^ 7^1 GrG7 blumbia Wini\itx&itv . q^ in tt}t Citp of i^etD Pork » O ^cljool of Bental anti d^ral burger? \ 3^cferente ILtbrarp DENTAL MEDICINE. GORGAS. STANDARD WORKS FOR DENTAL STUDENTS AND PRACTITIONERS. Published by P. BLAKISTON, SON & CO. OO Harris. — The Principles and Practice of Dentistry. 1 2th Edition. Thor- oughly Revised and Enlarged. By Prof. F. J. S. Gorgas. 1086 Illustrations. 1225 Pages, Cloth, $7.00; Leather, Harris. — Dictionary of Medicine, Dentistry, and Collateral Sciences. 5th Edition. Revised by Prof. F. J, S. Gorgas, . . Cloth, ^5. 00; Sh., 6.00 Richardson. — Mechanical Dentistry. 4th Edition, . . Cloth, $4.50; Sh., 5.50 Potter.— Compend of Anatomy. New 5th Edition. Illustrated by Litho- graph Plates and many Wood Cuts, Cloth, i.oo Talbot. — Irregularities of the Teeth and their Treatment. 2d Edition, 234 Illustrations, Cloth, 1.50 Blodgett. — Dental Pathology. Illustrated, Cloth, 1.75 Buxton. — Anaesthetics. Illustrated, Cloth, 1.25 Fillebrown. — Text-book of Operative Dentistry. Illustrated, . . . Cloth, 2.50 Taft.— Operative Dentistry. 4th Ed. 136 Illustrations. Cloth, ^4.25 ; Sh., 5.00 Leber and Rottenstein. — Dental Caries, Paper, 75c.; Cloth, 1.25 Sansom. — Chloroform: Its Administration, etc., . . . Paper, 75c.; Cloth, 1.25 White. — The Mouth and Teeth. Illustrated, Cloth, .50 Barrett. — Dental Surgery. 2d Edition, Cloth, 1.25 Gorgas. — Dental Materia Medica and Therapeutics. 4th Edition, . Cloth, 3.50 Heath. — Injuries and Diseases of the Jaw^s. 3d Edition. lUus., . Cloth, 4.50 Heath. — Lectures on Certain Diseases of the Javs^s. Illustrated, . Boards, i.oo Kirkes. — Physiology. 12th Edition. Illustrated, . Cloth, ^4.00; Leather, 5.00 Tomes. — Dental Surgery. Illustrated. 3d Edition, Cloth, 5.00 Torhes. — Dental Anatomy. 3d Edition. Illustrated, ...... Cloth, 4.00 Stocken. — Dental Materia Medica. 3d Edition, Cloth, 2.50 Yeo. — Manual of Physiology. 5th Edition. 321 Illus., Cloth, $3.00; Sh., 3.50 Flagg. — Plastics and Plastic Filling. 4th Edition, Cloth, 4.00 Potter. — Compend of Materia Medica. Sth Edition. Illustrated, . Cloth, i.oo Brubaker. — Compend of Physiology. Illustrated. 6th Edition, . . Cloth, i.oo Holden. — Anatomy. 5th Edition. 208 Illus., . . . .Oil Cloth Binding, 4.50 Potter. — Hand-Book of Materia Medica, Pharmacy and Therapeutics. 3d Edition. Revised, Cloth, ^4.00; Leather, '5.00 ^^° Catalogues of Medical atid Denial Books sent upon application. DENTAL MEDICINE A MANUAL DENTAL MATERIA MEDICA AND THERAPEUTICS. FERDINAND J. S. GORGAS, A. M., M. D., D. D. S., Editor of "Harris' Principles and Practice of Dentistry," and "Harris' Diction- ary OF Medical Terminology and Dental Surgery," Professor of the Principles of Dental Science, Dental Surgery, etc., in the University of Maryland, Baltimore. FO UR TH EDITION. RE VISED AND ENLARGED. PHILADELPHIA : P. BLAKISTON, SON & CO., No. IOI2 Walnut Street. i8qi. (l(^n Entered according to Act of Congress, in tlie year 1 891, by P. BLAKISTON, SON & CO., In the Office of the Librarian of Congress, at Washington, D. C. PRESS OF THE JA9. B. RODGERS PRINTrNQ 00. 62 8l 64 NORTH SIXTH ST.. PHILADELPHIA. PREFACE TO FOURTH EDITION. In presenting a fourth edition of the " Dental Medicine " to the dental profession, the author desires to express his grate- ful appreciation for the favor with which every one of the preceding editions has been received, and the kind notices they have elicited. The history of the Third Edition has been similar to that of the first and second editions, every copy having been disposed of some months before the present edition was ready for publication. So much has been added to this (fourth) edition, in order to bring the work up to the present status of dental materia medica and therapeutics, that the author cherishes