apart of the deciduous teeth. Fig. 12. — Decalcification of the Deciduous Teeth. (From a diagram prepared by Prof. C. N. Peirce, 1884.) The emergence of the permanent teeth takes place, normally, in the order given below : — First molars, 6 to 7 years. Central incisors, 7 to 9 Lateral " 8 to 10 First bicuspids, 10 to ii Second " 11 to 12 Cuspids, 12 to 13 Second molars, 12 to 13 Third " 16 to 25 Exceptions. — Deviations from the order of appearance and the respective ages as given above occur ; it is usually in 26 DENTAL PATHOLOGY AND DENTAL MEDICINE. Strong children that the teeth appear at a later period, a scrofulous diathesis being indicated in premature dentition.. Third Dentition. Cases of third dentition are reported by a number of writers, but undoubtedly the majority of these reports refer to teelh that in reality were part of the second set, which failed to emerge at the normal time, and had only appeared in old age when there was sufficient room for them, or the jaws had atrophied. The writer has extracted two well-developed third molar teeth (which had never emerged from the gums) for a patient sixty years of age ; this was after the extraction of the second molar roots. It was known that the patient had never had any "wisdom teeth." Anomalies of Number. — Supernumerary teeth are espe- cially frequent in the anterior portion of the superior maxil- lary. When sufficient room is wanted for them, they may stand within or without the arch. Usually the shape of both the crown and root of these teeth is conical, while the shape of the crown of those found in the posterior part of the mouth is cuboidal — resembling the molars. Dentures from which normal teeth are missing are more frequent than those containing supernumerary teeth. Occasionally the space from which the permanent tooth is missing may be occupied by a temporary tooth. Some- times temporary teeth may be seen in the mouth of persons twenty-five and thirty years of age j in these cases the per- manent ones are generally retained in the jaw, and may erupt later. INFLAMMATION. 27 DENTAL PATHOLOGY AND THERAPEUTICS. Dental pathology treats of the origin and progress of the various diseases to which the teeth and the surrounding oral tissues are liable. Dental therapeutics considers the medicines and reme- dies used in the treatment of such diseases. Disease, pathologically considered, is any abnormal con- dition in those processes which constitute perfect health. It is but the normal physiological force perverted^ tearing down what it had before built up. This cannot always be recog- nized at first, as it may be confined to an area so small as to involve but a single cell. Its chief manifestations are ex- pressed by the word inflammation. Inflammation. The most commonly observed features of inflammation are heat, redness, swelling, pain, and impaired function, modified only by peculiarities of the structure and intensity of action. It is a series of changing conditions, each the result of the preceding one. The first cause is irritation ; that is, the slightest foreign influence disturbing the harmony of the functions of the tissues. It is most readily traced in the vascular system. In this, the first stage of inflammation, the capillary vessels are excited into active contraction and relaxation, quickening the circulation of the blood, inducing warmth, and causing some discomfort. Acute inflammation, or the second stage, is charac- terized by warmth, a sense of fullness, slight swelling, and increasing pain ; the abnormal volume of blood in the parts piesses upon the nerve filaments supplying the inflamed tissue, causing pain in accordance with the expansion of the vessels. 28 DENTAL PATHOLOGY AND DENTAL MEDICINE. Chronic Inflammation. — In prolonged inflammation, the functions of the parts become somewliat changed, adapting themselves to the surrounding conditions ; thus, the tissues involved become less susceptible to the impression of an irritant, and comparatively little pain follows, this being one of the most noticeable characteristics of chronic disease. Treatment. — In treating inflammation eff'ort is made to effect resolution, or to hasten suppuration. Resolution is the subsidence of inflammation and a return of the tissues to normality. Suppuration, or pus formation, being the breaking down of the parts, the debris of which, with white blood corpuscles, forms ///i-. The remedies used are, first, to remove the cause, — that is, the irritant, — to administer laxatives, and apply sedatives and stimulants. The chronic stage of the inflammatory process, if not checked, may result in hypertrophy, induration, tume- faction, or congestion of the tissues. Hypertrophy. Hypertrophy is an excessive growth of normal tissue by the multiplication of cell elements. Of the oral tissues, the gum and mucous membrane are the most liable to this dis- ease. The usual form recognized is in a growth of the free border of the gum, lying loosely against the teeth, in some cases extending to the cutting edges. Another form consists in the thickening of the entire gums, covering the teeth to such an extent that only the masticating surfaces are visible ; the hypertrophied portion being firm and dense, protruding the lip to such an extent as to cause deformity ; this latter form of hypertrophy of the gum, however, is rare. Treatment consists in cutting away the long points and TUMEFACTION. 29 borders of the gum down to the necks of the teeth, and then reducing the inflammation with stimulants and astringents. Induration. Induration is a circumscribed, hardened swelHng ; it is an enlargement of individual cells, and not a multiplication as in hypertrophy. In this stage of chronic inflammation the func- tions of the tissue involved are inactive, the circulation being very much retarded. It may manifest itself in the gum, in the muscles of mastication, or in the muscles of the neck. Treatment. — In induration of cheek or neck, apply hot cloths and an active stimulant^ such as capsicum. When the disease is in the gum, apply capsicum plaster and lance freely. TUMEFACl'ION. Tumefaction is a condition of chronic inflammation, by which is produced an abnormal amount of tissue, of a different kind from the surrounding tissue, exhibiting a difference in color and texture. Tumefaction as found in the mouth is divided into epulis, cystic, and vasctilar tiuno's. Epulis tumors originate in the periosteum, and are usu- ally found in the interspaces of the anterior teeth. They are fibrous in structure, and usually of a dark red color. Treatment consistsof excision, care being taken to remove all the abnormal tissue ; the bistoury should be passed well around and under the tumor, as deep as the periosteum ; after removing the growth as entire as possible with the knife, car- bolic acid should be applied, to destroy the vitality of any fibres that should remain. Cystic tumors originate in the mucous membrane ; they are membranes in structure, of a lighter color than the normal mucous membrane, and are filled with a viscid fluid. Treatment consists in lancing at the lowest points, and 3© DENTAL PATHOLOGY AND DENTAL MEDICINE. emptying the contents by pressure, after which applications of stimulants and astringents should be made. Vascular tumors arise from some blood-vessel supplying the oral tissues. They are usually of a dark red color, and highly vascular; they have a smooth and shiny surface, and are more or less fibrous. Treatment same as in epulis tumors. Congestion is also often the result of inflammatory pro- cesses. The prominent feature of congestion is blood stasis, causing severe pain with each pulsation of the heart. The capillary vessels in the inflamed parts being engorged, the blood rebounds at each pulsation of the heart, thus causing the throbbing pain. The pain, however, is sometimes inter- mittent, by the capillaries being broken through, relieving the pressure temporarily. Treatment is to apply stimulants and sedatives. Alveolar Abscess. An abscess is a circumscribed cavity, containing pus — circumscribed by the development of a soft membrane, forming a sac, restraining the pus from passing into the sur- rounding tissues, causing it to seek the surface at the point of the least resistance, here parting the tissues, forming an escape called 2, fistulous opening. An alveolar abscess is, as the name indicates, an abscess originating within the alveolar walls. It is the result of inflam- mation of the pericemental membrane, consequent, usually, upon the death and septic decomposition of the tooth pulp. Symptoms of alveolar abscess are congestion and inflam- mation of the gunis about the aff"ected tooth ; severe pain which is often accompanied by considerable fever. There is also apparent elongation of the tooth, caused by inflammation ALVEOLAR ABSCESS. 3 1 of the pericemental membrane and accumulation of pus in its socket ; the pus formed, being confined in the apical space between bony walls, causes considerable pressure as it accumu- lates. The bone in this neighborhood is not of a very hard nature, and in consequence is readily destroyed by the pus in its efforts to seek the surface. During the time the pus is penetrating the bone the patient suffers most ; the pain at this stage being very severe and of a throbbing character. The features become swollen and disfigured on the affected side; the eye is sometimes entirely closed, and the jaws so stiff that the mouth can not be opened to any considerable distance. Other causes than that of the death and decomposition of the pulp may give rise to alveolar abscess ; any foreign matter, such as filling material, being forced through the apex of the root, calcic deposits within the walls of the alveolus, fiecrosed root or bone, impacted teeth, etc., may cause sufficient inflam- mation of the periosteum to produce an abscess, all the suc- cessive stages of inflammation being involved in the formation of an abscess, from irritation to suppuration. Treatment. — The surgical and local treatment consists in gaining free access to the diseased parts, and removing the cause, and breaking up the sac of the abscess. In securing ready access to the point of accumulation it is best to first open up the canals of the affected tooth. In doing this it is better to sacrifice good tooth structure than to attempt to work around corners and through too small a canal, being careful to follow the line of the canal, and not perforate the side of the root; after which the canal should be thoroughly irrigated with peroxide of hydrogen followed by a dressing of an eff"ective antiseptic and germicide before filling. Where the abscess has advanced to any considerable extent. 32 DENTAL PATHOLOGY AND DENTAL MEDICINE. it will sometimes be found necessary to more freely open or enlarge the fistulous canal by drilling in through the gum and alveolar process over the affected tooth with a medium-sized rose-head burr revolved by the dental engine. In so doing the parts may be more thoroughly drained and treated, and the sac, when attached to the end of the root, can be more readily reached and broken up. If the patient is in an other- wise healthy condition, nature will finish the work by throwing off the broken-down tissue and developing new granulations, without further treatment. It would be advisable, however, to assist in throwing off the foreign matter by injecting peroxide of hydrogen and warm water freely into the enlarged fistulous opening and socket. Where the patient is of low vitality, or the abscess of long standing, other therapeutic treatment must follow the surgical before a cure can be accomplished. After cleansing the canals thoroughly with peroxide of hydrogen, as before stated, some one of the more efficient antiseptic and disin- fectant remedies, such as carbolic acid and iodine, or oil of cinnamon, should be applied on a strand of floss silk, or a few fibers of cotton, or asbestos, which should be carried to the apex of the root by means of a nerve canal-plugger, and the crown cavity closed with a temporary stopping. The gum tissue about the affected tooth should then be painted with tincture of iodine and aconite, which will aid in the reduc- tion of the inflammation by counter-irritation. This treat- ment should be repeated in from two to three days, and con- tinued according to the character and symptoms of the case in hand. Ulceration. Ulceration is an open suppurating surface. When ulcera- tion is at all deep-seated, it differs from an abscess in not having a lining membrane, forming a sac, but involves the DISEASES OF THE DENTAL PULP AND MEMBRANE. 33 contiguous structure, the pus passing through the tissue at one or several partings. Treatment consists in applying astringents and anti- septics, and administering a tonic. DISEASES OF THE DENTAL PULP AND MEMBRANE. Inflammation of the Pulp. As in other tissues, inflammation is induced in the pulp by irritation. The most frequent cause is the encroachment of dental caries; this removes the normal covering of the pulp, allowing thermal, chemical, and mechanical irritation to readily reach that soft tissue. Treatment. — If irritation has been mild and only for a few days, immediate filling will give relief. If the irritation continues for several days, and has been severe enough to cause any actual pain, treatment consists in applying some stimulat- ing antiseptic and filling with a good temporary stopping. If no further pain is felt within ten days, fill permanently. When the irritation has continued for a considerable length of time, the pulp being seriously involved though it may not be exposed, or in cases where the pulp is exposed from the dis- integration of the dentine covering, and is subject to paroxys- mal pains, it is generally preferred to devitalize and extirpate the pulp and fill the canals before attempting to fill the crown cavity. In teeth that are not carious, inflammation of the pulp may arise from violent thermal changes, to which they are sometimes very sensitive, and if repeatedly exposed to such changes death of the entire pulp may be the result. Or some slight mechanical injury, resulting from a fall or blow, 34 DENTAL PATHOLOGY AND DENTAL MEDICINE. may cause sufficient congestion to cause death of the pulp. Hence, we not infrequently find teeth with devitalized pulps that are otherwise sound. Treatment in such cases is very simple. If the irritation is from thermal changes and has not been of long standing, the pulp will return to its normal condition by simply remov- ing the irritant ; that is, protecting the teeth from such marked thermal changes and applying a good stimulant, such as tincture of iodine, to the gum over the root of the tooth affected. If the pulp has been devitalized or the irritation has continued for such a length of time as to make devitalization necessary, — that is, where it will not respond to the treatment just described, — it should be removed by open- ing the tooth at a point making the pulp chamber and canal of most easy access; and after the devitalized organ is removed the canals should be thoroughly filled. Inflammation of Pulp Following Filling. — Occa- sionally inflammation of the pulp follows the filling of cari- ' ous teeth. This may arise from mechanical irritation, that is, undue pressure upon the pulp by the capping or filling material ; chemical, by the action of acids used in the capping or filling material ; or thermal, by the conductibility of the filling material, readily carrying every impression to the pulp. Treatment. — This can be readily diagnosed, and when the inflammation is only superficial the pulp may be restored to health by removing the irritant and treating as directed above. But when inflammation is more general (and every precaution has been taken in filling the tooth), there is no reasonable probability that it can be saved ; the filling, therefore, should be taken out, the pulp destroyed and removed, and the tooth refilled. Hypertrophy of the pulp is preceded by chronic in- flammation. // is the result of caries. The nerves do not DISEASES OF THE DENTAL PULP AND MEMBRANE. OD retain the same degree of growth as the connective tissue of the pulp ; the pulp polypus is, therefore, not so painful as the normal or acutely inflamed portion ; for this reason such growths are permitted to remain in the cavity for months before the patient calls for treatment. Treatment consists in the extirpation of the polypus, then the devitalization and removal of the remainder of the pulp, before filling. Pulp Nodules, or Nodular Dentine. Pulp nodules, or nodular dentine, is a formation of small nodules of calcified matter within the pulp cavity; they are generally confined to the body of the pulp, but at times nodules are found within the root canals. Since nodular calci- fications sometimes occur in the pulps of teeth the crowns of which are perfect, there being neither abrasion nor decay, though decay may be, and often is, found in connection with such formations, the presence of these bodies is evidently due to some other cause that is as yet unknown. These bodies give much trouble when connected with other diseases affect- ing the tooth pulp, h\x\. pain fro7n this cause alone is very rare. When these bodies do occasion trouble, it is generally in the form of infra-orbital neuralgia, with paroxysms of pain in one or more of certain teeth. Patients with these symptoms some- times present themselves. In these instances, where no carious or otherwise visibly diseased teeth are found, it may be pre- sumed that the pain is caused by an odontinoid formation in the pulp of one of these teeth. To ascertain the affected tooth, the usual tests of cold water and percussion should be employed, when the patient will usually express some abnormal feeling in the tooth or teeth containing these formations. Treatment. — When pulp stones are diagnosed, the tooth should be drilled into, in the best position and direction for 7,6 DENTAL PATHOLOGY AND DENTAL MEDICINE. reaching the pulp; this done, arsenious acid should be applied for the devitalization of the pulp, which, of course, should be thoroughly removed and the root canals and tooth filled. Gangrene of the Pulp. Gangrene of the Pulp (death in a body without loss of substance, as in suppuration). — Gangrene of the pulp not in- frequently is the result of acute inflammation ; the over-supply of blood in the arteries compresses the veins at the dental foramen, almost or entirely interrupting the circulation, thus causing the death of the pulp ui a body. Treatment consists in the removal of all remnants of pulp and in perfect disin- fection of the root canals before filling. Pericementitis (inflammation of the pericemental mem- brane) is consequent upon some one or more of the following irritants: inflammation of the pulp, putrescent pulp, excess of filling material, looseness of the tooth or root, salivary or sanguinary calculus, dental manipulation, mal-occlusion, want of occlusion, mercurial poisons, previous pericemen- titis, etc. Symptoms are knowledge of the presence of the tooth, apparent elongation of the tooth, pain following pressure from occlusion of the jaws, from the tongue, fingers, etc., the most decisive test being the tapping of the tooth, which, under these conditions, is followed by severe pain. Treatment. — First remove the irritants, vital or mechani- cal, then apply a good stimulant and sedative to the gum over the affected tooth, to hasten resolution. A hot foot-bath is also beneficial in relieving the blood pressure in the diseased parts. When gangrenous or putrescent pulp is diagnosed, the teeth should be thoroughly opened up, every vestige of the pulp removed, the canal roots thoroughly cleansed and disinfected as soon as the soreness will permit. DISEASES OF THE DENTAL PULP AND MEMBRANE. 37 PVORRHCEA AlVEOLARIS. Pyorrhoea alveolaris is a term applied to a condition characterized by a breaking-down of the alveolar walls ; a formation of pus about the roots of the teeth ; a deposit of calculi, either salivary, sanguinary, or both, upon the teeth ; a destruction of the pericementum, inflammation of the sur- rounding tissues, and accompanied by a general calcic diathe- sis. This disease has been divided by Professor Peirce into two classes : (i) Those of local origin, and (2) those having their origin in a constitutional derangement. In writing upon this subject* Dr. Peirce stated that in the effort to reduce the disease to the simplest factors and determine the primary ori- gin of each, he should coin two terms, which he thought would be more expressive as to the nature of the disease. The first form, where the salt is deposited from the saliva, he has designated as ptyalogenic calcic pericementitis, expressing the idea that in its origin it is local, peripheral, and salivary. The second he designated as hematogenic pericementitis, ex- pressive of the idea that in its origin it is constitutional, central, and associated with some modification of the normal composition of the blood plasma. The latter, however, is the condition which may be termed true pyorrhoea alveolaris. This latter form of the disease has been demonstrated bv Pro- fessor Peirce to usually accompany the gouty diathesis, and he has been misquoted by many in that it was the result of gout. His researches, however, show that it is not the result of this disease, as it may exist where there are no marked symptoms of gout, but that the predisposing cause, uric acid, or other waste products, are universally present. In other words, it is another expression of the uric acid condition. ^ For the O^ontological Society of New York, November, 1893. ;^S DENTAL PATHOLOGY AND DENTAL MEDICINE. When, however, this catarrhal condition of the gums is found to be of local origin only, it may be caused by the irritation resulting from the accumulation of salivary calcu- lus upon the necks and roots of the teeth, or a general lack of oral hygiene, or from the non-occlusion or mal-occlusion of the affected teeth, or possibly from a combination of these conditions. Clinical History. — The clinical history of pyorrhoea alveolaris is, as has been previously indicated, a deposition of calcic matter upon the necks or roots of the teeth ; a loosening, swelling, and more or less inflammatory condition of the gums; an oozing of pus from beneath the gum margins; a resorption of the alveolar borders ; and a progressive loosening and mal- position of the afl'ected teeth. Treatment. — In this, as in all diseased conditions, the first effort should be to remove the cause — that is, the source of irritation. Where the trouble is simply of a local nature, local oral treatment is all that is required. It may be simply the removal, by suitable scaling instruments, of calcareous deposits from the necks and roots of the teeth, followed with local, astringent, and stimulating treatment for the gums, and enforced hygienic treatment of the mouth, or if malocclu- sion or lack of occlusion play any part, this, too, should be corrected, if need be, by the insertion of a sufficient number of artificial teeth to overcome the difficulty ; or, if any of the teeth are very loose, as we more frequently find the lower incisors, they should be securely bound together by some light mechanical appliance. When the origin is in a systemic derangement, which is usually found to be a uric acid diathesis, the general treatment is directed toward the examination of waste pro- ducts ; a plain, wholesome diet and open-air exercise should be prescribed. In such cases the medicinal treatment should. DISEASES OF THE DENTAL PULP AND MEMBRANE. 39 as has been indicated, be directed toward the elimination of uric acid and its compounds. For this purpose some of the various lithium preparations are indicated. The writer has employed a preparation combining three important alkalies — bicarbonate of lithium, potassium, and sodium — known as " alkalithia," with much satisfaction. And as an adjunct has prescribed the free use of alkaline waters — Vichy, Carlsbad, Apollinaris, etc., as was originally recommended by Prof. Peirce. In addition to the above anti-gout regime, careful and frequent local treatment should be given. The roots should be cleansed as thoroughly as possible from all calcic deposits, the pockets formed about the roots should be freely irrigated with peroxide of hydrogen in warm water, followed by the introduction of a few drops of pyrozone, 25 per cent., or trichloracetic acid, 50 per cent., in each pocket. This will "burn out" the pockets, stimulating the formation of new granulations ; then the application of local stimulants, such as the tincture of iodine, should be made to the surface of the gums, and repeated at frequent intervals. Dental Erosion. Dental erosion is a chemical solution of the faces of teeth, and should not be confounded with dental caries or mechanical abrasion. The labial surfaces of the teeth are usually attacked, resulting in the formation of cup-shaped excavations. The erosion, in some cases, progresses until the pulp area is encroached upon ; in these cases, how- ever, it is usually found that nature has caused a deposit of calcic matter to be made at the periphery of this organ in advance of the progress of the erosion, so that when the pulp is reached it is found to be entirely obliterated through calcification. Cause. — Dental erosion is the result of the action of acid 40 DENTAL PATHOLOGY AND DENTAL MEDICINE. secretions from the labial glands, caused, probably, by the patient being of the uric acid diathesis. Treatment. — When the solution has proceeded to any depth, the cavities may be filled. At the same time an alka- line mouth-wash should be persistently used to counteract the acidity of the oral secretions; counter-irritants maybe ap- plied to the tissues surrounding the glands, and in some cases the destruction of the glands by the electric needle has been suggested by Professor Brubaker. Exostosis. Exostosis, or hypercementosis, is a disease common to all bones, but owing to the vascularity of the cementum of the tooth, it is oftener found there to a greater or less degree than in any other part of the osseous structure. It consists of outgrowth of new tissue from the cemental layer covering the roots of the teeth. It sometimes takes the form of prominent nodules, and again will be found in regular layers or masses covering a large portion of the cementum. The cause of exostosis is inflammation of the pericemen- tal membrane (pericementitis), which may be induced by mal-occlusion, want of occlusion, shock from severe dental operations, or other violence, such as biting thread — a habit formed by many seamstresses. Harris, in his "Principles and Practice," does not agree with this theory, that hyper- trophy of the cementum is attributable to irritation of the peridental membrane, but states '' that it seems to be due to some constitutional diathesis." This we can not entertain without some demonstration ; at most, it can only be a predisposing cause. Where any of the above conditions are continued for any lengtli of time it causes an abnormal energy in the odontoblastic layer of the cementum, pro- ducing increase in the growth of the structure. The alveolus DISEASES OF THE HARD DENTAL STRUCTURE. 4I is in many cases enlarged or absorbed in proportion to the growth of cementum, and the patient experiences little or no inconvenience, but there are often instances where the enlargement of the cementum causes such pressure on the nerves as to give more or less discomfort, and sometimes excruciating pain ; at times, too, it causes severe facial neural- gia quite remote from the seat of the trouble. It also happens in this way that the roots of adjacent teeth sometimes become firmly united. Treatment. — If it is possible to discover this disease at an early stage, the application of a good counter irritant, such as tincture of iodine, over the affected root may interfere with its progress. But where the disease has established itself, the extraction of the affected tooth or teeth is the only available treatment. DISEASES OF THE HARD DENTAL STRUCTURE. Dental Caries. Dental caries is the gradual softening and disintegration of the tooth substance, proceeding from the periphery toward the pulp. It first appears as a chalky, opaque spot in the enamel in which the structure is loosened and gradually broken down. In studying the causes of any disease, it is usually divided into predisposing and exciting. By "predisposing" we mean such causes as render the system or organ liable to attack, yet in themselves are not sufficient to cause the dis- ease. By ''exciting" we mean such causes as are actually responsible for the establishment of the disease. The etiology of dental caries will, therefore, be considered both from the predisposing and exciting standpoint. 4 42 DENTAL PATHOLOGY AND DENIAL MEDICINE. The exciting cause of dental caries is, primarily, an acid condition of the oral secretions, which may be the re- sult of fermentation of food debris, or acids taken in the food. After the enamel rods have been broken down (decal- cified), the tubuli of the exposed area of dentine is invaded by, and forms a habitat for, many varieties of micro-organisms. The micro-organisms active in the destruction or de- calcification of tooth structure are : (i) Those of fermentation — the yeast-plant, technically known as cryptococcus cerevi- siae ; (2) those responsible for destruction of the dentine — the bacilli (a cylindrical or rod-like form of bacteria). These micro-organisms do not act directly upon the dentine, but in the act of their ftiiiltiplication, — and they multiply in a cavity of decay by the millions, — their product is an acid, which, in its turn, attacks and decalcifies the dentine. The predisposing causes of dental caries are numerous, and are in nearly all cases due to constitutional or systemic disturbances. The character of the structure of the teeth regarding both the quality and quantity of the several tissues is an important factor; this is well illustrated by the interglob- ular spaces frequently met with both in the enamel and den- tine. These spaces are the result of some systemic disturbance during the period of calcification of the teeth, and later form weak points, or are predisposing causes of caries. The position of the teeth, too, is often a factor in the frequency of caries in these organs ; that is, whether they stand so that all surfaces may be readily cleansed, or very irregularly, presenting numer- ous surfaces for the lodgment of fermentable substances. The general tone of the system, whether giving to these organs their needed nourishment, or a nerve or blood supply of a sluggish nature, the effects of illness, and the relation of sex also present certain predisposing characteristics. Dental Caries During Illness. — In severe illness, DISEASES OF THE HARD DENTAL STRUCTURE. 43 several conditions favor dental caries : ist, the lack of nutri- tion causes the teeth to be less able to resist destructive influ- ences ; 2d, the abnormal acid secretion aids in the destruction of the tooth substance ; 3d, fermentation often progresses about the tooth without hindrance, on account of the patient's inability to keep the surface properly cleansed. Dental Caries in Its Relation to Sex. — In the male adult the conditions are more favorable than in the female. The male usually uses his teeth more in mastication, and par- takes of sweets less frequently between meals, there being a less desire for saccharine and farinaceous foods. Particles of food collecting about the teeth are readily converted into lactic acid, thus becoming injurious to the tooth substance. M. Parreidt, in writing upon this subject, says: — *' The female is also at a disadvantage during pregnancy, at which time a large quantity of lime phosphates are essential to the growth of the foetus, and this supply is diverted from the teeth. It is well known that during pregnancy fractures heal less readily, because the lime phosphates are needed for the foetus. If, in a similar manner, the nourishment of the teeth is affected, as during the healing of fractures, one may readily conceive that their power of resistance against unhealthy influ- ences must be materially diminished, and the reactions of the oral fluids during pregnancy are not infrequently acid. Finally, in these cases, the reflex disturbances of digestion should be considered also, for the acid eructations are also injurious to the teeth." The proximal surfaces are convenient positions for the lodgment of fermentable substances ; in consequence, fully 65 per cent, of the first appearances of caries occur on these sur- faces of the teeth. From the statistical examinations made by the writer of one hundred thousand permanent teeth, dental caries may be classified in the following groups: — 44 DENTAL PAIHOLOGY AND DENTAL MEDICINE. Superior central incisors, carious Inferior " " Superior lateral " Inferior " " Superior cuspids, Inferior " Superior first bicuspids, Inferior " " Superior second bicuspids, Inferior " " Superior first molar, Inferior " " Superior second molar, Inferior " " Superior third " Inferior " " Per cent. .144 .006 .14 .008 .07 .009 .10 •03 .08 .05 .16 .145 .II .12 .025 •03 Relative Location of Dental Caries. Superior central incisors, " lateral " " cuspids, . . . " first bicuspids, " second " " first molars, " second " " third " Inferior central incisors, " lateral " " cuspids, . . . " first bicuspids, " second " " firsl molars, . . " second " . . " third " . . Note. — The above tables ar Approx. 95 94 98 93 92 35 20 04 Approx. 99 98 95 91 91 30 16 02 La. .01 .01 .015 .DC 5 .005 La. .01 .02 •045 .01 .005 Pal. .04 •05 •C05 Lin Mas. .065 •075 .61 •75 •95 Mas. .08 .085 .64 •78 •95 Bhc. 04 05 01 Buc. 06 06 03 e made without respect to age or sex. DISEASE^ OF THE HAKD DENTAL STRUCTURE. -tD Therapeutics of Dental Caries. — The most effective treatment of caries consists in the removal of the diseased portions and the proper preparations of the cavity, followed by a well-inserted filling of the least destructible substance compatible to the tooth substance. There are exceptional cases, however, where decay does Hot extend into the den- tine — where the tooth may be preserved by removing the diseased parts with a fine stone, diamond disk, or diamond point, and leaving the surface thus treated \vell polished. Prophylaxis. — From the time of the eruption of the deciduous teeth the mouth should be kept scrupulously clean. A soft or medium brush and water should be employed daily after each meal, and with a good powder upon rising in the morning and just before retiring at night. Where the teeth are so closely situated that the brush cannot be w'orked be- tween them, so as to cleanse the proximal surfaces, floss silk or quill toothpicks should be used to remove any particles of food that become lodged between the teeth. Mouth-washes. — Alkaline mouth-washes, such as the milk of magnesia, lime-water, or bicarbonate of soda in solu- tion, are sometimes used ; not, however, as a substitute for the tooth brush and dentifrice, but as an adjunct. They neu- tralize the oral fluids when of an acid reaction. Dental Abrasion. Odontalgia (tooth pain) is not infrequently caused by sensitive dentine on the abraded or worn-down masticating surfaces of the teeth ; the enamel covering being removed, the dentine more readily carries the irritation to the pulp. If the irritation is very severe, and is continued for a consider- able length of time, it may cause acute inflanwiatio?i and lead to the death of the pulp. This condition, however, usually shows itself when there is a strong calcic diathesis. That is, 40 DENTAL PATHOLOGY AND DENTAL MEDICINE. where there is an abundance of lime in the system, making the teeth hard, and sometimes more or less brittle. Owing to this abundance of lime, the pulp, in these cases, generally responds to the irritation by throwing out a deposit of secondary dentine proportionate to the advance of the abrasion. Abrasion, as has been indicated, is a mechanical action, and should not "be confounded with erosion, which is the result of a chemical action. Treatment. — Apply to the abraded surface chloride of zinc crystals, or touch with nitrate of silver, and follow, when practicable, by building up the surface with gold ; also make application of tincture of iodine to gum, as a counter-irri- tant. INJURIES AND DISEASES OF THE MAXIL- LARY BONES. Fractures of the Lower Jaw. Fractures of the lower jaw are usually the result of direct violence, such as a kick from a horse, fall from a height upon the face, the unskillful application of the dental *'key " and forceps, etc. Professor Pancoast, however, met with a case in which the neck of the bone was fractured by a violent fit of coughing. The patient was nearly seventy years of age.* The Most Frequent Location. — Fractures occur most frequently in the neighborhood of the cuspid tooth, this posi- tion being determined by the weakness of the bone at this point, in consequence of the depth of the alveoli. Fractures of the alveolus are frequently unavoidable during the extraction of teeth. The displacement of portions of this bone, however, gives little inconvenience, and hastens the absorptive process. Should the fracture affect the alveoli *Gross' "Surgery." INJURIES AND DISEASES OF MAXILLARY BONES. 47 of the adjoining teeth, a troublesome exfoliation may follow. Since accidents of this kind are due to the natural conforma- tion of the parts, legal proceedings against the operator for this mishap are most unjust. Diagnosis. — Fractures of the lower jaw are readily recog- nized ; the regularity of the dental arch is altered, and the mobility of the fractured portions is shown when pressure is applied to the teeth or alveolar process at the site of pain. Crepitation is discernible during the first week after fracture. Its absence, after this time, is due to formations of granulations and of the partial union of the fractured ends. The gums, also, are usually lacerated at the point of frac- ture, accompanied by considerable inflammation and swelling. Fracture of the ramus of the jaw is less frequent than in the body, and is not so readily diagnosed, as the upper portion cannot be grasped with the fingers, and crepitation is difficult to make out. Treatment. — The appliances used for the maintenance of the fractured portions in position may be divided into two classes : — External and internal to the mouth, though it may be, in a few instances, necessary to combine the two methods. The simplest form of apparatus for external use is the ordinary four-tailed bandage or sling, with a slit for the chin to rest in (Fig. 13). It is made from a piece of muslin, about a yard in length and two or three inches broad ; this should have "a slit four inches long cut in the centre of it, parallel to, and an inch from, the edge. The end of the bandage should then be split to within a couple of inches of the slit, thus forming a four-tailed bandage, with a hole in the middle. The central slit can be readily adapted to the chin, the narrow portion going in front of the lower lip, and the broader beneath the jaw, and the two tails corresponding to 48 DENTAT. PATHOLOGY AND DEXTAL MEDICINE. the lower part of the bandage are then to be carried over the top of the head, while the others are crossed over them and tied round the na})e of tlie neck. The ends of the two ban- dages may then be knotted together." * Hamilton has devised a sling for which he claims supe- riority ; we give it in his own words: "The advantage of Fig. this dressing over any which I have yet seen consists in its capability to lift the anterior fragment vertically, and at the same time it is in no danger of falling forward and downward upon the forehead. If, as in the case of most other dressings, the occipital stay had its attachment opposite the chin, its effect would be to draw the central fragment backward. By * Heath. INJURIES AND DISEASES OF MAXILLARY BONES. 49 using a firm piece of leather as a maxillary band, and attach- ing the occipital stay above the ears, this difficulty is com- pletely obviated " (see Fig. 14). The interdental splint is an apparatus used in common among dentists for an internal appliance in the treatment of l-"i(".. 14. fractured maxilla. It is usually made of vulcanite rubber, and gives very satisfactory results. In 1866, Mr. Gunning, of New York, gave a description of this contrivance as then used by him.* * Nexu York Medical Journal and British Journal of Dental Sciefice. 50 DENTAL PATHOLOGY AND DENTAL MEDICINE. Method of Making Single Interdental Splint. — Take impression in wax or modeling compound, using as small an amount as will insure a good impression of the teeth and Fig. 15. gums. An assistant should stand behind the patient and hold the broken bone as near in place as can be done with any de- gree of comfort to the patient, while the operator stands Fig. 16. directly in front and takes impression. After the casts of both jaws have been secured, they should be carefully articulated. This is done by cutting with a small saw the lower cast at the INJURIES AND DISEASES OF MAXILLARY BONES. 51 point or points of fracture, and rearranging the sections thus made, so as to bring the teeth into correct articulation. The pieces should then be secured in this position with plaster-of- Paris, and the two models placed in an articulator. This is well illustrated in Figs. 15 and 16, the first showing the con- dition of the cast before using the saw, and the latter the condition after the pieces have been brought together to the proper articulation and secured with plaster. The casts are then covered with No. 60 tinfoil; this makes the cavities in the splint a little larger than the corresponding Fig. 17. teeth, making it easily adjusted, and leaves it with a smooth surface. Use two thicknesses of base-plate wax over the tin- foil, allowing it to pass down a trifle below the necks of the teeth. Flask and vulcanize in usual manner for rubber work. When the fracture is of an obstinate vertical nature, a splint that will enclose the teeth and gums of the upper jaw as well as the lower should be used (see Fig. 17). When the proper treatment is employed, a cure is effected in from six to eight weeks, according to the age and physical condition of the patient. 52 DENTAL PATHOLOGY AND DENTAL MEDICINE. Fractures of the upper jaw are less frequent and less difticult of treatment than those of the lower jaw. In recent cases a simple replacement of the parts is all that is necessary, and occasionally the application of a simple retention splint is employed. Angle's Method of Fixation. — A more recent method for treatment of fractures of the maxill?e is that devised by Dr. E. H. Angle, of Minneapolis. And through the doc- tor's courtesy the writer is enabled to give a description of his methods and appliances. He says : " The methods used by myself in treating fractures of the maxillae have been so suc- cessful and so gratifying that it would seem they approach for efficiency and simplicity more nearly the ideal than any yet devised." In order that this system of treating fractures of the maxil- lary bones may be more easily understood. Dr. Angle has divided them into three classes. The first class comprises all simple fractures in which the teeth are good and sufficiently firm in their attachments (especially on each side of the fracture) to afford anchorage for the appliance. The second class comprises all fractures where the teeth are unsuited, from disease or any other cause, for anchorage, but yet sufficient to give the correct articulation of the jaws. The third class comprises all fractures where the jaws are edentulous. The following cases treated by Dr. Angle will simply be alluded to in this place to illustrate his methods of treatment. For a fuller and detailed description of his ap- pliances, together with that of the interdental splint, the student is referred to Richardson's " Mechanical Dentistry," seventh edition. The method of treatment in Class No. i is illustrated in the following case : A young man fell from a pile of lumber, a distance of fifteen or twenty feet, and, besides severe bruises, INJURIES AND DISEASES OF MAXILLARY BONES. 53 suffered a simple fracture through the symphysis, terminating, however, in front between the central and lateral on the left Fig. 18. side, as shown by the line in the engraving, Fig. iS, which shows the appliance used in position. V^ Fig. 19. The treatment for cases of Class No. 2 is illustrated in Fig. 19. For Class No. 3, comprising fractures of edentulous jaws, which are fortunately very rare. Dr. Angle's method of treat- 54 DENTAL PATHOLOGY AND DENTAL MEDICINE. ment is similar in principle to that in Class No. i, only that in place of the teeth small bone hooks are used, drilling for their reception a suitable cavity on each side of the fracture, comparing in position to the original sockets of the teeth, the same as if the operation of implanting teeth were in- tended, excepting that the cavities thus made need not be nearly so large or deep. They should also be drilled obliquely, to correspond to the course taken by the hooks. The hooks before insertion should, of course, be made antiseptic. While Dr. Angle has confidence in this means of treatment for edentulous jaws, the writer should hesitate to employ it in this class of cases, as it seems evident to him that the inter- dental splint, already described, would be more practicable. Necrosis of the Jaws. Necrosis of the jaw is indicated by inflammation, similar to that of dental periostitis. The gum about the affected part is swollen and of a dark-red or purple color, pus oozing from the edge of the gum between the teeth, or through one or more fistulous openings ; this discharge is not always con- fined to the mouth ; we find the pus escaping sometimes through an opening on the cheek or neck, as low down at times as the clavicle. The effect of necrosis of the jaw upon the teeth is obvious, since great pain is produced by the least pressure, and in cases of entire necrosis they become loose and discolored ; in the majority of such cases the teeth prove such an annoy- ance to the patient that they are extracted, if they do not drop out of their own accord. Cases are met with, however, where the teeth remain in situation after the bone was both necrosed and had been removed. Treatment. — Remove the dead portions from around the living bone, — here the dental engine and burrs are useful, — INJURIES AND DISEASES OF MAXILLARY BONES. 55 syringe with tepid water and peroxide of hydrogen to cleanse the parts, followed by stimulants, tonics, and nourishing diet. Ne^v bone is produced in the lower jaw if the periosteum is. preserved, this with the surrounding tissue being active in producing new bone to take the place of the lost portion. In the superior maxillary there is a development of fibrous tissue in the young subject. In the adult, nature does not do this much. When a part of the superior maxillary is necrosed, the periosteum ordinarily makes no effort to renew the lost bone. (For an elaboration upon this subject see Heath's " Diseases of the Jaw.") Dislocation of the Lower Jaw. The causes of dislocation of the lower jaw are yawning, shouting, vomiting, the introduction of the stomach-pump, etc. Sometimes it occurs during operations upon the teeth ; in all cases the patient's mouth is opened to its fullest extent. The capsular ligament, being very large and tena- cious, is not ruptured. The manner in which dislocation takes place is as follows : When the mouth is opened to its fullest extent, each condyle of the jaw leaves the true articular eminence of the interarticular fibro-cartilage, which is drawn forward of the external pterygoid muscle. A cavity is thus left behind the condyle ; when the jaw is in this position, but very slight force is needed to carry the condyle over the articular eminence, producing a dislocation. Symptoms of Dislocation. — The mouth is open and the jaw fixed, mastication being impossible, as the lower teeth project beyond those of the upper jaw. Saliva dribbles from the mouth, and speech is indistinct. A careful examination reveals a concavity immediately in front of the ear, and the condyle may be both seen and felt in front of this. The 50 DENTAL PATHOLOGY AND DENTAL MEDICINE. masseter muscle is firmly contracted and very prominent (see Fig. 20). Treatment. — Reduction is made by placing the thumbs (protected by napkins) as far back upon the molars as pos- sible (see Fig. 21), depressing the back part of the jaw, fol- lowed at once by the raising of the chin, which results in sliding the capitulum backward into the condyle fossa. After Fig. 20. — Dislocation of Lower Jaw. — [Bryant.) Fig. 21. — Reduction of Dis- location OF Lower Jaw. — [Brya}ii.) correcting the dislocation the jaws should be secured by a bandage extending under the chin and over the top of the head. The patient should be recommended to take care, for some weeks, not to open the mouth too far, as a disposition to a recurrence is great. Inflammation of the Temporo-maxillary Articulation. Serious inflammation of the temporo-maxillary articulation is infrequent; when such complaint arises, it is usually found INJURIES AND DISEASES OF MAXILLARY BONES. 57 that some derangement of the teeth is the seat of the trouble ; however, when by a close examination we find the teeth and their surrounding tissues in an apparently good condition, inflammation of this articulation may be surmised. Symptoms. — The parts in the vicinity of the joint are sensitive to pressure ; they present a swollen appearance and cause considerable pain when the mouth is opened and closed. Treatment. — First, comparative rest must be given the joint, the patient partaking only of liquid or soft food. An application of some good stimulant, such as tincture of iodine, followed by ice-water compresses, to decrease the heat of the inflamed parts. Abscess of the Antrum of Highmore. The antrum of Highmore is separated from the apices of the superior molars by a very thin lamella of bone, which is sometimes penetrated by the roots of a tooth, usually the first molar. At times the inflammation from alveolar perios- titis extends to the mucous membrane of the antrum, but less frequently does an abscess of the alveolar process penetrate this membrane and discharge pus into the antrum. Ab- scesses, however, are sometimes formed in the antrum by the septic decomposition of the pulp of a tooth the roots of which extend into the cavity. When this takes place, the natural opening between the antrum and the nose becomes diminished by the swelling of the lining mucous membrane. Inflammation becomes exces- sive, and a large collection of pus takes place, which at length escapes into the nose, or burrows alongside of the root of a tooth and discharges into the mouth. Or a fistula may be established upon the cheek ; and in protracted cases the floor of the orbit may give way, and pus discharge along the lower eyelid. 5 58 DENTAL PATHOLOGY AND DENTAL MEDICINE. Symptoms. — Abscess of the antrum is indicated by a discharge of pus into the nose, usually accompanied by a bad odor, at times causing severe local and constitutional suffer- ing, or the pus may have other outlets, as given above. The cheek is hot, flushed, and somewhat swollen ; pain of a throb- bing character is complained of; the malar bone is elevated, with an apparent depression beneath it ; the palate in severe cases loses its concavity and becomes convex, and the floor of the orbit is pushed up, forcing the eye partly from its normal position. Treatment. — Free access should be gained by making an opening into the antrum, either through the process above the roots of the teeth, or by extracting the affected tooth and entering by perforating the floor of the antrum (if this is not already done) through the alveolar cavity of one of the roots. The latter procedure is usually practised. After this is secured, the cavity may be cleansed by syringing it with warm water, followed by dilute peroxide of hydrogen, and bichloride of mercury, i : 3000, and other stimulating and constitutional remedies should be applied as the case may indicate. During treatment a small plate may be worn while eating, to prevent particles of food from entering the cavity. A plate just large enough to cover the cavity, and attached to the adjoining teeth, ansv.-ers the purpose. Or some temporary stopping, such as iodoform gauze or gutta-percha, may be placed in the cavity. DEFECTS OF THE PALATINE ORGANS. Cleft Palate. — One of the most distressing deformities to which the human frame is liable is that defective condition of the palatine organs known as Cleft Palate. DEFECTS OF THE PALATINE ORGANS. 59 It is indicated by a fissure extending through the soft, or both the soft and hard, palate, causing an impairment of mastication, of deglutition, and of speech. They are divided into two classes — Acquired (by accident or disease), and Congenital (dating from birth). Congenital cleft palate is the result of a lack of de- velopment of the maxillary bones, which may be caused by hereditary disease, or malformation from lack of nourishment of the tissues involved during embryonic life.* These defects are sometimes accompanied by more or less deformity of the alveolar arch and of the teeth, which are usually of a soft texture, with imperfectly developed roots. The cleft is not always confined to the palate bones and the soft palate, but may be complicated with complete fissure of the alveolar process and with harelip. Acquired cleft palate includes all losses of tissue in either soft or hard palate that are not congenital, whether occasioned by disease or accident. The faculty of distinct articulate speech is impaired, and deglutition is performed with much inconvenience; acquired lesions coming generally in adult life, the individual has not the advantage of the training of the parts during infancy, as in cases of congenital defects. The infant resorts to a very curious expedient to secure the nourishment necessary for subsistence and growth. The nip- ple, instead of being taken between the tongue, upper lip, and gum, is taken between the lower surface of the tongue, and the lower lip and gum. This habit being acquired, it is ap- plied later in the mastication of solid food. The food being conveyed between the tongue and movable floor, is brought *See article on " Physiology of Voice and Speech," " American System of Dentistry," Vol. in. 6o DEXTAI, PATHOLOGY AND DENTAL IMEDICINF. back between the teeth for deglutition, which is usually per- formed in this way without any food entering the nose through the cleft palate. Treatment. — The remedy for these deformities must be the closing of the passage in such a way as to restore, as far as possible, to the organs, their functions. This may be done by a surgical operation or by the insertion of an artificial palate. Staphylorrhaphy. The surgical operation sometimes resorted to is an exceedingly painful one for the patient and difficult for the operator, and which, after all, often proves a failure. Indeed, it is claimed by some writers that failures of closure in these operations are in the majority. However this may be, there are many cases on record where such operations have been performed with a marked degree of success. Staphylorrhaphy is derived from a Greek word signifying suture of the uvula. It consists in freshening or paring the edges of the palate and passing ligatures or sutures through, drawing the edges together, and closing the gap by tying the sutures.* It is claimed that the idea of this operation was first con- ceived by one Le Monnier, an ingenious French dentist, and was successfully performed by him as early as 1764. It does not seem to have been recognized by the medical profession however, for more than half a century afterward ; it was then, 1820, practised by i\I. Roux, in France, and in America by Dr. J. C. Warren, of Boston. Dr. Warren's methods were considered simpler, and his operations are generally regarded as the basis of the various * For fuller treatment of this operation see ' ' American System of Den- tistry," Vol. III. EXTRACTION OF TEETH. 6 1 modifications that have since aided in perfecting the pro- cedure. It is now classed among the regular operations of surgery, and the writer has personally witnessed and assisted in a number of such operations. Artificial Palates. Artificial palates, according to some writers, were em- ployed by the Greek physicians, but the first description was given by the celebrated French surgeon, Ambrose Pare, in the early part of the sixteenth century. Many improvements upon these primitive forms have been made. They are divided into two distinct classes — obturators and artificial velum.* An obturator is a non-elastic and stationary cover or stopper for those defects in the hard or soft palate which have a complete and well-defined boundary. An artificial velum f is a movable valve, made to supply the loss of the posterior soft palate; being under the control of the surrounding muscles, opening or closing the passage at will. EXTRACTION OF TEETH. The extraction of teeth is an operation that need sel-- dom be resorted to. It is, in nearly all cases, from negligence of the patients or their fear of dental operations that the teeth are permitted to remain in diseased conditions until they reach such a state that extraction is necessary. It is not surprising that the operation is usually approached with appre- hension, since frequent accidents occur in its performance ; * See Richardson's " Mechanical Dentistry," seventh edition. I Velum : a veil, a cover ; hence, " a pendulous veil of the palate." 62 DENTAT, PATHOLOCV AND DENTAL MEDICINE this, however, is generally due to the neglect, awkwardness, or unskillfulness of the operator. It very often occurs in the hands of medical practitioners, and is a subject that should receive more attention from physicians, by whom, though not belonging to their province, it is frequently performed. In fact, if a chair of dental pathology were established in our medical colleges, it would be a wise step in the higher educa- tion of medical students. Indications Justifying the Operation. — Firsi^ with the teeth of first dentition, it is sufficient to state that when a tooth of replacement is about to be erupted, or has actually made its appearance, either in front of or behind the corre- sponding deciduous tooth, the latter should at once be ex- tracted ; and when these teeth have been so neglected that they, together with the surrounding tissue, have become seriously diseased, it is best that they should be removed. It is desirable, however, whenever they can be retained in a fair state of health, to do so, retaining the shape of the arch until it is time for their successors to replace them, as well as giving the child their service in mastication. Second. In regard to the propriety of extracting the per- manent teeth, it should first be stated that none of these should be sacrificed unless called for by some urgent necessity. Uncontrollable pain and incurable disease surrounding the tooth are instances. Third. Extensive loss of surrounding tissue, leaving the tooth or root very much loosened, acting as an irritant and becoming a source of disease to the adjacent parts. Fourth. Where a tooth is the cause of an incurable alve- olar abscess, the offending member should not be allowed to remain ; such cases, however, are rare. Fifth. To prevent or correct irregularity in the arrange- ment of the teeth. CALCAREOUS DEPOSITS. 63 Sixth. In preparing the mouth for an artificial denture it is sometimes found that the loss of one or more remaining teeth may be advantageous. There are other cases presented at times, to which fixed rules would not be applicable, where experienced judgment must determine the practice to pursue. In conclusion, it is scarcely necessary to say tliat when- ever a tooth can be restored to a healthy condition it should always be done, and that we should not for any reason be too hasty in extracting the first tooth from an unbroken arch. As all teeth, except the inferior central incisors, have nor- mally two antagonists in articulation, the loss of one tooth would place two otliers partially without function, and tlie adjoining teeth would soon become irregular by gradually leaning into the spaces. Hemorrhage after Extraction. — In cases where extrac- tion is foliOived i'}' excessive hemorrhage, or where the tendency to hemorrhage exists, the ap])lication of some reliable styptic should be made, the following .being the most powerful of these agents: tannic acid, gallic acid, solution of persulphate of iron, and the powdered subsiilphate of iron (Monsel's powder). Some of the simple local remedies are spider web or a pledget of cotton or sponge" saturated with sandarach varnish as mechanical obstructors ; this packing should be allowed to remain until all danger of a return is past. CALCAREOUS DEPOSITS. There are two varieties of calculus, or tartar, as it is most commonly called, found upon the teeth ; namely, sali- vary and sanguinary. Salivary calculus is deposited from the saliva upon the crowns or any exposed surfaces of the teeth. It varies in 64 DENTAL PAIHOI.OGV AND DENTAL MEDICINE. color from a light cream to a dark brown or black, depending upon its age and the habits and general health of the patient. The characteristics of the substance, therefore, furnish diag- noses of importance to the physician and dentist. Composition. — Salivary calculus is composed of mineral and animal matter ; about 75 and 25 per cent, respectively. Phosphate of lime, and in some cases a little magnesia, car- bonate of lime, fibrin or cartilage, mucus, and a small quantity of animal fat, are its principal ingredients. The relative proportions of its constituents vary according to its density. All persons are subject to salivary calculus to a greater or less extent, but its physical characteristics are exceedingly variable. Hence it is that analyses made of it by different chemists differ. Origin and Deposition. — It is generally conceded that this concretion is a deposit, chiefly from the saliva, with an admixture of mucus. Saliva is the mixed fluid from the different salivary glands and mucous follicles, and in its normal state is either alka- line or neutral. On exposure to the atmosphere, and the decomposition liable to occur in the mouth, it may be found strongly acid or strongly alkaline, holding salts of lime in solution. On the formation of acids in the mouth, and by the action of the carbonic acid exhaled,* decomposition takes place, and the salts of lime are deposited upon the teeth. It is precipitated in great quantities upon the surfaces of the teeth opposite the ducts from which the saliva is emptied, upon the lingual surfaces of the inferior incisors and cuspids, and the buccal surfaces of the superior molars. The necks of the teeth about the free margins of the gum afford favorable * Carbonic acid having a strong aftinity for lime, unites with it in the salivary solution, forming carbonate of lime. CALCAREOUS DEPOSITS. 65 points for its collection. A nucleus once being formed, it deposits particle by particle, rapidly encroaching upon the crown, where it is deposited more abundantly. In the mouths of uncleanly persons it sometimes accumulates in such quanti- ties that nearly all the teeth are encrusted. Salivary calculus is not deposited upon the soft tissues, but upon some substance that forms nuclei, such as the natural and artificial teeth, plates, etc. ; though it is found sometimes in the ducts of the salivary glands, owing, no doubt, to a sluggish condition of the saliva. Treatment. — The removal of salivary calculus is an opera- tion of importance to the health of the gums and alveolar process, and the preservation of the teeth. For its removal, instruments (scalers) that may be readily'applied to every part of the tooth should be employed. Considerable tact and practice are necessary to perform the operation skillfully. The scaler should be passed well down beneath the margin of the gums — that is, below the edge of the deposit — until it is brought in contact with the surface of the tooth, and the mass scaled off in the direction of the cutting or masticating sur- face. Every particle of the deposit should be removed, care being necessary that the tooth substance is not roughened by the edge of the instruments, and the surface polished, lest a nuclei for immediate reaccumulation be formed. Chemical agents are employed by some for the removal of salivary calculus. This should be scrupulously avoided, as any acid capable of dissolving this accumulation is more or less injurious to the teeth. '' Their careless administration by physicians is a fruitful source of injury to the teeth, and they certainly should form no part of any dentifrice, or be in any way used for the removal of stains of any kind from the teeth." * * Harris' " Principles and Practice of Dentistry." 66 DENTAl. PATHOLOGY AND DENTAL MEDICINE. Sanguinary calculus is deposited upon the roots of the teeth, and not upon their crowns, as with salivary cal- culus. It is precipitated from the liquor sanguinis of the blood, upon its disorganization, in connection wiih the sup- purative process of inflammation. It is in the form of dark granulations, approaching crystaHization. It is much harder than salivary calculus, and adheres more firmly. Composition. — Sanguinary calculus is composed chiefly of lime salts, colored with the hgematin of the blood, which increases its tendency to take crystalline form. It should be remembered that while salivary calculus causes inflammation, sanguinary calculus is a result of the inflamma- tory action. Mucous Deposit. — The teeth of children are especially liable to mucous deposit, or ^' soft tartar." It is generally found upon the labial surfaces of the superior front teeth, though it is occasionally found upon the same surface of the inferior teeth. Source. — It can readily be seen that it is not precipitated by the saliva, from its not collecting upon the surfaces of the teeth opposite the mouths of any of the ducts leading from the salivary glands. It is generally considered to be deposited from the mucus. It is most abundant when the mucus is secreted in large quantities and when this secretion is in an abnormally acid condition. Color. — It varies in color from a grayish-brown to a dark green. The Effect of Mucous Deposit upon the Teeth. — " This green stain so erodes the enamel that decay advances in the part which it covers more or less rapidly, according to the quality of the teeth and the length of time it is allowed to remain. The removal of this mucous deposit requires more skillful manipulation than that of salivary calculus, on account CALCAREOUS DEPOSITS. 67 of its being a thin film entering into the substance of the enamel, rendering it difficult to detach without injury to the tooth substance." * Treatment. — Where the erosion is but slight, this mucous deposit may be removed by finely-powdered pumice stone and water, applied on a piece of some hard, fine-grained wood, such as orange wood, or on wood points, rotated by means of the dental engine, the surface being left thoroughly polished or burnished. When the effects are more serious, the enamel not only being discolored, but deeply eroded, the use of the corundum point, rotated by the dental engine, is necessary ; after which the surface should be left well polished. * Harris" '* Principles and Practice of Dentistry." DENTAL MEDICINE. Dental materia medica is an embodiment of the nature, medicinal properties, and therapeutical action, of all sub- stances used as medicine in dental practice. The classification of medicines is made according to their action upon the animal economy. The different classes in common use by dentists are as follows : Narcotics and hypnotics, analgesics or ano- dynes, and anaesthetics, stimulants, tonics, sedatives, anti- pyretics, irritants, astringents, styptics, and haemostatics, caustics, escharotics, antizymotics or antiseptics, and disin- fectants and laxatives. NARCOTICS AND HYPNOTICS. Narcotics (stupor) are medicinal substances which, by impairing or destroying nervous action, lessen the relationship of the individual to the external world. They at first, how- ever, have a stimulating effect, to which their therapeutic efficacy is largely due, which is followed by profound sleep and stupor. If the dose be sufficient, death will ensue by paralysis of the centres of the medulla, wliich govern respi- ration and the other functions of organic life. Hypnotics (sleep) belong to the class of narcotics, but are capable of causing sleep without any preliminary cerebral 68 NARCOTICS AND HYPNOTICS. 69 excitement, by bringing the brain into a favorable condition for it. The principal narcotics are opium (see Anodynes), alcohol (see Stimulants), belladonna (see Anodynes), chloro- form, ether (see Anesthetics), etc. The hypnotics are opium, the bromides, chloral, etc. When administered to relieve pain, they are termed anodynes. BROMINE, Br.— BROMIDES. Deriviation. — Bromine is obtained from sea-water and certain saline springs. Properties. — Bromine is a dark brownish-red, liquid, non-metallic element. It has an offensive, suffocating odor, somewhat resembling chlorine and iodine. In its pure state it is an active escharotic and internally a violent poison. The salts of bromine are cerebral and cardiac depressants and are highly valued as hypnotics. The Principal Preparations: — Ammonium Bromide, NH^Br. — Colorless, prismatic crystal. Dose, gr. v-xx. Calcium Bromide, CaBr^. — A white, granular, deliques- cent salt. Dose, gr. V-5J. Lithium Bromide, LiBr. — A white, granular, deliques- cent salt. Dose, gr. v-xx. Potassium Bromide, KBr. — Colorless, cubical crystals. Dose, gr. V-3J. Sodium Bromide, NaBr. — Colorless, monoclinic crys- tals. Dose, gr. V-3J. Zinc Bromide, ZnBr,. — A white, granular, deliquescent powder. Dose, gr. ss-ij. Syrup of Bromide of Iron. — Contains 10 per cent, of ferrous bromide, FeBr,. Dose, 5ss-j. Therapeutic Uses. — The bromides are used as sedatives 70 DENTAL PATHOLOGY AND DENTAL MEDICINE. to the nervous system to produce sleep, and in affections of the heart or cerebrum, when shown by increased action, in neuralgia, spasmodic cough, etc. Dental Uses. — Bromide of potassium is a useful remedy in convulsions from the irritation of dentition, in neuralgia, also in cases of extreme sensitiveness of the soft palate. Dose, gr. I0-20 every hour for several hours before taking impression. CHLORAL, CJlClaO. Derivation. — Chloral is obtained by the action of chlorine gas on absolute alcohol. It is a colorless, unstable, oily fluid, which readily combines with water and forms ch/oral hydrate , the official "chloral" having the formula QHClsOH^O. Properties and Actions. — The official body, chloral hydrate, is in the form of a white, crystalline substance, having a pungent odor and taste, and is soluble in water, alcohol, and glycerine. It is hypnotic, antispasmodic, and to a limited degree anaesthetic. It is serviceable in fevers, accompanied by cere- bral excitement, convulsions, delirium tremens, etc. Dose, from gr. v to gr. xxx. Liebreich claims to have produced pro- found sleep, lasting from five to fifteen hours, with twenty- five to thirty grains. The hypnotic action is preceded by a stage of excitement of short duration, which is followed by sudden calm and refreshing sleep, from which the patient can be easily aroused to partake of nourishment and will readily fall asleep again — differing in this respect from narcotism, which is marked by profound stupor. Dental Use. — Hydrate of chloral is sometimes used in dental practice for the relief of odontalgia from pulpitis, from one-half to one grain being applied to the inflamed body. It has also been thought a serviceable agent by some ANALGESICS OR ANODYNES. 7I in the treatment of putrescent pulp-canals, and as a stimulant and antiseptic injection in chronic alveolar abscesses. ANALGESICS OR ANODYNES. Anodynes are agents which are capable of relieving pain. They are divided into two classes, general and local. General anodynes, when taken internally, affect the whole organism, by depressing the cerebral centres of percep- tion and sensation. Local anodynes, when applied, affect the parts either by impairing the conductivity of the sensory nerve-fibres, or by reducing the local circulation. Some of the most efficient anodynes act either general or local. The principal agents of this class are as follows : — General Anodynes. — Opium, morphia, belladonna, aco- nite, ether, and chloroform (see Anaesthetics). Local Anodynes. — Opium, belladonna, carbolic acid (see Escharotics), cocaine (see Anaesthetics), aconite, etc. OPIUM. Source. — Opium is obtained from the white poppy, an annual herb grown in Asia Minor. Nature. — It is a gummy exudatipn which follows the incising of the unripe capsules. It should yield not less than nine per cent, of morphine when in its normal moist condition. Opium contains seventeen alkaloids, the most important of these being iiwrp/iine — dose, gr. 2-V~/^ — hypnotic, narcotic, and anodyne. Principal Preparations of Opium: — Pulvis Oipii, powdered opium. Dose, gr. ^-ij. Tinctura opii (laudanum), composed of powdered opium, 72 DENTAL PATHOLOGY AND DENTAL MEDICINE. oz. iiss ; and diluted alcohol, Oj (pint). Dose, n^xij, or 25 drops, equivalent to i gr. of opium. Tincture opii camphorata (camphorated tincture of opium, paregoric) is prepared by macerating "sixty grains of opium in two pints of diluted alcohol, with sixty grains of benzoic acid, a fluidrachm of oil of anise, two ounces of clarified honey, and forty grains of camphor." Dose, (^]- f5J. Dose for infant, v to xx drops (gtt.) — 5SS. contains about gr. j. It therefore contains -2^q- the strength of the tinc- ture. Pulvis ipecacuanhse et opii (Dover's powder), com- posed of ipecac i part, opium i part, sugar of milk 8 parts, triturated to a fine powder. Dose, gr. v to gr. xv. BELLADONNA. {Deadly Nightshade.) Source and Composition. — It is an European plant, the leaves and root being the medicinal portions. It contains two alkaloids — atropine, the active principle, and belladonnine. Preparations of Belladonna. From the leaves: — Tincture of Belladonna. — Dose, n^^j-^ss. Extract of Belladonna. — Dose, gr. %-%■ From the root : — Abstract of Belladonna (powdered). — Dose, gr. }i-]4. Fluid Extract of Belladonna. — Dose, y\]-v. Sulphate of Atropine. — Dose, gr. y^o^-eV- Therapeutics. — Belladonna is especially useful in the pain of inflammation, particularly that of rheumatism, neu- ralgia, etc., and is used locally in connection with morphine to relieve the pain of abscesses, boils, etc. Atropine is used by ophthalmologists to lessen pain, dilate the pupils, paralyze the accommodation, etc. ANALGESICS OR ANODYNES. 73 ACONITE. Source and Composition. — It is obtained from the tuberous root of Aconituiii fiapellus, a perennial plant, found in the mountainous regions of Europe and Asia. The leaves are sometimes used, but the root makes the most powerful drug. The active principle is the alkaloid aconitine, a sedative poison. Principal preparations : — Extract of Aconite. — Dose, gr. ^-j. Fluid Extract of Aconite, — Dose, "l/if-U- Tincture Aconite. — Dose, iTLss-iv. Medical Properties and Action. — Aconite is a power- ful sedative to the nervous system. In large doses it acts as a cardiac, respiratory, and spinal depressant. It proves fatal in poisonous doses by paralyzing the heart and respiration. It is also diaphoretic and antipyretic. Dental Therapeutics. — Aconite, in the form of a tinc- ture, is administered in inflammatory affections and in chronic cases of neuralgia. It is an active antagonizer of the fever process, and has been termed the "therapeutic lancet." When applied locally, it checks inflammation in its first stages, by paralyzing the peripheral ends of the nerves in the parts, and favoring resolution ; also limits the extent of an abscess where pus has already formed. In combination with the tincture of iodine, in equal parts, it acts very promptly in the incipient stages of dental periostitis, relieving the inflammation, retarding the circula- tion, and stimulating lymphatic action. In such cases the gum over the affected tooth should be thoroughly dried and then painted with this combination, protecting the lip or cheek until the remedy is absorbed. It 6 74 DENTAL PATHOLOGY AND DENTAL MEDICINE. is also considered useful by many in the dressing of pulp canals, preventing the formation of inflammatory products. When applied to a large surface, or where the skin is abraded, care should be exercised, or dangerous constitutional effects may result. The physiological antagonists are atropine, morphine, digitalis, and ammonia. In aconite poisoning the stomach should be evacuated, stimulants administered, warmth applied to the extremities, and the recumbent position maintained. ANESTHETICS. Anaesthetics are agents which temporarily destroy sensa- tion and relieve pain. They are generally employed for this purpose during surgical operations. They are divided into general and local anaesthetics. General anaesthetics are volatile substances, capable of producing (when inhaled) complete unconsciousness, loss of sensibility, and lessened motor power. The principal agents of this class are ether, chloro- form, nitrous oxide gas, and bromide of ethyl. Local anaesthetics are agents whose action is limited to the circumscribed parts to which they are applied. They paralyze the nerves of the part, thus temporarily destroying sensation. They act similarly to the local anodynes, except that while the anodynes diminish the sensibility of the parts, the local anaesthetic destroys sensation entirely for a time. The principal agents of this class are cocaine, abso- lute ether, aconite, atropine, etc. yETHER— ETHER, C^HjoO. Derivation. — Sulphuric ether (improperly so called) is ethylic ether, or oxide of ethyl. It is obtained by the dis- AN/ESTHETICS. 75 tillation of ethylic alcohol and sulphuric acid, the acid dehy- drating the alcohol and remaining in the retort. (C2H60)2 — H.,0 = QHioO. Medicinal Properties and Actions. — Ether is a color- less, volatile, and inflammable liquid. It is an anaesthetic and anodyne, a diffusible stimulant, and a narcotic poison. Administered internally, it is one of the most powerful secretion stimulants known. The action of the heart, and hence the circulation, is increased, flushing and warmth of the surface soon follow. The senses are more keen, and the phenomenon of alcoholic intoxication results, which is less protracted, however, ether being quickly eliminated, chiefly by the lungs. Principal Preparations: — ./Ether Fortior, stronger ether, ethyl oxide, "C4H10O," contains about six per cent, of alcohol. Sulphuric Ether, ethyl sulphate, C4H10SO4. Nitrous Ether, ethyl nitrite (sweet spirit of nitre), C0H5NO2. The well-known antipyretic and diaphoretic. Dose, in^v-3ij. Dental Use. — Ether is employed as a general and local anaesthetic, as a local anodyne in neuralgia and odontalgia, and as a counter-irritant, evaporation being prevented. Ether as an Anaesthetic Agent. — The practicability of producing anaesthesia by the inhalation of ether was first demonstrated by Dr. Horace Wells, of Hartford, Conn., and Dr. AV. G. S. Morton, of Boston, Mass., during the years 1844-46. Ether, though less prompt in its action, is much safer than chloroform. It has its necrology, however; a number of fatal cases (about thirty) have been reported. The Administration of Ether. — The operator should be well assured, before administering an anaesthetic, that the 76 DENTAL PATHOLOGY AND DENTAL MEDICINE. patient is not laboring under any serious disease of the heart, brain, or lungs, as ignorance in this direction might lead to fatal results. The clothing about the neck and chest should always be loose, lest it act as an impediment to respiration, and if artificial teeth be worn, they should be removed before the administration of the anaesthetic. For the inhalation of ether and chloroform a num- ber of instruments have been devised, but the simplest and probably the best method is from a sponge, napkin, or hand- kerchief, placed within a cone, formed of a towel or stiff paper, with a small opening at the apex for the admission of air; or a small piece of lint can be held in the palm of the hand and on tliese pour the anaesthetic agent. The inhalation should be commenced cautiously, the patient should be directed to breathe quite naturally, and to obey any instructions given, as the raising of the hand, etc. The towel or napkin should be held three or four inches from the patient's face, approaching it gradually, thus overcoming the irritating effect and a sense of strangulation, which follow when the agent is placed at once to the mouth and nostrils. Action of ether. — The first stage of anaesthesia is a slight relaxation, the second is tetanic or convulsive, the third, com- plete relaxation. During complete anaesthesia the face is cool, there being a profuse perspiration ; the eyes are closed, insensible to the touch, and the pupils are somewhat contracted. The respiration and pulse are somewhat slower tlian normal, as shown in the following table : — Normal pulse, 72 a minute. Pulse on administration of ether: — ist mill. 2d mill. 3d miii. 4th min. 5lh miii. 92 109 no 94 69 ANitSTHETICS. 77 Normal respiratory movements average about 20 a minute. Respiration on administration of ether : — 1st mill. 2d mill. 3cl miri. 4th miii. 5lh miii. 23 24 26 18 15 Order in which Nerve Centres are Acted Upon. — First, the cerebrum; second, cerebellum; third, the spinal cord ; fourth, the medulla oblongata. The Quantity of Ether Required. — Largest quantity, 9 ozs. ; minimum, 2JE^ ozs. ; average quantity to produce an?e>thesia, 5 ozs. The Time Required for Full Anaesthesia. — Longest time reqtiired, 24 minutes; shortest time, -^jj minutes; aver- age time, S minutes. The Dangers of Anaesthesia. — There are conditions rendering general anaesthesia dangerous, and the practitioner, whether medical or dental, should be well assured, before administering ether or chloroform, that none of these are present. They are fatty degeneration of the heart, valvular lesions, kidney disease, brain tumors, respiratory obstructions from enlarged tonsils, thoracic tumors or aneurism, and chronic alcoholism. An anaesthetic should never be admin- istered on a full stomach, as 'sickness would likely follow that would interfere with the operation, and anaesthesia of the glottis prevents the expulsion of vomited matter in case it enters the larynx by regurgitation ; neither should it be given after long fasting, as an absence of nutrition would tend toward cardiac paralysis; excitement should be avoided, in- struments should be kept out of sight, and too many spec- tators should not be present. A painful operation should not be commenced before the stage of complete anaesthesia is reached, or it may cause death from shock, as the result of peripheral irritation. 78 DENTAL PATHOLOGY AND DENTAL MEDICINE. Treatment of Dangerous Symptoms. — In case of the suspension of the heart's action, the agent should be withdrawn, the body placed in a reclining position, and, if need be, inverted, and air freely admitted. The failure of respiration requires the drawing forward of the tongue, by a finger being thrust deeply into the mouth ; the inhalation of a good stimulant, nitrite of amyl, gtt. ij to gtt. v; but care is necessary in its use, and not more than two or three drops should be administered to patients who have never inhaled it. The inhalation of ammonia is probably as efficient, and can be used with more freedom than nitrite of amyl. Galvanism, too, has been successfully employed as a cardiac and respira- tory stimulant, " the positive pole being placed to the nos- tril and the negative pole over the diaphragm, to excite a reflex action between the fifth pair and the pneumogastric, or the poles may be applied directly over both phrenic nerves, or on a line with the fourth cervical vertebra, in order to stimu- late respirations ; or one pole may be placed over the upper dorsal spinous process and the other pole over the apex of the heart, to induce cardiac contraction."* And if necessary, artificial respiration should be employed (see Appendix) and warmth applied. The extremities should also be rubbed briskly, rubbing upward. Note. — It should be remembered that ether vapor is heavier than air, and forms therewith a highly explosive mixture. Therefore, if a light must be in the room, it should be high above the patient. A grate fire, gas stove, etc., in the vicinity are very dangerous. * Gorgas' " Dental Medicine." ANAESTHETICS. 79 CHLOROFORM, CHCI3. Derivation. — Chloroform (Ter-cliloride of Methyl, or Methylic Ether) is obtained by distilling alcohol with chlo- rinated lime. It was discovered in 1831, by Samuel Guthrie, of Sackett's Harbor, N. Y. The form for medicinal use is Chloroformum Purifica- tum, or Purified Chloroform. Medicinal Properties and Action. — When inhaled, chloroform is an anaesthetic, and when administered inter- nally, it is an anodyne and antispasmodic. If swallowed un- diluted, it excites great inflammation of the mucous mem- brane and causes violent gastritis. Its effects are similar to those of ether, but more rapidly produced, and it is more powerful in its action ; hence, requiring more care in its administration. When first administered (internally) it causes a feeling of warmth in the stomach, which is soon followed by a sense of coldness. It increases the action of tlie heart, producing excitement of the brain, followed by dei)ression and deep, heavy sleep. In large doses it causes stupor and insensibility, and has caused death. Therapeutic Uses. — Chloroform is used for the same purposes as is ether, and is much employed locally in lini- ments. Administered by inhalation, it is a general anaes- thetic, and when administered internally, in substance, it is an anodyne and antispasmodic, and is used as such in cases of nausea, sea sickness, sick headache, and in cases of cholera. In the last named it has probably proven more efficacious than any other single remedy. Dose, n\^ j-^ss, diluted, internally. Spirit of chloroform (chloroform, Bj ; diluted alcohol, §ij), 5SS-3J. So DENTAL PATHOLOGY AND DENTAL MEDICINE. For inhalation, 3J-5J. Average, 3iij. Dental Use. — Chloroform is employed by some in dental practice as a general angesthetic ; its use, however, is growing less every year, in favor of ether and nitrous oxide gas. It is also used as a local anaesthetic; in this case it is generally combined with other substances, as aconite, alcohol, ether, opium, etc. For administration as an anaesthetic, treatment of dangerous symptoms, etc., see Ether. Chloroform Narcosis. — Shortest time, 2 minutes 30 seconds. Longest time, 14 " 30 " Average time, 6 " 24 " Chloroform mortality is i in 3000 (over 500 fatal cases are reported, none of which were in obstetrical practice). Compared with ether mortality, i in 16,000. NITROUS OXIDE GAS, NjO. History. — Nitrous Oxide, or "Laughing" Gas, was dis- covered by Dr. Priestly in 1776, and its respirability demon- strated by Sir Humphry Davy, though the results were not published until some twenty years afterward. In 1844 Dr. Horace Wells practically demonstrated the value of its anaesthetic property for the relief of pain during surgical or dental operations. Nitrous oxide gas is manufactured by slowly melting and boiling the salt nitrate of ammonia in a glass retort, dissolving it into a vapor of water and a permanent gas (NH,N03 + Heat=zN20 + 2H.,0). The gas should pass through three wash bottles, the first containing a solution of the sulphate of iron or caustic potash, and the other two pure water, for the purpose of purifying it before it enters the receiver, from which it is administered to the patient through ANESTHETICS. 8 1 an inhaling tube. A pound of the salt will generate about thirty gallons of the gas. It is perfectly fused at 226° F., white fumes are emitted at 302° F., and gas begins to evolve at 460 F. If the temperature is raised to 500° F., a danger- ous impurity, nitric oxide, is given off; this need not be generated, however, if the proper care is observed, not allow- ing the temperature to rise above 480° F. Liquefied Nitrous Oxide. — The most convenient form for use is the liquefied gas, it being liquefied and solidified under intense cold and great pressure (50 atmospheres, or 750 pounds pressure). It is then secured in strong iron cylinders, from which it is allowed to escape into an inhaling bag when needed for use. The advantages of this form of gas are its purity, convenience for use, the large supply which can be kept on hand, and its comparative freedom from deterioration, not- withstanding its age. Properties and Actions. — Nitrous oxide gas is an elas- tic, colorless gas, with a very slight and agreeable odor. It will freeze into a beautiful, clear, crystalline solid, at about 15° F. below zero. '^ By the evaporation of this solid, a degree of cold may be produced far below that of carbonic acid bath in vacuo, or lower than 17° F." * Nitrous oxide gas supports combustion with nearly the same promptness as oxygen. As an Anaesthetic. — Nitrous oxide gas is the most pleasant and the safest general anaesthetic known. The short- ness of the anaesthetic stage is the greatest objection to its administration for surgical operations, though its rapid action, comparative safety, and the transient nature of its effects on *Gorgas' "Dental Medicine." 82 DENTAL PATHOLOGY AND DENTAL MEDICINE. the system render it the most useful anaesthetic agent for all minor operations, such as the extracting of teeth, removal of nerves from the teeth, where the tooth substance is lost to such an extent that a devitalizing agent could not be retained, for the lancing of abscesses, etc. The Administration of Nitrous Oxide Gas, for dental operations, should be conducted with the same care that is given to ether and chloroform, though it is a compara- tively safe anaesthetic. The patient should be seated in an operating chair which will admit of the back being lowered to such a degree that the patient could at once be placed in ^ horizontal position. The dress about the throat and waist, if tight, should be previously loosened, and the patient should not have partaken of food for at least two hours previous to the inhalation of the gas. A mouth prop, of which there are several patterns manu- factured, should be placed between the teeth, to prevent the closure of the jaws, as the muscles become rigidly contracted during the administration of this gas. The most suitable prop is one made of India rubber — the ordinary lead-pencil eraser, cut in proper lengths, answers the purpose very nicely — or a firm cork, as it prevents injury to the teeth or fillings, as sometimes occurs when a mouth prop of some hard substance is used. The patient is then directed to take full, regular, and deep inspirations of the gas, the nose being held or covered, to prevent the admixture of atmospheric air. Its anaesthetic effects are soon made manifest by strong, involuntary respira- tions, accompanied by snoring, this being caused by the relaxation of the muscles of the pharynx, and paralysis of the tongue, causing it to fall back toward the throat, interfering with breathing, and a livid appearance of the lips, cheeks, and finger nails, which is due to the discolored blood in the capil- laries. But the most delicate test for complete anaesthesia is, ANAESTHETICS. 83 as in ether and chloroform, the loss of sensibility to the touch in the conjunctiva of the eye. The amount of gas required to produce complete anaesthesia varies, from five to fifteen gallons being the usual amount. Out of 3000 administrations the writer has had one case where 65 gallons were required, and another where 80 gallons were inhaled before the anaesthetic stage was reached. The first stage under nitrous oxide gas is muscular activity. The second stage is muscular rigidity. It can not be continued until complete muscular relaxation, lest the patient die of asphyxia. Nitrous Oxide Gas Mortality. — There is about one death to each 125,000 administrations. Dangerous Symptoms, with Treatment, etc. — See Ether. BROMIDE OF ETHYL, C^H-Br. Derivation. — Bromide of ethyl, or hydrobromic ether, is obtained by distilling bromide of potassium and sulphuric ether, and redistilling with chloride of lime. Properties. — It is a colorless, volatile fluid, possessing an agreeable ethereal odor and a pungent taste. It is not in- flammable, caustic, nor irritant; in this respect it is preferable to chloroform or ether as an anaesthetic agent. The Administration. — Bromide of ethyl is administered as is ether or chloroform, or in a folded starched napkin, so as to cover the face, as directed by Prof. Gorgas. A soft linen handkerchief is placed inside the napkin, and upon this the agent is poured ; one drachm should be used at first, directing the patient to take deep, full inspirations. At the end of two minutes the second drachm should be added ; this should be repeated at intervals of two minutes, until complete 84 DENTAL PATHOLOGY AND DENTAL MEDICINE. anaesthesia is produced. The quantity differs according to the susceptibility of the patient. Action. — The administration of bromide of ethyl is at- tended with some danger, and clinical experience has not demonstrated to careful operators that it is as safe as some other and older agents of this class. It has a toxic action on the centres of respiration. The heart force is decreased and its action is more frequent, which contributes to the paralysis of the respiratory centres. Several deaths occurred in a very limited number of administrations of this agent. COCAINE. Source. — Cocaine is the active crystalline alkaloid of Ery- throxylon coca, a small Peruvian shrub. The leaves resemble those of Chinese tea, and in South America they are used by eight millions of people much as we use tea or coffee. In the preparation of the alkaloid, it is necessary that the leaves be carefully gathered, as the best quality only should be used. They should be dried, and not injured by age or exposure to the air, as moisture deprives them of value. Preparations of Erythroxylon : — Extractum Erythroxyli Fluidum, fluid extract of erythroxylon. Dose, 3ss-ij. Salts of cocaine. Cocaine Hydrochlorate, Cj^H^iNOi. — Dose internally, gr. j^-ij ; most commonly used as a local anaesthetic in aqueous solutions, 2-5 per cent. Cocaine Oleate, cocaine and oleic acid, 5-20 per cent. solutions for external use. Cocaine Hydrobromate, cocaine and hydrobromic acid, 2-10 per cent, as a local anaesthetic. Cocaine Wines, Pastes, Lozenges, etc., are made in great varieties. ANESTHETICS. 85 Medicinal Properties and Action. — Cocaine, when applied locally, acts as an anaesthetic ; when taken internally in small doses, it is a general stimulant, improving digestion, stimulating the respiration, circulation, etc. It produces wakefulness and a marked diminution of the sense of fatigue and hunger. For this reason the leaves are chewed by the Peruvian Indians to sustain them during long journeys or arduous labor. A toxic dose, or long-continued use (cocaine habit) pro- duces insomnia, decay of the moral and intellectual powers, hallucinations, insanity, and death. Dental Use. — The salts of cocaine have proven very efficient for their local anaesthetic and anodyne effects; their power as a local anaesthetic is very great over a limited area, and hence it is of special value to the dentist, for operations upon the submucous tissues and the extraction of teeth, where it should be used. by hypodermic injection, or applied to the gum on either side of the tooth to be extracted, the latter method being the safer; two or three applications should be made at intervals of about two minutes each, when a painless operation is generally secured. I have found it to act very happily, also, in connection with arsenious acid, for the devi- talization of dental pulps, the pulp dying without giving the patient any discomfort. But as for its use as a pain obtundent in hypersensitive dentine, its practical benefits are question- able. A warning, however, should be given, that a potency for evil lurks in this most valuable drug. In many cases where it has been injected into the gum tissue for extraction of teeth, toxic results of an alarming nature have occurred and patients have been rendered ill for several weeks. This, however, is not apt to follow when the patient is of a sanguine tempera- ment and in good health. I have made a record of many S6 DENTAL PATHOLOGY AND DENTAL MEDICINE. cases where toxic results have followed the use of this drug, and find them all to be of a nervous or hysterical tempera- ment, or pregnant women. The lesson is that we should use judgment and discrimination in its application. Dangerous Symptoms. — The extremities usually become cold and rigid, the eyes staring and glassy, and the face pallid, while the pulse is weak, the heart beats faint, and respiration slow and weak — the symptoms of an impending collapse. Treatment of Dangerous Symptoms. — Fresh air should be admitted and some good stimulant administered, such as brandy, or aromatic ammonia and nitrite of amyl — by inhalation, or ether in case of convulsions, and if need be the battery. As soon as the patient is able, assist him to stand up and promenade. CHLORIDE OF ETHYL, C^H-Cl. Properties. — Chloride of ethyl is a colorless liquid pos- sessing a strong ethereal odor, and is very volatile and inflam- mable in ordinary temperature. Its boiling point is about 50° F. It is due to this low boiling or vaporizing point that it is so exactly adapted to the special requirements of a local anaesthetic. It is put up in convenient glass tubes, drawn out to a fine point, and hermetically sealed. The point of the tube is marked by a file scratch at its smallest part. Here the point is broken off when ready for use, either by the fingers or the forceps. Immediately the chloride in a gaseous state escapes from the small opening, and if the tube is partially inverted, a small jet of the liquid is projected ; this is further accelerated by allowing a good por- tion of the tube to come in contact with the hand, the warmth of which hastens the vaporization of the liquid. The preparation of chloride of ethyl, as spoken of above (in glass tubes), is a patented process, controlled by ANAESTHETICS. 87 P. Monnet, of Lyons, France. As the chloride evaporates in ordinary temperature and is very inflammable, the point has to be drawn out and sealed while the tube and its con- tents are immersed in ice water. The Application and Action. — When about to apply, the parts to be anaesthetized should be thoroughly dried, by means of absorbent cotton or napkin, then the point of the tube should be broken, as previously directed, and the fine jet of chloride directed upon the surface. If teeth are to be extracted, a napkin should be placed in the mouth back of the teeth to be operated upon, and the patient directed to breathe entirely through the nose ; the liquid should then be projected upon the mucous membrane around the tooth or root and upon the cheek over the track of the inferior maxillary nerve for the lower, and on the temple over the emergence of the fifth nerve for the upper teeth. This application upon the face, however, need not be made unless the teeth are very difficult to extract, and prolonged anaesthesia is desired. It is seldom necessary to use the entire contents of a tube for a single operation ; from one-quarter to a half will usually produce complete anaesthesia of the parts. The opening in the tube can then be closed and the contents preserved for a subsequent operation by folding a small piece of rubber dam and placing it over the end and over this stretch a wide rubber band, from end to end ; then place the tube in an upright position, preferably in a glass of cold water. The writer has employed chloride of ethyl in over two hundred minor surgical operations with uniform success. It is a most satisfactory local anaesthetic in the extraction of teeth, lancing of abscesses, removal of small tumors, extrac- tion of the tooth pulp, and in the preparation of roots of teeth and the fitting of bands and caps in crown- and bridge-work. SS DENTAL PATHOLOGY AND DENTAL MEDICINE. EUCAINE HYDROCHLORATE, ''A." Derivation. — EucaiVie hydrochlorate *'A" is obtained by the action of one naolecule of ammonia upon three mole- cules of aceton which fornns triacetonamin. This is then transformed into dry triacetonamincyanhydrin by hydrocyanic acid. This compound when saponified becomes triacetonalkamin- carbonic acid, ammonia being given off in the process. When benzylated and methylated we get n-methyl-ben- zoyltetramethyly-oxypiperidincarbonic acid-methylester, or eucaine. As will be apparent from this synthesis, eucaine is nof a coal-tar product. Properties and Actions. — Eucaine (A) is a white, neu- tral, crystalline powder, soluble in ten parts cold water, mak- ing about a nine per cent, solution. This solution is stable and may be boiled without suffering deterioration. It may be employed in all cases where cocaine is used and in similar strength or stronger, since the two drugs are quite similar as regards the rapidity, intensity, and duration of anaesthesia; eucaine, however, being much less toxic. Therapeutics. —Eucaine is employed as a local anaesthetic for minor surgical operations, and, as has been indicated, the only important difference of this drug and cocaine, physiologi- cally or therapeutically, is the difference in their toxic effects. It is claimed, after many careful experiments, that the pulse is not materially affected by the use of eucaine, either in rate or character. Some writers have stated that unpleasant disturb- ances of sensation follow the use of this drug, particularly when used upon the pharynx. These disturbances, however, are less unpleasant and less marked than those produced by cocaine, and are more transient, and, speaking generally. STIMULANTS. 89 after the lapse of an hour from the time of application, the subjective sensations may be described as normal. Dental Uses. — In dental practice, eucaine, from two to five per cent, solution, is employed as a local anaesthetic in the extraction of teeth ; it is applied locally, by freely bathing the parts, for lancing painful abscesses; is injected hypoder- matically in minor surgical operations in the mouth, such as the removal of small tumors, necrosed bone, and in operations upon the antrum of Highmore. Eucaine may also be em- ployed, cataphorically, for the obtunding of sensitive dentine, the removal of the dental pulp, etc. The writer has secured very satisfactory results with a ten per cent, solution of the drug, both as a local anaesthetic in operations upon the antrum, and in conjunction with cataphoric instruments in the usual dental operations. STIMULANTS. Stimulants are medicinal agents which increase organic activity. The most powerful and rapid in action, though transient in effect, are termed diffusible stimulants, while the local stimulants, which are of a vegetable nature, containing a volatile oil, are termed aromatic. Among the first class are such agents as the alcoholic preparations, ammonia, camphor, ether, nitrite of amyl, myrrh, etc. The principal members of the class of aromatic stimulants are capsicum, oil of cloves, peppermint, etc. Heat and cold also act as local stimulants. ALCOHOL, C2H6O. Derivation. — Alcohol is obtained by repeated distillations from the product of fermented grain or starchy substances, 90 DENTAL PATHOLOGY AND DENTAL MEDICINE. easily converted into grape sugar, which in the presence of and by the growth of low vegetable organisms (the yeast plant, etc.) splits up into alcohol and CO2. Commercial alcohol contains about 90 per cent, of absolute alcohol with 10 per cent, of water. Properties and Action. — Alcohol is a colorless, inflam- mable fluid, wholly vaporizable by heat, and unites in any proportion with water and ether. It possesses a pungent odor and burning taste. All of the alcoholic preparations are powerful diff"usible stimulants, causing general exhilaration of spirits. In large doses, however, it is a depressant, producing muscular incoordination and the effects of narcotic poisons, ending in delirium, coma, and death. The Most Important Alcohols are — Methylic Alcohol, CjH^O, methyl hydrate, wood spirit. Ethylic Alcohol, CaHgO, ethyl hydrate, grain spirit. Amylic Alcohol, C5H12O, amyl hydrate, potato spirit, also occurs with the ethylic alcohol, in excessive distillations of fermented grain. Principal Preparations of Alcohol ; — Absolute Alcohol, rarely obtainable in the shops, how- ever, stronger than 98 per cent. Alcohol contains about 91 per cent, of absolute alcohol. Alcoholis Dilutum contains equal parts of alcohol and water. Spiritus Frumenti, whisky from rye, corn, barley, and potatoes, contains from 45 to 50 per cent, of alcohol. Rum, obtained by the distillation of fermented molasses. Wines — port wine, sherry white wine (made by ferment- ing the juice of the grape without the seeds, stems, or skins); red wine (from the juice of grapes with their skins) ; cham- STIMULANTS. 9 1 pagne, claret, Rhine, etc. These contain from 5 to 40 per cent, of alcohol. Beer by slow fermentation, contains 2 to 3 per cent, alcohol. Ale, by rapid " " 2 to 6 " Porter and stout " 4 to 6 " " Therapeutic Uses. — The alcoholic preparations are most valuable agents in disease, for appropriate cases; they are employed as stimulants in acute inflammations, such as pneumonia, pleurisy, bronchitis, phthisis, and in the last stages of typhoid fever, diphtheria, acute neuralgia, etc. In insomnia from cerebral anaemia, small doses of some alco- holic stimulant at bedtime are found beneficial. In poisoning by cardiac depressants and snake venom, alcohol, freely, sustains the heart. In chloroform anaesthesia, an ounce of whisky beforehand will sustain the heart and prolong narcosis. Dental Uses. — In the administration of nitrous oxide gas, a small quantity of wine taken beforehand will often be found beneficial, increasing the heart's action at about the time the efl'ects of the anaesthetic are passing off. In painful operations upon the teeth, I have found small doses of sherry or champagne to be very beneficial. As a styptic, it arrests hemorrhage by coagulating the blood by its effects upon albumin, and contracts the mouth of the vessels by its astringent properties. For suppurating wounds it is a useful antiseptic dress- ing. For the treatment of softened and sensitive den- tine, and for drying cavities preparatory to filling, absolute alcohol is generally an efficient agent ; after drying the cavity with cotton or bibulous paper, it should be bathed with alco- hol, which evaporates rapidly and causes the almost perfect absorption of moisture from the dentine. 92 DENTAL PATHOLOGY AND DENTAL MEDICINE. Treatment of Acute Alcoholism. — Evacuate the stom- ach, administer ammonia cautiously by inhalation, apply warmth to the extremities and cold affusion to the head, and, if need be, artificial respiration. AMMONIA. Medicinal Properties and Action. — It exists most commonly in the form of ammonia gas, NH3 ; which, dis- solved in water, is the aqua ammoniae of commerce. It is intensely alkaline, and is an irritant to the mucous mem- brane. When inhaled, it acts as a stimulant, especially as an antagonist of cardiac depressants. Prolonged inhala- tion induces spasmodic coughing, a sense of suffocation, and inflammation and oedema of the glottis ; when swallowed, the aqua sets up violent inflammation of the passages and stomach. The salts of ammonia, in medicinal doses, are stimulat- ing expectorants, and stimulate the heart's action ; while in large doses or continued use they produce rapid emaciation, by impairing digestion and increasing tissue waste. In large doses they also injure the red blood corpuscles. Principal Preparations : — Aqua ammoniae, water of ammonia, containing 10 per cent, of the gas in water. Dose, n\^v-xxx, diluted. Aqua ammoniae fortior, containing 28 per cent, of the gas in solution. Ammonium carbonate. Dose, gr. ij-x. Ammonium chloride, sal ammoniac. Dose, gr. j-xx. Ammonia spirits (a 10 per cent, solution of aqua ammoniae in alcohol). Dose, nix-^j, diluted. Aromatic spirits of ammonia, the carbonate with aro- matics (oil of lemon, lavender, etc., and alcohol and water). Dose, in^x-^ij. STIMULANTS. 93 Ammonia liniment, aqua ammoniae, 30 per cent., and cotton-seed oil, 70 per cent. Ammonium nitrate, used in preparing nitrous oxide gas, Ammonium sulphate, used in preparing other ammo- nium salts, etc. CAMPHOR, CjoHigO. Source. — Camphor is a white, concrete, and translucent gum, obtained from the volatile oil of the camphor laurel, an evergreen tree indigenous in China, Japan, Formosa, etc. Refined camphor is prepared in large circular cakes, one to two inches thick. Properties and Action. — Camphor is slightly soluble in water (about i to 1300), but freely in alcohol, ether, chloro- form, oils, and milk. Alcohol forms a 75 per cent, solution. It has a penetrating, fragrant odor, a bitter, pungent taste, leaving a slight sense of coolness. It is a stimulant, anodyne, diaphoretic, antiseptic, and irritant. In medicinal doses it temporarily increases the heart's action, stimulates respiration and mental activity, promotes perspiration, and allays pain and spasm. Large doses depress the heart and excite narcotic symptoms, and have proved fatal. Principal Preparations : — Aqua camphorse, camphor water (8 parts of camphor to 1000 of distilled water, with 16 parts of alcohol to aid in the suspension of camphor). Dose, 3J-iv. Spiritus camphorse, spirit of camphor (camphor, ^iv, alcohol, Oj). Dose, rr\^v-xx. Linimentum camphorse, camphor liniment (camphor i part to olive oil 4 parts). Linimentum saponis, soap liniment (soap 10 parts, camphor 5, oil rosemary, i, alcohol 70, water 15). Is an anodyne and mild irritant for sprains, rheumatic pains, etc. 94 DENTAL PATHOLOGY AND DENTAL MEDICINE. Dental Use. — In dental practice the spirit of camphor is sometimes employed by local application to allay the pain of sigi7a It's purpurea, or purple foxglove : the leaves of the second year's growth are considered the best. The plant grows wild in Europe, and is cultivated in this country, where it is some- times seen in private gardens, grown for its beautiful spike of purple flowers. The Shakers cultivate it quite extensively for the drug market. Medicinal Properties and Actions. — Digitalis is chiefly used in disease for its tonic and diuretic properties, its tonic eff'ect upon the- heart, principally ; though the heart is slowed by its action, its force is at the same time increased. For the full cardiac effects the recumbent posture should be maintained. TONICS. lOI When the doses are large, severe gastric disturbance is caused. In toxic doses, the muscles and peripheral nerves are paralyzed ; respiration is first slowed and then becomes rapid and feeble; coma and convulsions followed by death from the sudden paralysis of the heart. Preparations and Doses : — Digitalis (the leaves). Dose, gr. ss-iij. Abstract of Digitalis. Dose, gr. ^-j (strength 200 per cent.). Extract of Digitalis. Dose, gr. i^-j. Fluid Extract of Digitalis. Dose, TT|^j-iij. Tincture of Digitalis (15 per cent.). Dose, n\^v-xx. CIMICIFUGA. Source. — Cimicifuga, or the black snakeroot, is the root of the Cimicifuga racemosa, a common plant in the United States. Medicinal Properties and Actions. — Cimicifuga has a bitter and nauseous taste, somewhat resembling that of opium. It is an efficient cardiac tonic, antispasmodic, diaphoretic, and diuretic. It is feebler in its action than digitalis, and should be used more frequently when the latter drug is indicated. Preparations and Doses : — Fluid Extract of Cimicifuga. Dose, n^^v-xxx. Tincture of Cimicifuga (20 per cent, in strength). Dose, n^xx-lx (5J). EUCALYPTUS. Source. — Eucalyptus is obtained from the leaves of the Eucalyptus globulus, or ''blue gum tree," a native of Austra- lia, but is now grown in Northern Africa, Southern Europe, and in the United States. Properties and Actions. — The leaves are the only por- I02 DENTAL PATHOLOGY AND DENTAL MEDICINE. tion of the tree which possesses medicinal qualities, the fresh being more active than the dried leaves. Tlieir medicinal properties are due to a volatile oil, called oleum eucalypti, which contains three oils, eucalyptene, turpene, and cymol, which distill over at different temperatures, the first product being the most important. Eucalyptus promotes appetite and digestion, and increases the heart's action. In large doses it causes indigestion, nausea, diarrhoea, and great muscular weakness, and if continued will cause irritation and congestion of the kidneys. It is eliminated by the skin, bronchial mucous membrane, and kidneys, the secretions of which become strongly odorous, owing to the presence of the oil. Eucalyptus is also an antiseptic, disinfectant, sedative, and diaphoretic, ''and has anti-malarial properties, absorbing noxious germs, as well as enormous quantities of water from the soil, and by its emanations purifying the atmosphere in the vicinity. It is largely cultivated in malarial districts for these properties, and has rendered habitable a portion of the deadly Roman Campagna." * Preparations of Eucalyptus : — Extract. Dose, gr. j-xv. Fluid Extract. Dose, n\^xx-3j. Tincture. Dose, f^ss-ij. Oil. Dose, iTLv-xx in emulsion or capsules. Dental Use. — In dental practice the oil of eucalyptus is employed either alone or combined with iodoform, for its antiseptic properties, in the treatment of putrescent pulps of teeth and chronic alveolar abscesses. This combination has also proven very efficient in the treatment of necrosis and caries of the bone of the jaws. By taking advantage of the solvent effect of eucalyptol * Potter's " Materia Medica." TONICS. 103 upon the gutta-percha, it will be found of great benefit in the insertion of fillings of this material. IRON. Ferrum, or iron^ is a metal of a bluish-gray color, fibrous in texture, is hard, ductile, malleable, and magnetic. Chemical analysis demonstrates the presence of iron in the bfood, i part to 230 of red corpuscles, also in the gastric juice, chyle, bile, lymph, urine, milk, and pigment of the eye. Properties and Actions. — Iron taken into the stomach in the metallic state, meeting with the acids of that cavity, is dissolved, which causes an evolution of hydrogen gas, and gives to the iron molecular activity. Given i?iedicinally in small doses, the salts of iron act through and upon the blood, improving its quality and increasing the number of red corpuscles ; they also promote the appetite and improve digestion, and hence it is recognized as one of the most efficient tonics. In large doses these salts cause nausea and vomiting and act as irritants. Or the prolonged administration of small doses exhausts the gastric glands by over-stimulation. Monsel's preparations of iron are principally used ex- ternally, for hemorrhage, and are considered to be among the very best styptics in use. When internally employed it is for their hemostatic effect in hemorrhage from remote organs. In administering iron care should be exercised, as nearly all the preparations are more or less astringent, and act injuriously on the teeth. Contra-indications. — Iron should never be given when plethora (a superabundance of blood) exists, especially when accompanied with a hemorrhagic tendency. Principal Preparations : — Tincture of the Chloride of Iron. Dose, n^^v-xx. I04 DENTAL PATHOLOGY AND DENTAL MEDICINE. Powdered Sulphate of Iron, Monsel's Powder. Dose, gr. ss-iij, in pill; used also as a styptic. Solution of Subsulphate of Iron, or Persulphate, Monsel's Solution. Possesses powerful astringent proper- ties ; used only as a styptic. Dental Uses. — In dental practice the chief indications for iron are where hemorrhage follows the extraction of teeth, or from any other cause, such as wounds of the gums and mucous membrane. Monsel's solution or powder is em- ployed for this purpose. See chapter on Extraction of Teeth. ARSENIC, As. Properties. — Arsenic is a brittle, granular metal, of steel- gray color, is very combustible, and volatilizes before melting, the vapor having an odor like that of garlic. It is a powerful poison, not of itself, however, but by virtue of the facility with which it absorbs oxygen. It is generally found in cobalt ore. It is not employed as medicine in its native state. Preparations : — Arsenious Acid (?), White Arsenic, " Ratsbane." Dose, Solution of Arsenious Acid, i per cent, solution (strength, y^^-) with hydrochloric acid and distilled water. Dose, Tr^ij-x, after meals. Solution of Potassium Arsenite, Fowler's solution (strength, y^-q). Dose, n^ij-x, after meals. White Oxide of Arsenic (AsaO^), Arsenious Acid, is in the form of irregular solid lumps, having a chalky appearance externally, though it is often perfectly transparent internally. It is usually furnished in the shops, however, in the form of a fine white powder, and is often adulterated with chalk or lime. It is odorless and has a faint sweetish taste. Physiological Actions. — In s?nall doses, arsenic is a TONICS. 105 general tonic, promoting the appetite, digestion, and cardiac action, stimulates mental activity, and causes rotundity of form and clear skin. In large doses it becomes a violent corrosive poison, creates skin eruptions and itching of the eye- lids, nausea, dysentery, and an irritable and feeble heart, death following from narcotism. Externally, it is a powerful escharotic. Toxicology. — The antidote to arsenic is the hydrated oxide of iron. After the prompt evacuation of the stomach this should be administered, the dose being eight times the quantity of the poison taken. This should be followed by mucilaginous or oily drinks, to protect the mucous membrane, and iodide of potassium or alkaline mineral w^aters, to pro- mote elimination. Tests for Arsenic. — There are a number of tests for arsenic, the following being considered the best : If in a solid state, place the suspected material on burning charcoal, when the arsenic, if present, will become deoxidized and emit the garlic odor spoken of above. When in an aqueous solution, it may be detected by adding sulphide of ammonium, which produces a yellow sulphide of arsenic, or the addition first of ammonia, then a small quantity of nitrate of silver, will pro- duce a light yellow arsenite of silver. Again, the addition of potassa and sulphate of copper produces a light green arsenite of copper. Marsh's Test. — The most delicate test for arsenic con- sists in subjecting the material to the action of nascent hydro- gen.* The arsenic is deoxidized and forms with the hydrogen arseniuretted hydrogen gas; this also has the peculiar odor of garlic, burning with a bluish-white flame, which deposits * Nascent hydrogen is evolved by the action of diluted sulphuric acid on zinc. Io6 DENTAL PATHOLOGY AND DENTAL MEDICINE. metallic arsenic in the form of a black spot on the surface of a cold plate if held directly in the flame. Reinsch's test consists of boiling the material suspected of containing arsenic with hydrochloric acid and copper foil, when, if arsenic is present, it will manifest itself in the form of a coating of gray metallic arsenic upon the foil. Dental Uses. — Arsenic is employed in dental practice for its devitalizing power in destroying the vitality of the pulps of teeth. It is generally combined with other agents, in the form of paste or. fibre, for this purpose. But I have found the white arsenic alone to act very happily when applied to the pulp and retained by a small pledget of cotton which had been previutisly saturated with cocaine. The cavity should be completely secured, that none of the arsenic come in contact with the part outside of the tooth. The quantity to be used for this purpose is about the ^ of a grain, and the time required is usually about 24 hours, though there are instances where 48 hours or more are required to thoroughly destroy the vitality. ZINC, Zn. Properties. — Zinc is one of the metallic elements — it is very hard, has a bluish-white color, and the fresh surface has considerable lustre, but is soon dulled, from the facility with which it oxidizes. Principal Preparations: — Zinci Oxidum. Dose, gr. j-x, insoluble in water. Zinci Acetas. Dose, gr. ^~ij ; as a lotion, gr. ij to 3J of water, in which it is very soluble. Zinci Sulphas. Dose as a tonic and astringent, gr. yV"J' As an emetic, gr. vj in 3iv of water, in tablespoonful doses, repeated every few minutes until emesis takes place. Zinci Carbonas Praecipitatus. As ointment, or dusted over wounds as a protection. TONICS. 107 Zinci lodidi. Dose, gr. ss-v, in the form of a syrup. Zinci Chloridum, tonic and escharotic. Dose, gr. ss-ij, well diluted. Zinci Chloridum Liquor, solution of chloride of zinc, ^ to I per cent, in strength. Physiological Actions. — The salts of zinc are more or less poisonous, the soluble salts, the acetate, sulphide, and chloride being corrosive poisons. /;/ small doses they are tonic and astringent, while in larger quantities they are strong emetics. The sulphate is a specific emetic, acting without much depression. The chloride is a powerful and penetrating escharotic. It is also a useful deodorizer and disinfectant. **When applied to malignant and indolent ulcers, it promotes healthy granu- lations, and when topically applied it not only destroys the diseased structure, but excites a new and healthy action of surrounding parts." The antidotes for zinc poisoning are, the white of an tgg, carbonate of soda, magnesia, etc. Dental Uses. — In dental practice the chloride of zinc (ZnCla) is a valuable agent. It is employed as an obtunding agent for sensitive dentine — the sensitive surface being pre- viously bathed with chloroform, which will modify the painful action of the chloride. It has also been employed as a styptic to arrest superficial hemorrhage from a wound of the gum during the filling of the teeth. It induces union of the wounded parts by first intention, by its effect upon the glutinous matter, also as an injection for chronic alveolar abscess, and in dis- eases of the antrum of Highmore. It is also used in the recession of the gum and the absorption of the alveolar pro- cess from the necks of the teeth. The application can be conveniently made by means of a piece of orange wood, so I08 DENTAL PATHOLOGY AND DENTAL MEDICINE. shaped as to permit of its being introduced beneath the gums. The chloride of zinc, in solution, is also used as one of the ingredients of the filling material known as the oxychlo- ride of zinc, the other ingredient being the oxide of zinc. The combination of these two forms of zinc makes an excellent capping material, and is probably the best of all materials for root filling. , The oxide of zinc — ZnO — is sometimes employed, com- bined with carbolic acid, in the form of a paste, for capping exposed pulps ; it is also one of the ingredients of the zinc filling materials, and of the celluloid base of artificial teeth. The sulphate of zinc — ZnSO^yHgO — is sometimes em- ployed in disease of the antrum of Highmore, and ulcerations of the mucous membrane, for its stimulant and astringent properties. SULPHURIC ACID, HjSO,. Properties. — Sulphuric acid, or oil of vitriol, is a dense, inodorous, colorless, oily, and corrosive liquid. It consists of not less than 96 per cent, sulphuric anhydride and about 10 per cent, of water. Preparations : — Sulphuric Acid. Used as an escharotic or caustic. Diluted Sulphuric Acid (10 per cent, of the acid to 90 per cent, of water). Dose, ii\^v-xv, well diluted. Aromatic Sulphuric Acid (Elixir of Vitriol). Sulphuric acid diluted with alcohol and flavored with ginger and cinna- mon (strength 20 per cent.). Dose, tt|^v-xxv, well diluted. Action. — The action of sulphuric acid in its different forms is as follows : Aromatic stilphuric acid, tonic and astrin- gent ; diluted sulphuric acid, tonic, astringent, and refrigerant (in fevers) ; sulphuric acid, escharotic. Treatment of Sulphuric Acid Poisoning. — Being a corrosive poison, sulphuric acid causes death from asphyxia TONICS. 109 (the suspension of vital phenomena, from the non-oxygena- tion of the blood — an excess of carbon dioxide). Administer alkalies, as washing soda, magnesia, lime-water, soapsuds, etc., to neutralize the acid, and mucilaginous drinks freely, to pro- tect the mucous membrane. Stimulants, opium, ammonia intravenously, to combat the depressed condition of the vital powers. Dental Uses. — The concentrated sulphuric acid is em- ployed in dental practice as a caustic ; in the laboratory, in a diluted state, for the cleansing of metals before and after soldering ('' the acid bath"). It is also used in the manu- facture of pyroxylin — gun cotton. Aromatic sulphuric acid is more agreeable for use in the mouth, while its action resembles that of diluted sulphuric acid. It is a valuable agent in the treatment of pyorrhoea alveolaris and necrosis of the maxillary bones, stimulating the parts to healthy action. It is also employed in the treatment of chronic alveofer abscesses, in combination with a few drops of tincture of capsicum. NITRIC ACID, HNO3. Properties. — Nitric acid, or aqua fortis, is a highly caustic liquid, very volatile, its fumes being corrosive and suffocating, and in the pure state is colorless and transparent, but that usually found in shops is of a yellow color, owing to the pres- ence of nitric peroxide. Strong nitric acid is never given internally; it is used in the form of the diluted fiitric acidy 10 per cent, absolute acid. Dose, n\^iij-x, well diluted. Action. — Pure nitric acid is a powerful caustic and escha- rolic, and is rarely used except as an application to foul, indolent ulcers, or to warts. The diluted acid is a tonic, alterative, and refrigerant, used as a drink in fevers. It is, as are most mineral acids, injurious to the teeth ; hence, care no DENTAL PATHOLOGY AND DENTAL MEDICINE. should be taken in its use. It should be taken through a glass tube or quill, and followed by an alkaline mouth wash. It is not as agreeable to the stomach as diluted sulphuric acid. The antidotes for nitric acid poisoning are magnesia or soap and mucilaginous drinks. Dental Uses. — Nitric acid is employed in dental practice as a caustic for malignant ulcers of the mouth, and has been used for devitalizing pulps of teeth when nearly exposed by mechanical abrasion. It is also used in combination with hydrochloric acid (aqua regia) as a solvent for gold. PHOSPHORIC ACID, H3PO4. Properties. — Phosphoric acid is a solid, colorless com- pound, soluble in water and vitrifiable by heat (converted into glass). It is obtained from bones, where it exists in combina- tion with lime. Diluted phosphoric acid is the form in which phosphoric acid is usually employed in medicine. It contains 10 per cent, of the absolute acid. Dose, tt|^v-xx. Action. — Phosphoric acid is tonic and refrigerant, and in large doses an irritant poison. It has been employed exter- nally in the treatment of osseous tumors and caries of the bones. Glacial phosphoric acid, HOPO5, is obtained from calcined bones. They are first treated with sulphuric acid, '•'which produces an insoluble superphosphate of lime, then dissolving out the latter salt and saturating it with carbonate of ammonia, which generates phosphate of ammonia in solu- tion, and, finally, obtaining the phosphate of ammonia by evaporating to dryness, and then igniting it in a platinum crucible. The ammonia and all of the water, except one equivalent for each equivalent of the acid, are driven off, and the glacial phosphoric acid remains. It is a white, transpa- rent, fusible solid, generally in the form of sticks, inodorous, SEDATIVES. Ill and sour to the taste. It slowly deliquesces, and is sparingly soluble in water, but freely soluble in alcohol." * Dental Uses. — Phosphoric acid has been employed in dental practice as a local treatment of osseous tumors and caries of the maxillary bones. Glacial phosphoric acid is employed as one of the ingredients of the plastic filling material, known as oxyphos- phate of zinc, the other ingredient being the white oxide of zinc. HYDROCHLORIC ACID, HCl. Properties. — Hydrochloric or muriatic acid is nearly colorless when pure, but that usually found in the shops is of a pale yellow color, being contaminated with chlorine, iron, and other substances. It is volatile, emitting a dense white and suffocating vapor; taste very acid and caustic. Actions. — Hydrochloric acid is caustic, escharotic, and disinfectant. The diluted acid administered internally is tonic, refrigerant, and astringent. Diluted Hydrochloric Acid (ten per cent, solution of absolute acid and water). Dose, rr^v-xx. Dental Uses. — It is sometimes a useful application for treatment of ulceration and inflammation of the mucous membrane and^ums. **The strong acid is employed in the laboratory for dissolving zinc, in the preparation of a flux for soldering certain metals." SEDATIVES. Sedatives are agents which exert a soothing influence — that is, diminish pain — by lessening the functional activity of organs. * Gorgas' " Dental Medicine." 112 DENTAL PATHOLOGY AND DENTAL MEDICINE. The principal agents of this class are opium and aconite (see Anodynes), digitalis (see Tonics), alcohol (see Stimu- lants), chloroform (see Anaesthetics), etc. ANTIPYRETICS. Antipyretics are agents which reduce the temperature of fever. They act either by lessening heat production or by radiation of heat. The most prominent of this class are antipyrine, quinine (see Tonics), aconite, alcohol (by increasing heat radiation), also cold bath, ice to the body, etc. ANTIPYRINE, C2oHi8Np2- Derivation. — Antipyrine is an alkaloidal product of the destructive distillation of coal-tar oil. Properties. — It is a whitish, crystalline powder, soluble in water (one-half its weight of hot and its own weight of cold water); less soluble in alcohol, chloroform, and ether; is slightly bitter and odorless. It may be administered hypodermically ; is non-irritant to the stomach or the tissues. When combined with ferric chloride it gives a bright-red color, and with nitric acid a beautiful green color. Actions. — Antipyrine is a powerful and popular antipy- retic, a general anodyne, haemostatic, and also possesses mild anaesthetic and hypnotic powers. A full medicinal dose (gr. xxx) produces a stimulant stage of short duration, which is soon followed by profuse sweating, coolness of the surface, slowed pulse, and more or less depression. The temperature in fevers is reduced from 2 to lo degrees in from i to 5 hours, according to the size and continuance of the dose. In health the reduction of the temperature is very slight, and it gives IRRITANTS. 113 rise to slight nausea and depression. It is eliminated by the kidneys, appearing in the urine a few hours after taking. ''In toxic doses its principal influence is exerted upon the blood, altering the shape of the red blood corpuscles, sepa- rating the haematin, and causing decomposition of that fluid."* Dose, for adult, gr. v-xxx ; children, gr. j-x. Dental Uses. — Antipyrine may be employed in dental practice forits haemostatic, anaesthetic, and anodyne powers. IRRITANTS. Irritants are agents which produce more or less vascular excitement or inflammation. They may be either chemical, mechanical, or nervous. Chemical irritants are those which act by virtue of their affinity for^ organic tissue, exciting the action of the capillaries, and causing an afflux of vascular and nervous power to the part to which they are applied. Included in this class are iodine, capsicum (see Stimulants), turpentine, am- monia (see Stimulants), etc. Mechanical irritants are agents or means that cause lesions or inflammation by mechanical operation. Filling material or other foreign substance being forced through the apical foramen of the root of a tooth will causes sufficient irri- tation to produce an abscess; and cuts, contusions, etc., are included in this class. Nervous irritants act through the medium of the nerves, as nervous shock, depression, or sympathetic inflammation. * Potter's *■ Materia Medica." 114 DENTAL PATHOLOGY AND DENTAL MEDICINE. lOblNE. Derivation. — Iodine is obtained principally from marine plants, though it occurs in cod-liver oil and shell-fish to a limited extent. Properties. — Iodine is a n,on-metallic element, is usually in the form of bluish-black crystalline plates or scales, having a metallic lustre, a peculiar odor, hot, acrid taste, and is of neutral reaction. It volatilizes at a low temperature, giving off a beautiful purple vapor, is slightly soluble in water (i in 7000), readily soluble in alcohol and ether (i in 12), also in a solution of chloride of sodium and iodide of potassium. Principal Preparations : — Tincture of Iodine, 8 per cent, in alcohol. Dose, ttj^J-v. Compound Tincture of Iodine (iodine, 5 per cent., potassium iodide, KI, 10 per cent., and water 85 per cent.). Dose, infij-x diluted. Potassium Iodide. Dose, gr. v-xxx. Iodoform, CHI3. Dose, gr. j-v, in pill form. Actions. — Iodine in its elementary state is an irritant to the skin, and is much used in the form of tincture to produce counter-irritation. Internally in small doses it is stimulant and tonic; it excites a sensation of heat or burning in the stomach, and in large doses acts as an irritant poison. If continued for any length of time, iodine induces great waste and rapid elimina- tion of waste products, causing anaemia and depression. The local irritant effect is diminished when combined with potassium ; hence, potassium iodide (aqueous solution of potassa and iodine) is usually employed for internal use, which allows the administration of larger doses and for a greater length of time. Toxicology. — T/ie antidote for iodine is starch, forming IRRITANTS. 115 an iodized starch, which should then be evacuated from the stomach. Colorless Iodine. — There are a number of methods for bleaching iodine; among them are the following : ist. Add to a drachm of tincture of iodine six ounces of hot water and twelve grains of phenol; stir with a glass rod. 2d. Iodine is bleached by mixing with carbolic acid ; this, carbolate of iodine, combines all the advantages of both agents. Dental -Uses. — Iodine is a very valuable agent in dental practice, the tincture being employed locally in the treatment of periostitis, inflammation and ulceration of the gums, fun- gous growths, suppurating pulps of teeth, alveolar abscess, and for ulcerations of the mucous membrane ; it is often combined with carbolic acid, and for dental periostitis it is generally combined with tincture of aconite; this combination forms an excellent treatment for the incipient stages of this affection, as well as those of alveolar abscesses. TURPENTINE. Derivation. — Turpentine is a concrete, oleo-resinous exudation from various species of pine, but principally from the ** yellow pine." Properties. — Turpentine is in the form of tough, yellow- ish masses, more or less transparent, inflammable, having a strong, unpleasant odor, and warm, pungent taste. It is composed entirely of resin and the essential oil known as oil of turpentine, CioHigO. It is soluble in alcohol. The oil is the form mainly used. Actions. — Turpentine is a stimulant, diuretic, antispas- modic, and rubefacient (counter-irritant), and antiseptic externally. Principal Preparations : — Oil of Turpentine, Spirits of Turpentine, a volatile oil Il6 DENTAL PATHOLOGY AND DENTAL MEDICINE. distilled from turpentine. Dose, n;^v-xv in emulsion as a stimulant. Turpentine Liniment. — Resin cerate (a composition of wax, oil, or lard), 65 per cent., oil of turpentine, 35 per cent. Pitch is a resinous exudation from the stem of certain pine, fir, and spruce trees. It melts at the boiling-point of water, and softens by the heat of the human body. It is of a dark-brown color, and possesses a well- known odor and taste. It is used principally as the base of plasters. Dental Uses. — Turpentine may be used in dental prac- tice for its rubefacient and antiseptic properties. ASTRINGENTS. Astringents are agents which produce contraction and condensation of organic tissues, with a tendency to remove morbid affections, arrest hemorrhage and excessive secretions from the mucous membrane. They are divided into two classes, known as vegetable and mineral. The principal vegetable astringents are tannic acid and gallic acid, the chief element of these being tannin, while the mineral asf?'inge7ifs are persalts of iron (see Tonics), alum, sulphuric acid, nitric acid, etc. TANNIC ACID, C.^H.Pi^. Derivation. — Tannic acid is obtained from nut galls. Galls are the excrescence on the twigs of the Dyer's oak, grown in Asia Minor and Persia, caused by the punctures and deposited ova (s^%) of an insect. Properties. — Tannic acid is obtained in the form of thin, yellowish crystals, inodorous, very soluble in water, less so in alcohol and ether. ASTRINGENTS. 1 I 7 Action. — Tannic acid is the most powerful of all vege- table astringents and styptics. It is especially active upon albumin, gelatin, and fibrin, forming therewith insoluble tannates, thus protecting the parts beneath until resolution occurs. Dose, gr. j-xx, in pill. Dental Uses. — Tannic acid is a very valuable agent to the dental practitioner. It is used locally in the treatment of hemorrhage following the extraction of teeth, wounds of the mucous membrane, fungous growth of the tooth pulp, hypertrophy of the gums, and to many it has proven bene- ficial in the treatment of sensitive dentine, a strong solution of tannin being mixed with alcohol. In mercurial salivation, the powdered tannic acid, moistened with water, -will check the tendency to absorption and the consequent loosening of the teeth, and will render the gums firmer and more comfortable. Glycerite of Tannic Acid (tannin, ^ij ; glycerin, ^viij), for external use. Ointment of Tannic Acid (tannin, ^j ; lard, gj), for application to ulcers, etc. GALLIC ACID, C^H605. Derivation. — Gallic acid is prepared from nutgalls. The powdered galls,*in water, are left to the action of the atmos- phere, when the acid, in the form of fine, almost colorless, crystals are deposited. Properties. — Gallic acid is obtained in the form of very fine, silky, and almost colorless crystals. It is slightly soluble in cold water (loo parts), and rapidly so in hot water, glycerine, or alcohol. It has a slightly acid and astringent taste. Action. — Gallic acid is a powerful astringent, styptic, and disinfectant. It is given directly for internal hemorrhage Il8 DENTAL PATHOLOGY AND DENTAL MEDICINE. profuse perspiration (night sweats), and excessive expectora- tions of phthisis and chronic diarrhoea. Dose, gr. v-xx, in pill form. Dental Uses. — In dental practice gallic acid may be used as a styptic in superficial hemorrhages; it is not so efficient, however, as tannic acid. It is employed in the form of a gargle, in acute inflammation of the mucous membrane, etc. For hemorrhage following extraction of teeth, Dr. Bartholo- mew claims that a teaspoonful of gallic acid in a glass of water, internally administered, is very efficacious. ALUM. Source. — Alum is found native in Italy, in the neighbor- hood of volcanoes. It is also obtained from aluminous slate or shale by roasting and exposure to the air. Formula. — The official alum (potassic-aluminic-sulphate) has the formula K2AL24SO4-I-24H2O. Dried or '' burnt alum " has the water of crystallization, 24H2O, driven off by gentle heating, which leaves it in the form of a soft, white powder. Properties. — Alum is a white, transparent salt, crystalliz- ing easily in octahedrons (having eight equal and equilateral triangles). It dissolves easily in hot water, and by about fifteen times its weight in cold water ; is insoluble in alcohol. It possesses an astringent and sweetish taste. Actions. — When taken internally in large doses, it causes vomiting, purging, and inflammation of the gastro-mucous membrane. As an emetic, powdered alum, in teaspoonful doses, is very efficient. Applied locally, it is an excellent astringent to relaxed or bleeding parts. Dose, in powder or solution, gr. x-xl (29). Dental Uses. — In dental practice, alum is employed as a styptic in alveolar hemorrhage, superficial hemorrhage of the STYPTICS AND HAEMOSTATICS. II9 mucous membrane, ulcers of the mouth, etc. It also serves an excellent purpose as a gargle in ulceration and sponginess of the gums. STYPTICS AND HEMOSTATICS. Styptics are agents which arrest hemorrhage by local ap- plication. They are divided into chemical and mechanical, according to their action. Chemical styptics coagulate the exuding blood, and at the same time stimulate the tissues to contraction. The principal members of this class are, tannic and gallic acids (see Astringents), persulphate of iron — solution, subsulphate of iron — powdered (see Tonics), and alum (see Astringents). Mechanical styptics are agents which promote clot for- mations in the mouths of bleeding vessels. They retard the flow by detaining the blood in their meshes, or absorb it until it coagulates. ^ The principal mechanical styptics are spider's web, plaster-of-Paris, sandarach varnish, cotton, etc. Haemostatics are agents capable of arresting hemorrhage by internal administration, such as ergot, antipyrine (see As- tringents), the dihited mineral acids (see Tonics), etc. ERGOT. Source. — Ergot is obtained from a parasitic fungi replac- ing the grain of rye. It is a diseased state of the grain, occasioned probably by a hot summer succeeding a rainy spring. Corn ergot is obtained from a similar growth upon the Indian corn. Principal Preparations ; — Fluid Extract of Ergot. Dose, 3ss-ij. Extract of Ergot. Dose, gr. j-xx. I20 DENTAL PATHOLOGY AND DENTAL MEDICINE. Medical Properties and Actions. — Ergot is a haemo- static, aiding coagulation by slowing the blood current. It is also used to stimulate the contraction of unstriped muscular fibre, particularly those of the uterus, causing continuous labor pains. It has been much used for this purpose in obstetrics, and very often injuriously, causing laceration of the perineum and paralysis of the foetal heart, the natural intermitting con- traction being the most desirable. Dental Uses. — Ergot may be used in dental practice for its haemostatic properties in alveolar or other hemorrhages. ESCHAROTICS OR CAUSTICS. Escharotics or caustics are agents which are capable of destroying the life of the tissue with which they come in con- tact, producing an eschar or sloughing of the tissue. Fire itself is the actual cautery, while the potential cautery (caustic substances) is represented by silver nitrate, arsenious acid (see Tonics), carbolic acid, zinc chloride (see Tonics), and the mineral acids (see Tonics), etc. NITRATE OF SILVER, AgNOj. Derivation. — Nitrate of silver, or "lunar caustic," is made by dissolving silver in nitric acid, and evaporating the solution. The reaction being Agg -j- 4HNO3 = 3AgN03 -}- 2U,0 + NO. Properties. — Nitrate of silver is in the form of colorless, shining crystals, but is readily blackened by mixing with or- ganic matter or by exposure to the light, is very soluble in water, and has a strong metallic and styptic taste. It is often cast in sticks, by first being melted (fusing at 426°F.) and then poured into suitable moulds. Actions. — Nitrate of silver is a powerful caustic and ESCHAROTICS OR CAUSTIC. 121 astringent, a heart and nerve stimulant, antispasmodic and sedative. When applied locally to the mucous membrane, ulcers, etc., it first turns the surface white, owing to its union with the coagulated albumin, but finally turns to a black color, which is due to the partial reduction of the silver by the sulphuretted hydrogen contained in the atmosphere. Co7itijii{ed tese of nitrate of silver will cause a peculiar blue line in the gums, similar to that from lead poisoning; this is fol- lowed by a- blue appearance of the skin. The remedy should be discontinued at once when this discoloration is observed. Dose of nitrate of silver, gr. ^ gradually increased to gr. j, in pill form. Never should be given with tannin or a vegetable extract ; an explosive compound may result. The fused or solid form is used externally. The antidote for nitrate of silver is chloride of sodium (common salt) freely; it precipitates it in the insoluble chlo- ride of silver ; also acts as an emetic. Dental Us^s. — Nitrate of silver is employed in dental practice for obtunding sensitive dentine, especially where the cause is mechanical abrasion, or from the fracture of a .tooth, exposing the healthy and sensitive dentine, the stick form being employed, or the end of a silver wire may be immersed in nitric acid aiyi carefully applied. It is also a valuable ap- plication for ulcerated conditions of the mucous membrane of the mouth, also as a treatment for caries in deciduous teeth. CARBOLIC ACID, CgH^O. Derivation. — Carbolic acid, phenylic alcohol or phenol, is obtained as an alcoholic product of the distillation of coal tar, between the temperatures of 338° and 370° F. Carbolic acid, though the universal name, is inappropriate. It does not belong to the acid series (it will not turn blue litmus paper red), being neutral in its reaction. 9 - 122 DENTAL PATHOLOGY AND DENTAL MEDICINE. Properties. — Carbolic acid, when pure, is in the form of colorless or pinkish acicular (needle-like) crystals. It becomes an oily liquid at 95° F. , or, if exposed to the air, the crystals readily absorb moisture and are thus liquefied. Five per cent, of water liquefies it ; any further addition simply forms a mechanical mixture. It is freely soluble in alcohol, ether, chloroform, glycerine, and the essential oils. It has a strong aromatic odor and taste, resembling creasote somewhat. Actions. — Carbolic acid in its pure state is escharotic ; when diluted, it is a powerful antiseptic, germicide, rubefa- cient, and is a violent poison ; internally, it is a sedative and carminative, allaying vomiting and gastric irritability. It resembles creasote closely in many of its medicinal prop- erties, but is probably more efficacious, and its odor is surely less objectionable ; the use of creasote by the dental practitioner may therefore well be discarded. Dose, gr. ^, for relief of nausea, etc. Dental Uses. — Carbolic acid is a valuable agent in dental therapeutics, it being one of the best escharotics, styptics, antiseptics, sedatives, etc. It is used to obtund sensitive den- tine, to relieve odontalgia, when caused by the exposure of the tooth pulp, by applying it to the exposed surface; it arrests putrefactive changes, is a valuable agent in the treat- ment of alveolar abscess ; is also used to bathe cavities in the teeth, both for its obtunding effect upon the sensitive dentine and to destroy any low organisms that may be in the softened dentine. In a form known as phenol sodique, carbolic acid is very useful as a styptic for the treatment of superficial hemor- rhage after the extraction of teeth, and forms an excellent antiseptic mouth-wash. "Combined with glycerine (i part to 12 of glycerine) it will stimulate the mucous secretion, and hence has been ESCHAROTICS OR CAUSTICS. 1 23 applied to the palate, in cases of deficiency of this secretion, to promote the suction of upper dentures." * ACETIC ACID, C2H^02. Derivation. — Acetic acid is produced from wood by destructive distillation. Properties and Actions. — The purified acid contains about 28 per cent, of anhydrous acetic acid. The dilute acid, the only form employed internally, is composed of one part acetic acid to seven parts distilled water. It is a stimulant, astringent, diaphoretic, escharotic, etc. The strong acid, when applied to the skin, causes considerable redness and pain, which rapidly results in a blister (vesica- tion). Dose. — Acetic acid, dilute, 3J-ij. Therapeutic Uses. — Acetic acid is sometimes employed in fevers, night-sweats, hemorrhage of the lungs or stomach. Externally, the^trong acid is used in the treatment of cancer, corns, warts, or fungous growths. The dilute acid is some- times employed externally to gangrene, ulcers, and sprains or bruises. Dental Uses. — Acetic acid is sometimes applied to indo- lent ulcers of the mouth, and to fungous growths of gum or dental pulp ; for the latter the concentrated form is em- ployed. Gorgas gives the following formula for indolent ulcers, cancrum oris, etc. : Acetic acid three fluid ounces to distilled water five fluid ounces; apply with camel's-hair brush. TRICHLORACETIC ACID. Derivation. — Trichloracetic acid is formed from acetic acid, three atoms of the hydrogen of which is, in the new * Prof. Gorgas. 124 DENTAL PATHOLOGY AND DENTAL MEDICINE. acid, replaced by chlorine. It is one of a group of three acids, having similar properties ; the difference in their com- position is due to the proportion of chlorine they contain. The others referred to are monochloracetic and dichloracetic acids. Properties and Actions. — Trichloracetic acid is in the form of colorless, deliquescent crystals, having an agreeable odor, and is readily soluble in water and alcohol. Its con- centrated solutions are powerful caustics, while the weaker solutions make a good antiseptic. Therapeutic Uses. — As an antiseptic it is used in putrid and indolent wounds and erysipelas. Diluted with water to a 3 per cent, strength it is an effective stimulant and astringent. Dental Uses. — It is used in dental practice as an escharotic ; 10 per cent, solution is often employed in the treatment of pyorrhoea alveolaris, acting, it is claimed, as a solvent on calculi upon the roots of teeth. A one per cent, solution is recommended as a mouth-wash, owing to its astringent and stimulating qualities. ANTIZYMOTICS. Antizymotics are agents which arrest or prevent fer- mentative processes ; they are divided into antiseptics and disinfectants. Antiseptics are those agents which prevent or retard septic decomposition, either by destroying the bacteria upon which putrefaction depends, or by arresting their development. The most important of this group are bichloride of mercury, peroxide of hydrogen, carbolic acid (see Escha- rotics), potassium permanganate, iodoform, phenol sodique, alcohol, eucalyptol, etc. ANTIZYMOTICS. 1 25 Disinfectants are those agents which destroy the germs of infectious diseases. The principal members of this group are carbolic acid (see Escharotics), zinc chloride (see Tonics, Zinc), potassium permanganate, iodine (see Irritants), aromatic sulphuric acid (see Tonics, — Sulphuric Acid). BICHLORIDE OF MERCURY, HgCl^. Derivation. — Bichloride of mercury, mercuric chloride, or *' corrosive sublimate," is obtained by distilling * a mix- ture of sodium chloride and mercuric sulphate ; a double decomposition takes place, forming mercuric chloride and sodium sulphate. Properties. — Bichloride of mercury is in the form of col- orless crystalline masses. It is inodorous, fusible, soluble in 16 parts of water, 7 parts of alcohol and ether, and has an acrid, styptic taste. Actions. — Bichloride of mercury is one of the most active salts of mercury. It is one of the most efficient of all the antizymotics in the strength of i part to 2000 parts of water. It is internally employed in chronic diarrhoea, dysentery, and syphilis. Dose, gr. -sV^^o" ^'"^ pi^^ form. Antidotes to bichloride of mercury are albumin, wheat flour, milk, etc. Dental Uses. — For prophylactic treatment of the oral cavity, particularly of the teeth, bichloride of mercury, i to 10,000, is most effective. It should be carefully used, how- ever, on account of its poisonous character. It is also used extensively in dental practice, in treatment * The double process of vaporization and condensation of the vapor. 126 DENTAL PATHOLOGY AND DENTAL MEDICINE. of alveolar abscesses, and in diseases of the antrum of High- more, in a solution of i to 2000, to i to 5000. PEROXIDE OF HYDROGEN, Hfi^. Derivation. — Peroxide of hydrogen is obtained by com- bining an extra molecule of oxygen with hydrogen monoxide, H2O (water), the result being a water-like liquid, H2O2. ** As when barium dioxide is dissolved in dilute hydrochloric acid : — BaO^ + 2HCI + H2O = BaCl2 -f- H2O -f H2O2." * Properties. — Peroxide of hydrogen is in the form of a colorless, transparent liquid, is inodorous, and almost tasteless. Actions. — Peroxide of hydrogen is one of the most effi- cient and at the same time the least harmful of all antiseptics and disinfectants. The second molecule of oxygen, spoken of above, is very loosely combined, and the mixture is always on a strain to break up into water and oxygen ; for this reason it should always be kept in a cool and dark place, and it is owing to this fact (that peroxide of hydrogen generates ** ozone," O3) that pus and the bacteria of diseased surfaces, when treated with this agent, are at once destroyed. '*As soon as ozone has accomplished its cleansing effects upon the infected surface, it is readily transformed into ordinary oxygen, owing to its instability." // is employed as an in- ternal remedy in fevers, whooping cough, bronchitis, con- sumption or phthisis, diphtheria, dyspepsia, catarrh of the stomach, etc. Locally Employed. — Peroxide of hydrogen may be em- ployed for its antiseptic and pus-destroying properties in the treatment of abscesses, ulcers, carbuncles, wounds, both fresh *Leffmann's "Chemistry. ANTIZYMOTICS. I27 and putrid, catarrh of the nose, hay fever, diphtheria, etc. It is also the base of most hair-bleaching solutions. Dose of peroxide of hydrogen, 3ss-ij. Dental Uses. — It is one of the most valuable remedies in dental therapeutics, being especially valuable as a cleansing agent, and is employed also in the treatment of alveolar abscesses, pyorrhoea alveolaris, inflammation and ulceration of the oral mucous membrane, fungous growths, etc. PYROZONE. Derivation. — Pyrozone solutions are aqueous or ethereal fluids, containing exact percentages of hydrogen peroxide. The solutions are prepared in two strengths, aqueous 3 per cent, solution, and ethereal 25 per cent, solution. Properties and Actions. — Pyrozone 3 per cent, solu- tion is a rapidly acting, harmless antiseptic, which can be employed externally or internally without danger of toxic effects. It may be used in all cases where carbolic acid or other disinfectant is indicated. The 25 per cent, solution is a bleaching agent, and when applied to diseased parts acts as a powerful caustic, bringing about resolution in a short time. Therapeutic Uses. — The 3 per cent, solution is used in certain forms ^f indigestion or dyspepsia, ulcers of the stomach, and gastritis ; 25 per cent, solution is applied to ulcers, syphilitic patches, pus-generating surfaces, and for chronic eczema. Dental Uses. — Pyrozone is used in the 3 per cent, solu- tion as a mouth-wash ; it is non-poisonous, and in cases where the micro-organisms of the mouth threaten septic invasion of the stomach, it forms a perfect gargle or spray. It completely destroys pus and mucous secretions, and renders the mouth aseptic. The 25 per cent, solution is, as has been indicated. 128 DKNTAL PATHOLOGY a'nD DENTAL MEDICINE. employed principally as a bleaching agent, and is proving a most valuable drug for that purpose. PEROXIDE OF SODIUM. Derivation. — Sodium peroxide is obtained by adding hydrogen peroxide to an excess of caustic soda, 20 per cent, solution, whicli is then poured into alcohol. Properties and Actions. — Sodium peroxide is the chemical analogue of hydrogen peroxide, and is dispensed as a yellowish white powder, which is soluble in water, which action produces an increase in temperature and evolves a cer- tain amount of oxygen. It is a strong caustic alkaline, which properties' it retains after the loss of part of its oxygen, be- coming NaaO, which, -in combination with water, is ordinary caustic soda. Dental Uses. — It is used in dental practice as a bleach- ing and sterilizing agent. It is claimed that sodium peroxide removes, more completely than any other drug, the dental tubular contents ; and it is further claimed that the normal translucency of the tooth is more fully restored. PERMANGANATE OF POTASSIUM, K2Mn208. Derivation. — Permanganate of potassium is prepared by fusing the black oxide of manganese with chlorate of potas- sium and caustic potassa. Properties. — It is in the form of dark purple crystals; it is very soluble in water, forming a beautiful lilac-colored solution ; inodorless, and has a sweetish, astringent taste. Actions. — Permanganate of potassium taken internally is a stimulant, and is given with benefit in dyspepsia; is a mild escharotic, and a powerful disinfectant and deodorizer. The solution is decomposed by organic matters, sulphides and ANTIZYMOTICS. 1 29 sulphites, yielding up its oxygen readily (on which property its use depends), and is converted into a colorless solution. The most important uses for this agent are external, where it is employed as a deodorizer and disinfectant in abscesses, ulcers, cancers, caries of the bone, etc., in the form of a lotion and spray, while the powder may be sprinkled on gangrenous surfaces, acting as a local stimulant as well as a deodorizer. Dose, for internal use, gr. }(-]. For external use, f5j to water, f^v-x. Dental Uses. — It is employed in dental practice in the treatment of foul abscess, in diseases of the antrum, necrosis of the maxillary bones, ulcers of the mouth attended with fetid discharges, offensive breath, etc. IODOFORM, CHI3. Derivation. — Iodoform is a preparation of iodine. It is ''obtained by the action of chlorinated lime upon an alco- holic solution of iodide of potassium, heated at 104° F. , the product being iodoform and iodate of lime, the iodoform being separated by boiling alcohol." Properties. — Iodoform is in the form of small yellow crystals, which are soft to the touch, of a sweetish taste; is volatile, and has a very unpleasant odor (which may be covered with oil of rose, etc.) ; is insoluble in water, but is soluble in alcohol, ether, chloroform, and the essential oils. Actions. — Iodoform is an efficient antiseptic, inhibiting and destroying the microbes of putrefaction and suppuration ; it has also slight local anaesthetic properties. Internally in small doses it is a tonic, alterative, anodyne, and antiseptic. In large doses it causes a form of intoxication, followed by convulsions, collapse, and death. T30 DENTAL PATHOLOGY AND DENTAL MEDICINE. Dose, gr. j-v, in pill form. Dental Uses. — In dental practice iodoform is a valuable agent; it is an excellent antiseptic for the treatment of alveolar abscesses, putrescent pulps, especially when com- bined with oil of eucalyptus. Prof. Peirce recommends iodo- form ground with equal parts of oil of cloves and oil of eucalyptus, a portion of which may be introduced to the inflamed part on the point of a small broach. Iodoform is also serviceable as a packing for the pockets of pyorrhoea alveolaris, and as a dressing or packing for wounds, where it may be used in the powdered form or in the form of a gauze which is prepared for the purpose. ARISTOL. Derivations. — Aristol is a preparation of iodine, and has gained a position in recent therapeutics as a perfect substitute for iodoform. It is a thymol iodide, and is ''produced by treating an aqueous solution of iodine in iodide of potassium with an aqueous solution of thymol in the presence of caustic potash." Properties. — Aristol is in the form of a reddish brown powder ; is volatile, and has a slight aromatic odor, though when compared with iodoform we may say it is practically inodorous. The quantity of iodine contained in it is from 45 to 50 per cent. Aristol is insoluble in water and glycerine, slightly soluble in alcohol, but is readily soluble in ether, chloroform, collo- dion, and the fixed and ethereal oils. Actions. — Aristol is an efficient antiseptic ; it is particu- larly applicable as a dressing for wounds, ulcerations, and abrasions of the skin and mucous membrane. It may be dusted over the wound, or applied in the form of aristol ointments (compounds of vaseline or cold cream) ANTIZYMOTICS. I3I or in combination with collodion. All of these are excellent and easy of application. Its efficiency as an antiseptic and alterative is largely due to the fact that it slowly gives off its iodine, and it is also due to this fact that it does so decom- pose, when exposed to the light or undue heat, that it should be kept in a colored bottle or a closed box and in not too warm a place. If this is not done, the loss of iodine will be readily noticed by its gradually becoming paler in color. Dental. Uses. — Aristol is a welcome addition to our catalogue of therapeutic agents. I have found it an excellent agent for treating root-canals from which putrescent pulps have been removed and for alveolar abscesses. It can also be used advantageously in combination with root-filling materi- als ; it may be used by mixing the powder with chloro-percha, or, where gutta-percha cones are to be used, the cone may be dipped in a solution of aristol and chloroform and immediately carried to position. Dr. Kirk says of it in this connection : *'I have made use of aristol in connection with root-filling materials by another method. A strong solution of aristol is made in the oil known to house-painters as ' Japan dryer,' sufficient of the drug being added to make the liquid some- what thinner than glycerine; into this is worked with a spatula freshly calcined oxide of zinc until the mass is like putty, in which condition it is to be worked into the root- canals. The mass becomes quite hard, and seems to fulfill admirably the requirements of a root-filling." FORMALIN. Derivation. — The name formalin has been given to a 40 per cent, solution of chemically pure formaldehyde in water. Formaldehyde (CH2O), as is well known, is a gaseous body which is prepared by subjecting methyl-alcohol to oxidation. It is readily absorbed by water ; for this reason it is put on 132 DENTAL PATHOLOGY AND DENTAL MEDICINE. the market in the form of an aqueous solution termed "formalin." It mixes with water in all proportions, making it easy, therefore, to prepare any dilution required. Properties and Actions. — Formalin can be used either in a gaseous or liquid form ; it is non-poisonous, of a peculiar, penetrating odor. When brought into contact with the animal skin, undiluted formalin exerts a kind of tanning effect, making the skin impermeable and finally brings about necrosis. The tissue is destroyed with suppuration or forma- tion of a wound. Therapeutic Uses. — Formalin is an ideal germicide, disinfectant, deodorant, and antizymotic, possessing the same germicidal power as corrosive sublimate, without its toxicity. It is used in aseptic and antiseptic surgery, for inhalations, in ophthalmic practice, in bacteriology, as a hardening and preserving medium, and in the recognization of the typhoid bacillus. Dental Uses. — It may be used in dentistry to kill the nerves of teeth, and as an antiseptic agent. GAULTHERIA. Derivation. — Gaultheria is obtained from the leaves of the gaultheriae procumbens {Ericacece), a small plant common to North American woods. These leaves contain tannic acid, urson, arbutin, ericolin, a volatile oil, etc. Properties and Actions. — Gaultheria has an aromatic, bitter, and astringent taste. The volatile oil is composed principally of methyl salicylate and gaultherilene, which pro- duce pure salicylic acid. Therapeutic Uses. — The oil of gaultheria is antipyretic and antiseptic, and is used in wounds, and administered in- ternally for articular rheumatism. The spirit of gaultheria is used as a flavoring extract. ANTIZYMOTICS. 1 33 Dental Uses. — Gaultheria, being one of the essential oils, is useful to the dentist for its antiseptic properties, either alone or combined with other medicines for the treatment of alveolar abscess and putrid root-canals; it is also an ingredient of local anaesthetic mixtures. CREASOTE. Derivation. — Creasote is one of the products of the distillation' of wood-tar, and consists principally of such phenols as phloral, creasol, methyl-creasol, and guaiacol. It can also be obtained from crude pyroligneous acid. That made from beech-wood, however, is the better form for medicinal use. Properties and Actions. — Creasote is a colorless, oily fluid, with an odor somewhat resembling carbolic acid, and has a burning taste. It is a stimulant, antiseptic, styptic, sedative, and rubefacient. In large doses it is a narcotic poison, causing death by coagulating the albumen of the blood, preventing its circulation through the arteries. It is used in small doses, generally, for its astringent qualities. Therapeutic Uses. — Internally, creasote is administered for pulmonarjr consumption, chronic bronchitis, vomiting and gastric troubles, diarrhoea, diabetes, etc. Externally, applied to hemorrhage from wounds, etc., diseases of the skin, erup- tions, ulcers, etc. Dental Uses. — Creasote has for many years been em- ployed in dental practice for relieving odontalgia, as an obtundent, for alveolar abscess, ulcers of the mouth, etc. Its antiseptic powers render it valuable for offensive puru- lent discharges; and its styptic properties are sometimes taken advantage of in the treatment of hemorrhage after extraction of teeth. 134 DENTAL PATHOLOGY AND DENTAL MEDICINE. NAPHTHOL. Derivation. — Naphthol is derived from naphthalene (CioHg), which is a coal-tar product and in the form of white crystals, liaving a strong, unpleasant odor; soluble in alcohol, but not in water. This alcoholic solution is known as naphthol. Properties and Action. — There are two forms of naphthol, a-naphthol and /3-naphthol ; the latter, owing to its less irritating effects, is generally employed medicinally. It is a light-brown crystal, soluble in hot water. Therapeutic Uses. — Owing to its antiseptic properties, it is used in parasitic diseases of the skin ; it is given in- ternally, and applied externally as an ointment. Dental Uses. — Hydronaphthol, supposed to be a form of /9-naphthol, is most generally used in dental practice for treating canals of pulpless teeth, pericemental inflammation of septic origin, especially in early stages before pus has formed. Professor James Truman recommends a solution of 1 : looo of water for injection into pulp canals. It is also recommended as an ingredient for a mouth-wash for diseased gums and mucous membrane. CAMPHO-PHENIQUE, C^H^fi. Derivation. — Campho-phenique is obtained from the chemical union of carbolic acid and camphor. It is prepared as follows: Nine parts of carbolic acid to one part of alcohol are mixed with twenty-five parts camphor. The clear oily solution is the result. Properties and Actions. — Campho-phenique is a limpid, volatile fluid, having an aromatic taste and the odor of camphor. It is an antiseptic, a mild local anaesthetic, and germicide ; is non-irritant, non-poisonous ; insoluble in water or glycerine, ANTIZYMOTICS. , 135 but will mix in all proportions with alcohol, ether, or chlo- roform. D-ental Uses. — As a dressing in the treatment of putres- cent pulp-canals it has given quite satisfactory results. It has been employed hypodermically as a local anaesthetic, causing no constitutional disturbance. It is also recommended for the relief of pain following the extraction of teeth, in which case it is introduced into the sockets upon pledgets of cotton. CINNAMON (Cassia Bark). Source. — The commercial cinnamon is the prepared bark of a tree of the natural order LauracecE. The best varieties of this bark are obtained from Ceylon. It contains a volatile oil, an acid peculiar to itself, — cinnamic acid, — a trace of tannic acid, mucilage, etc. Properties and Actions. — Cinnamon is placed upon the market in the form of long, thin, cylindrical pieces, having a yellow-brown color, a fragrant odor, and a sweetish, aromatic, and mildly-astringent taste. It is more powerful as a local than as a general stimulant. Its medicinal virtues, however, reside in a volatile oil, oleum cinnamomi, or oil of cinnamon. Therapeutics. — Cinnamon is sometimes employed to allay nausea and vomiting, and in combination with chalk and with other astringents it is used for the treatment of diar- rhoea. The oil of cinnamon is often employed to conceal the taste of other medicines, and is a strong local stimulant. Oil of Cassia. — Oil of cassia is prepared from the bud of the same order of tree, and the oil of cinnamon from the bark. The oil of cassia is preferred by many as an antiseptic for local treatment. Dental Uses. — Oil of cinnamon and oil of cassia are employed by many as antiseptics in dental practice. In the 136 QENTAL PATHOLOGY AND DENTAL MEDICINE. treatment of putrescent root-canals the writer has secured very satisfactory results from both these drugs. Applied to exposed and inflamed dental pulps, they will give temporary relief, and have been recommended for the treatment of pyor- rhoea alveolaris, combined with iodoform. Dr. Black's '' i, 2, 3 mixture" is composed of oil of cinnamon, i part; car- bolic acid (crystals), 2 parts; oil of gaultheria, 3 parts. This is employed in the local treatment of pyorrhoea alveolaris, and for alveolar abscesses, etc. ELECTROZONE. Derivation. — Electrozone is the product of sea-water specially treated by electrolysis. It has been so named from the fact that it is manufactured with the aid of the electric current, and the oxidizing agent being ozone. The result of electrolysis thus performed is the formation of new compounds, consisting of the hypochlorites, hypobromites, etc., and, it is claimed, the substitution of free oxygen and peroxide of hydrogen for the air between the molecules of water. Properties and Actions. — It is a clear, colorless liquid, having an unpleasant, salty taste, and an odor resembling chlorine. It is a non-poisonous and efficient antiseptic, ger- micide, and disinfectant. Therapeutic Uses. — It is much used for diphtheria, catarrh, and fevers, and is applied to burns, scalds, and wounds of any nature. Dental Uses. — It is valuable to the dentist for its anti- septic and gemicidal qualities, and is very efficacious in the treatment of acute pulpitis, giving almost instant relief. The writer has also found it very valuable in the treatment of root-canals, as a mouth-wash, and wherever a harmless germ- icide and deodorizer is desirable. CATHARTICS. I37 CATHARTICS. Cathartics, or purgatives, are agents which hasten the intes- tinal evacuations ; they comprise such substances as magnesia preparations (Epsom salt), senna, rhubarb, fruits of various kinds, etc. MAGNESIA, MgO. Derivation. — Magnesia, or magnesium oxide, is obtained by subjecting magnesium to a red heat in the open air, when it will burn with a bright light and produce MgO. Properties. — Magnesia is a very light, white powder, odorless, has an earthy taste, is freely soluble in water, — more so in cold water, — and neutralizes acids. Actions. — Magnesia is an efficient aperient (mild purga- tive), is antacid, — hence an excellent remedy for great acidity of the stomach, — and is the antidote for poisoning by mineral acids. Wherf it is desirable to administer magnesia in large doses and for a considerable length of time, it may be given in connection with lemonade, which v/ill render it more soluble, avoiding its accumulation in the bowels. Chief Preparations : — Sulphates of Magnesia, " Epsom salts," ''salts." Dose, 5J-5J, in water, a popular purgative. Liq. Citrate of Magnesia (magnesium carbonate), citric acid, potassium bicarbonate, and water. Dose, ^iv-vj. Dose of Magnesia as an aperient, gr. x-^j. As an antacid, gr. 20 Oj). Dental Uses. — The form of magnesia usually employed in dental practice is known as magnesium hydrate, or viilk of magnesia, and consists of precipitated magnesium hydrate held in suspension in water, and is employed for counter- 10 138 DENTAL PATHOLOGY AND DENIAL MEDICINE. acting the injurious action of acid secretions, especially in cases of erosion. It is applied in the same way that lime- water or precipitated chalk is used for the purpose of bring- ing about an alkaline condition of the oral fluids, by neutral- izing the excess of acids present. A teaspoonful of the pre- paration taken into the mouth and allowed to float around over the teeth coats them with a slight alkaline film, which protects the tooth surface from the acid action for several hours. MISCELLANEOUS DRUGS. GLYCERIN. Derivation. — Glycerin is a production of the saponifica- tion of fixed oils and fats; it also contains a small percentage of water. Properties and Actions. — It is a colorless, syrupy liquid, having a sweet taste but no odor; soluble in water or alcohol. It is a solvent, preservative, emollient, and nutrient. Therapeutic Uses. — It is used to dissolve iodine, iodide of potassium, borax, tannic acid, creasote, carbolic acid, etc. It is much used in poultices and for roughness of the skin, as one of the ingredients for dressings for wounds and ulcers, erysipelas, and small-pox (to prevent pitting). Glycerin is used in cases of earache and deafness. It should be mixed with a little water before applying to abraded or cut surfaces to prevent smarting. Dental Uses. — Glycerin is much used in dental practice as a solvent and emollient. It is used in the treatment of diseases of the mucous membrane of the mouth, such as ulcers, stomatitis, alveolar abscess, etc. Combined with lime- water, rose-water, gum tragacanth, etc., it forms ointments MISCELLANEOUS DRUGS. 1 39 and emollients. Combined with atropine, acetate of lead, morphine, etc., it is used as an anodyne and emollient. COLLODION. Derivations. — Collodion is a solution of pyroxylin, stronger ether, and alcohol, in the proportion of 4, 70, and 26 respectively. Pyroxylin, or common gun-cotton, is a mixture of nitric and sulphuric acids added to cotton freed from im- purities. Properties and Actions. — Collodion is a colorless, in- flammable liquid, of the consistency of syrup, with an ethereal odor. It is used to protect abraded or cut surfaces from the air, by means of the film which it forms. Owing to its astringent tendencies it draws together and holds in apposition divided parts. Therapeutic Uses. — It is applied to ulcers, abraded sur- faces, fissures,* and is also used in skin diseases and erysipelas. Dental Uses. — Combined with carbolic acid it is applied for odontalgia. With iron, etc., it forms a styptic prepara- tion. When a number of layers are applied, it will sometimes prevent an alveolar abscess from discharging on the face, causing it to open in the mouth. It is useful in the dental laboratory for coating plaster models, protecting the sur- face. Should it become too thick, dilute with a solution of ether and alcohol, 3 to i. SANDARACH. Derivation. — Sandarach is derived from an evergreen tree common to Northern Africa. Properties and Actions. — Sandarach gum is in the form of small, irregular drops, of a light yellow color, occasionally I40 DENTAL PATHOLOGY AND DENTAL MEDICINE. brown ; brittle, and slightly transparent. It has an agreeable odor and a resinous, acrid taste. It is inflammable, and when melted by heat throws out a strong balsam odor. It dis- solves readily in alcohol or ether. Dental Uses. — The alcoholic solution of sandarach is much used in dental practice as a varnish for coating plastic fillings, etc. ; and applied on cotton as a temporary stopping, and for a coating for cotton used for separating purposes. APPENDIX. EMERGENCIES. PRELIMINARY REMARKS. Nothing, of course, can take the place of the advice and service of an experienced physician in time of emergencies; but the physician is not always at hand, and accidents of various kinds may occur in the dental office, or patients in distress present themselves to the dental practitioner for im- mediate relief; or some one maybe burned, cut, poisoned, or suff'ocated, where, if we possess presence of mind and sufficient knoAvledge, it may be our privilege to save an endangered life. It is, therefore, expedient that the dental student should have a more thorough knowledge of what to do in case of such emergencies ; it is for that purpose that this chapter of practical suggestions is prepared. Apoplexy is the rupturing of a blood-vessel in the brain. The symptoms are stupor, heavy snoring breathing, slow pulse, flushed face, followed by paralysis usually of one side, this being marked by the drawing up of one side of the face. Treatme7it. — Loosen clothing about the neck, make cold applications to the head, and keep the patient in a sitting posture until the physiician arrives. Burns or Scalds. — Not infrequently does some one's clothing take fire, usually that of women, on account of the character of their clothing. The first thing to do in time of such an accident is to have the patient lie down, but if she 14T 142 APPENJJIX. loses her presence of mind and will not obey instructions, she must be quickly placed upon the floor or ground and then covered or enveloped at once with the first article you seize that will exclude the air and smother the flame — a breadth of carpet, rug, blanket, or coat will serve the purpose. After the fire is extmguished, or after an extensive scald, if there is much of a burn or blister, the clothing, as much as need be removed, should be carefully clipped away, so as not to break the blisters that may have formed. These may be punctured at one edge and their contents discharged, when the outer skin will fall back in place. Then a dressing of pure sweet-oil or castor oil should be carefully applied on strips of soft linen. When the skin is destroyed, the air may be excluded by applying at once any of the following: sweet oil, linseed oil, collodion, vaseline, etc. Dr. Charles Dulles, in his manual on accidents and emergencies, says : "In case of a person severely and extensively burned, the entire body may be immersed in a bath, which shall be kept, as long as necessary, at a temperature of ioo°. Where the shock of a burn is great some stimulant should be given, and laudanum, in twenty-drop doses to an adult, and half as much to a child, to allay the suffering." For Slight Burns or Scalds, an excellent dressing is to quickly sprinkle the parts with bicarbonate of soda and cover same with wet cloth, or they may be painted with white lead, or covered with the white of an tgg or carron oil (equal parts of linseed oil and lime-water) — in fact, anything that will ex- clude the air and prevent friction, and will not prevent after- examination, may be used. Aristol ointment (aristol in cold cream or vaseline) is also being used with good results, while for small burns on the hand, arm, leg, etc., immerse in- stantly in cold water, and let it remain for some length of time. APPENDIX. 143 Burns with Acids or Caustic Alkalies, such as soap lye, should be deluged with water, and followed by an application of bicarbonate of soda for the former and vinegar for the latter, to be followed by an application of oil. Catalepsy in appearance somewhat resembles death. The patient becomes unconscious, the muscles rigid, and the skin pallid. In itself it is by no means dangerous, and it affords time enough to summon a doctor, which is the only sensible thing to do under these circumstances. Choking is usually caused by the lodgment of some foreign substance in the trachea or oesophagus. When the body is lodged in the trachea, there is great irritation and coughing, though it does not materially interfere with deglutition. While, on the other hand, when the oesophagus is closed, it is usually impossible to swallow, and there is little or no coughing. Treatmejit. — Hold the head low and slap the back quite forcibly. Blow into the ear, which will excite a reflex action that will aid the patient in expelling the foreign body. The removal of pins, needles, splinters, fish bones, etc., from the throat is usually an extremely delicate operation. They should be grasped with a small pair of forceps or tweezers, or a blunt pair of scissors may be used for the same purpose. Convulsions are usually caused by some irritation of the digestive apparatus, or by some interfei'ence in the eruption of the teeth. Treatment. — When the physician's coming is delayed, the child should be placed in a hot bath ; the head at the same time should be kept cool by cold applications. This should be continued for about ten minutes, when the child should be wrapped in warm blankets and put to bed. If there should be one or inore teeth endeavoring to erupt at this time, the gums should be freely lanced. 144 APPENDIX Dislocations can be easily detected. There is always de- formity, pain, and stiffness of the joint affected. Dislocation of the lower jaw, with treatment for same, is fully treated upon pages 55 and 56. Dislocation of the fingers can usually be corrected by strong pulling and at the same time pressing the parts into place, where they should be retained for several days by a splint and bandage. Dislocations of other joints had better be left for the surgeon's hands. *' The risk of doing injury by injudicious efforts to set a joint is greater than that of waiting until a surgeon can be summoned." The patient, however, should be placed in the most comfortable position and hot fomenta- tions should be applied. Drowning. — It is important to remember that tlie body, as a whole, is a very little lighter than water; therefore, a person who is in danger of drowning sliould lie flat on the back and keep the entire body, with the exception of the mouth and nose, under water. The arms should be stretched at full length above the head, and the lungs should be kept filled with air as much of the time as possible. This would very materially aid both the one in danger and the rescuing party. Resuscitation. — Avoid delay. Do not wait to carry the patient to a house or hospital, but treat him on the spot. *' Remember that the patient is suffering from two things, want of air, or oxygen, and loss of heat from the body." The first thing to do, then, is to free the body from any clothing that may interfere with respiration — that is, about the neck, chest, and waist. If natural breathing has ceased, artificial respiration should be commenced as soon as possible. First, hastily make a roll from clothing, blankets, or anything that may be at hand, place the patient over this, face downward, APPENDIX. 145 ta o 146 APPENDIX. allowing his forehead to rest upon one hand to keep the mouth and nose clear of the ground. Place the hands, well spread, upon the pa-tient's back, over the stomach and base of thorax. Then, with a forward motion, throw all the weight upon them that the age and sex of the patient will justify. Repeat this three or four times, which will cau^e the water and mucus to run out of the mouth, throat, and trachea. (See Fig. 22.) Wrap a handkerchief around the forefinger and pass it into the mouth and remove any mucus that may remain. Turn the patient on his back, grasp the tongue and draw it forward and down onto the chin ; lay a strip of the handkerchief or other material across the tongue and pass the ends behind the neck and tie, or have some one to hold the tongue to keep it from falling back and closing the throat. Then begin artificial respiration. Howard's Method. — The patient is placed upon his back, his arms extended backward and outward, where they should be held by an assistant. A roll of something (cloth- ing, a folded blanket, coat, or stick of wood, if nothing better is at hand) is then placed under the false ribs so as to throw them prominently forward. The operator should then kneel astride the patient's abdomen, placing both hands so that the fingers will press into the intercostal spaces on each side, and the base of the thumb rest upon the anterior margin of the false ribs. The operator should then place his elbows firmly against his sides, and throw himself forward, bringing his weight to bear upon the patient's false ribs, forcing them inward and upward toward the diaphragm, then suddenly let go and return to the erect position. Repeat these movements ten to twelve times a minute until natural breathing begins, which may gradually take the place of the artificial. Fig. 23 illustrates this method. Sylvester's Method. — After the patient has been placed APPENDIX. 147 o [^ 148 APPENDIX. upon his back, with folded clothing under his shoulders, the operator should kneel behind his head and go through the following manipulations: — First, to induce inspiration : Grasp both arms just below the elbows and swing them around horizontally until they nearly meet above the head, with the back of the hands or elbows touching the ground ; hold them there for three or four seconds. This draws the ribs up so as to expand the chest and allows the air to enter the lungs. (See Fig. 24.) The second movement is to induce expiration. Bend the arms at the elbows, and carry them down so that they rest upon either side of the chest. Bring the weight of your body upon them, pressing forcibly and steadily, which pressure, if continued for a few seconds, will force the air out of the lungs. (See Fig. 25.) These movements should be continued alternately twelve to fifteen times a minute. lVhe7i natural breathing is attempted, it may be stimulated by applying smelling salts or ammonia to the nose, or by slapping the chest. When the patient is able to swallow, some stimulant should be given every few minutes until the danger-point is passed — such as a teaspoonful of whisky or brandy, or double the quantity of hot water. After the patient is resuscitated he should be wrapped in warm blankets and carefully carried, with the head low, to a warm bed. Epileptic Fits are characterized by sudden loss of con- sciousness and power of coordination of motion ; there is a rigidity of motion which is followed by violent convulsions of short duration, usually accompanied by more or less foaming at the mouth. There is also a peculiar cry that accompanies these attacks, caused by laryngeal spasms. 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From, The Southern Clinic. " We know of no series of books issued by any house that so fully meets our approval as these ?Quiz-Compends?. They are well ar- ranged, full, and concise, and are really the best line of text-books that could be found for either student or practitioner." BLAKISTON'S PQUIZ-COMPENDS? The Best Series of Manuals for the Use of Students. Price of each. Cloth, .80. Interleaved, for taking Notes, $1.25. 4^ These Compends are based on the most popular text-books and the lectures of prominent professors, and are kept constantly re- vised, so that they may thoroughly represent the present state of the subjects upon which they treat. 4®°" The authors have had large experience as Quiz-Masters and attaches of colleges, and are well acquainted with the wants of students. J$^ They are arranged in the most approved form, thorough and concise, containing over 6oo fine illustrations, inserted wherever they could be used to advantage. 4^ Can be used by students of any college. 4®* They contain information nowhere else collected in such a condensed, practical shape. Illustrated Circular free. No. I. POTTER. HUMAN ANATOMY. Sixth Revised and Enlarged Edition. Including Visceral Anatomy. Can be used with either Morris's or Gray's Anatomy. 117 Illustrations and 16 Lithographic Plates of Nerves and Arteries, with Explanatory Tables, etc. By Samuel O. L. Potter, m.d.. Professor of the Practice of Medicine, Cooper Medical College, San Francisco ; late A. A. Surgeon, U. S. Army. No. 2. HUGHES. PRACTICE OF MEDICINE. Part I. Sixth Edition, Enlarged and Improved. By Daniel E. Hughes, m.d., Physician-in-Chief, Philadelphia Hospital, late Demonstrator ot Clinical Medicine, Jeflferson Medical College, Phila. No. 3. HUGHES. PRACTICE OF MEDICINE. Part II. Sixth Edition, Revised and Improved. Same author as No. 2. No. 4. BRUBAKER. PHYSIOLOGY. Ninth Edition, with new Illustrations and a table of Physiological Constants. Enlarged and Revised. By A. P. Brubaker, m.d., Professor of Physiology and General Pathology in the Pennsylvania College of Dental Surgery ; Adjunct Professor of Physiology, Jefferson Medical College, Philadelphia, etc. No. 5. LANDIS. OBSTETRICS. Sixth Edition. By Henry G. Landis, m.d. Revised and Edited by Wm. H. Wells, m.d.. Instructor of Obstetrics, Jefferson Medical College, Philadelphia. Enlarged. 47 Illustrations. No. 6. POTTER. MATERIA MEDICA, THERAPEUTICS, AND PRESCRIPTION WRITING. Sixth Revised Edition (U. S. P. 1890). By Samuel O. L. Potter, m.d., Professor of Practice, Cooper Medical College, San Francisco ; late A. A. Sur- geon, U. S. .Ajrmy. MEDICAL BOOKS. 23 PQUIZ-COMPENDS ?— Continued. No. 7. WELLS. GYNECOLOGY. Second Edition. ByWM. H. Wells, m.d., Instructor of Obstetrics, Jefferson College, Philadel- phia. 140 Illustrations. No. 8. GOULD AND PYLE. DISEASES OF THE EYE AND REFRACTION. Second Edition. Including Treatment and Surgery, and a Section on Local Therapeutics. By George M. Gould, m.d., and W. L. Pyle, m.d. With Formulae, Glossary , Tables, and 109 Illustrations, several of which are Colored. No. 9. HORWITZ. SURGERY, Minor Surgery, and Bandag- ing. Fifth Edition, Enlarged and Improved. By Orville HoRWiTZ, B. S-, M.D., Clinical Professor of Genito-Urinarj' Surgery and Venereal Diseases in Jefferson Medical College ; Surgeon to Philadelphia Hospital, etc. With 98 Formulse and 71 Illustrations. No. 10. LEFFMANN. MEDICAL CHEMISTRY. Fourth Edition. Including Urinalysis, Animal Chemistry, Chemistry of Milk, Blood, Tissues, the Secretions, etc. By Henry Leffmann, M.D., Professor of Chemistry in Pennsylvania College of Dental ' Surgery and in the Woman's Medical College, Philadelphia. ' No. II. STEWART. PHARMACY. Fifth Edition. Based upon Prof. Remington's Text-Book of Pharmacy. By F. E, Stewart, M.D., PH.G., late Quiz-Master in Pharmacy and Chemistry, Phila- delphia College of Pharmacy ; Lecturer at Jefferson Medical College. Carefully revised in accordance with the new U. S. P. No. 12. BALLOU. VETERINARY ANATOMY AND PHY- SIOLOGY. Illustrated. By Wm. R. Ballou, m.d., Professor of Equine Anatomy at New York College of Veterinary Surgeons ; Physician to Bellevue Dispensary, etc. 29 graphic Illustrations. No^. 13. WARREN. DENTAL PATHOLOGY AND DEN- TAL MEDICINE. Third Edition, Illustrated. Containing a Section on Emergencies. By Geo, W. Warren, d.d.s., Chiet ot Clinical Staff, Pennsylvania College of Dental Surgery. No. 14. HATFIELD. DISEASES OF CHILDREN. Second Edition. Colored Plate. By Marcus P. Hatfield, Profes- sor of Diseases of Children, Chicago Medical College. No. 15. HALL. GENERAL PATHOLOGY AND MORBID ANATOMY, gi Illustrations. By H. Newberry Hall, ph. o., M.D., late Professor of Pathology, Chicago Post-Graduate Medi- cal School. Second Edition. No. i6. DISEASES OF THE SKIN. By Jay T. Schamberg, M.D., Instructor in Skin Diseases, Philadelphia Polyclinic. With 99 handsome Illustrations. Price, each, Cloth, .80. Interleaved, tor taking Notes, $1.25. In preparing, revising, and improving Blakiston's ? Quiz-Com- PKNDS ? the particular wants of the student have always been kept in mind. Careful attention has been given to the construction of each sentence, and while the books will be found to contain an immense amount of knowledge in small space, they will likewise be found easy reading ; there is no stilted repetition of words ; the style is clear, lucid, and dis- tinct. The arrangement of subjects is systematic and thorough ; there Is a reason for every word. They contain over 600 illustrations. Morris' Anatomy Second Edition, Revised and Enlarged. 790 Illustrations, of which many are in Colors. Royal Octavo. Cloth, $6.00; Sheep, $7.00; Half Russia, $8.00. From The Medical Record, New York. '• The reproach that the English language can boast of no treatise on anatomy deserving to be ranked with the masterly works of Heiile, Luschka, Hyrtl, and others, is fast losing its force. During the past few years several works of great merit have appeared, and among these Morris's " Anatomy " seems destined to take first place in disputing the palm in anatomical fields with the German classics. The nomencla- ture, arrangement, and entire general character resemble strongly those of the above-mentioned handbooks, while in the beauty and profuseness of its illustrations it surpasses them. . . . The ever-growing popularity of the book with teachers and students is an index of its value, and it may safely be recommended to all interested." %* Handsome Descriptive Circular, with Sample Pages and Colored Illustrations, will be sent free upon application. Seventh Revised Edition. A UNIQUE BOOK. POTTER'S MATERIA MEDICA, PHARMACY, AND THERA- PEUTICS. Seventh Edition, Enlarged and Revised. A Hand- book, including the Physiological Action of Drugs, Special Therapeutics of Disease, Official and Practical Pharmacy, Prescription Writing, etc. By Sam'l O. L. PoTTER, M.A., M.D., Professor of the Principles and Practice of Medicine and Clinical Medicine, College of Physicians and Surgeons, San Francisco, etc. Octavo. 929 pages. Thumb Index. Cloth, net, S5.00; Leather, net, S6.00 This edition contains much new material under the headings "Albumin," "Animal Extracts," "Antitoxins." Dr. Potte-r has become well known as an able compiler by his Compends of Anatomy and of Materia J^Iedica, both of which have reached six editions. In this book, more elaborate in its design, he has shown his literary abilities to much better advantage, and all who examine or use it will agree that he has produced a work containing more correct information in a practical, concise form than any other publication of the kind. The plan of the work is new, and its contents have been combined and arranged in such a way that it offers a compact statement of the subject in hand. Part I. — M.\teria Medica and Therapeutics, the drugs being arranged in alphabetical order, with the synonym of each first ; then the description of the plant, its preparations, its antidotes and antagonists, physiological action, . and, lastly, its Therapeutics. This part is preceded by a general Introduction and a section on the classification of medicines as follows : Agents acting on the Nervous System, Organs of wSense, Respiration, Circulation, Digestive System, on Metabolism (including Restoratives, Alteratives, Astringents, Antipyretics, Antiphlogistics, and Antiperiodics, etc.). Agents acting upon Excretion, the Generative System, the Cutaneous Surfaces, Microbes and Ferments, and upon each other. Part II. — Pharmacy and Prescription Writing. Written for the use of physicians who put up their own prescriptions. It includes — Weights and Measures, English and the Metric Systems. Specific Gravity and Volume. Prescriptions : Their principles and combinations ; proper methods of writing them ; abbreviations used, etc. Stock solutions and preparations, such as a doctor should have to compound his own prescriptions. Incompatibility, Pharmaceutical and Therapeutical. Liquid, Solid, and Gaseous Extempo- raneous Prescriptions. Part III. — Special THERArp:uTics, an alphabetical List of Diseases — a real Index of Diseases — giving the drugs that have been found serviceable in each disease, and the authority recommending the use of each ; a very im- portant feature, as it gives an authoritative character that is unusual in works on Therapeutics, and displays an immense amount of research. 600 prescrip- tions are given in this part, many being over the names of eminent men. The Appendix contains lists of Latin words, phrases, and abbreviations, with their English equivalents, used in medicine, Genitive Case Endings, etc. 36 Formulae for Hypodermic Injections; a comparison of 10 Formulae of Chlorodyne ; Formulae of prominent patent medicines ; Poisons and their Antidotes ; Differential Diagnosis ; Notes on Temperature in Disease ; Clinical Examination of Urine ; Table of Specific Gravities and Volumes ; Table showing the number of drops in a fluidrachm of various liquids and the weight of one fluidrachm in grains, and a table for converting apothecaries' weights and measures into grams. Medical Students' Manuals* VAN HARLINGEN. SKIN DISEASES. Third Edition. The Diagnosis (including Diflerential Diagnosis) and Treatment of Skin Dis- eases. By Arthur Van Harlingen, late Lecturer Jefferson Medical College, Professor of Dermatology, Philadelphia Polyclinic, etc. Third Edition, Revised and Enlarged. 60 Illustrations. Cloth, net, $2.75 Following a short introduction devoted to symptomatology, classification, etc., each disease is taken up in alphabetical order; special attention is given to treatment, and there are a number of tables of differential diagnosis that will prove particularly useful. A great deal of new material has been added to this edition ; some of the old sections have been entirely rewritten, and many new methods of treatment with accompany- ing formulae have been incorporated. WALSH AM. SURGERY. Sixth Edition. Surgery: Its Theory and Pidctice. By Wm. J. Walsham, m d., Assistant Surgeon to, and Lecturer on Anatomy at, St. Bartholomew's Hospital, London, etc. 410 Illustrations. 846 pages. Cloth, net, %'^.oo "Walsham, besides being an excellent surgeon, is a teacher in its best sense, and having had very great experience in the preparation of candidates for examination, and their subsequent professional career, may be relied upon to have carried out his work successfully. Without following out in detail his arrangement, which is excel- lent, we can at once say that his book is an embodiment of modern ideas neatly strung together, with an amount of careful organization well suited to the candidate, and, indeed, to the practitioner'." — British Medical Journal. HOLDEN'S MANUAL OF DISSECTIONS. Seventh Edition. 311 Illustrations. By John Langton, f.r.c.s.. Lecturer on Anatomy, St. Bartholomew's Hospital. Revised by A. Hewson, m.d.. Demon- strator of Anatomy, Jeff^erson Medical College ; Chief of Surgical Clinic, Jefferson Hospital; Mem. Assoc. Amer. Anatomists, etc. In Press. " The work before us is a brilliant example of the new order of text-books. ... We would call special attention to the character of the illustrations with which the volume is bountifully furnished." — American Journal of Medical Sciences. WHITE AND WILCOX. MATERIA MEDICA, PHARMACY, PHARMACOLOGY, AND THERAPEUTICS. Fourth Edition. By William Hale White, m.d., f.r.c. p., etc.. Physician to, and Lecturer on Materia Medica, Guy's Hospital ; Examiner in Materia Medica, Royal College of Physicians, London, etc. Fourth American Edition. Revised in accordance with the U. S. P. by Reynold W. Wilcox, m.a. , m.d. , Professor of Clinical Medicine at the New York Post-Graduate Medical School and Hospital ; Assistant Visiting Physician, Bellevue Hospital. Cloth, ne't, $3.00 " Practical experience with Dr. White's book on general therapeutics, both as to its usefulness to the student and as to the soundness of the advice which he gives, has proved that he is an author upon whom much dependence may be placed, and a care- ful examination of the American version of his second work, which has been published under Dr. Wilcox's eye, shows that it is also worthy of both its author and editor."— Therapeutic Gazette. 4®=" See Next Page. P. BLAKISTON'S SON & CO., Publishers and Booksellers, 1012 Walnut Street, Philadelphia. ^i--.^ TlTT^^^^^^Jg^ ERT U. cal De- to the 2 been )/' the irged land- M.K., Hhal- vised ?3.oo \ and mself. be i)RD, ;eons •cond ^3.00 nient, It for ireast lorate nage- BARTLEY. MEDICAL CHEMISTRY. Fifth Edition. A Text- Book for Medical, Dental, and Pharmaceutical Students. By E. H. Bartley, M.D., Professor of Chemistry and Toxicology at the Long Island College Hospital ; late Chief Chemist, Board of Health of Brooklyn, N. V., etc. Revised and Enlarged. With 92 Illustrations, Glossary, and Complete Index. i2mo. Cloth, mt, S3. 00 P. BLAKISTON'S SON & CO., Publishers and Booksellers, 1012 WALNUT STREET, PHILADELPHIA.