the hope that its value as a text-book and work of reference, has been greatly increased over that of former editions. Considerable matter has been added to Diagnosis of the Affections of the Mouth, the different Remedial Agents, the various substances classed as dental materia medica, with their medicinal properties, action, dental uses and mode of applica- tion ; among the number — Arsenious Acid, Carbolic Acid, Aromatic Sulphuric Acid, Tannic Acid, Chloroform, Nitrous Oxide, Chloral, Antipyrene, Antifebrin, Bichloride of Mercury, Peroxide of Hydrogen, Creolin, Chloride of Methyl. Sulpho- nal, etc., etc. A new chapter has been added on the use of Antiseptics in Dental Practice, which includes the Sterilization of Dental 6 PREFACE TO FOURTH EDITION. and Surgical Instruments. The list of new antiseptics, disin- fectants, germicides and hypnotics, etc, referred to in the present edition, includes, Aristol, Bromol, Campho-Phenique, Phenol-Camphor, Chloralamide, Synthetic Carbolic Acid, Biniodide of Mercury, Iodine Tri-Chloride, Chloral-Phenol, lodophenacetin, Lysol, Bichloride of Methylene, Microcidine, Myrtol, Phenacetine, Pyoktanin, Salol, Sodium Silico-Fluoride, Salipyrene ; also the effects of the Vermilion of Vulcanized Rubber on the Mouth, Test Papers for Dentists, List of New Remedies, Rendering the Hands Aseptic, Organic and Inor- ganic Acids, and Carbon Compounds, Alkalies and Alkaline Earths. A number of new and valuable formulae have also been added, and the Index to " Dental Diseases and Remedies " has been correspondingly increased. Ferdinand J. S. Gorgas. Hamilton Terrace, Baltimore. October i, i8gi. PREFACE TO THIRD EDITION. In presenting a third edition of the " Dental Medicine," the author trusts that the new matter it contains, comprising nearly one hundred pages, will add to its value as a text- book, and increase its usefulness to the dental practitioner. The universal favor with which the preceding editions have been received, is gratefully appreciated, and the fact that, like the " Principles and Practice of Dentistry," the second edition of the " Dental Medicine " was exhausted for several months before the present one could be prepared for publi- cation, is an evidence of its favorable reception. What the author deems an improvement, has been made in the arrange- ment of a portion of the subject matter of the present edition, and considerable additions have been made to a number of subjects, among them being the following : Diagnosis of the Affections of the Mouth, General and Local Anaesthesia, the Action of Arsenious Acid as a Devitalizing Agent, etc., etc. In the new matter will be found : The Action of Antisep- tic Agents, The Proper use of Antiseptics in Dental Practice, The value of Germicides and Disinfectants, The Digestibility of Foods, Incompatibility, etc., etc. To the Dental Materia Medica and Therapeutics have been added such agents as lodolj Hydronaphthol, Bromides of Ammonium, Calcium, Lithium, Sodium, Benzoates, Lithium and its Preparations, Phosphates and Phosphites, Creolin, Cresylic Acid, Hydrate PREFACE TO THIRD EDITION. of Amylene, Herbst's Obtundent, Lanolin, Kandol, Methyl Chloride, Nux Vomica, Turpentine, Rhubarb, Paraldehyde, Sodium and its Preparations, Sulfanol, Stenocarpine, Sali- cylates, Serpentaria, Prunus Virginiana, Naphthalene, Guiacol, Cod-liver Oil, Colchicum, Sulphite of Aluminium, Anthemis, Antifebrin, Antipyrene, Aloes, Acetanilide, Sulphurous Acid, Ammonia and its Preparations, Cresylicum, Aromatic Bitters, etc., etc., etc. A number of new formulas have also been added, and the Index to " Dental Diseases and Remedies " has been correspondingly increased. Ferdinand J. S. Gorgas. Hamilton Terrace, Baltimore. PREFACE TO THE FIRST EDITION. This work has been prepared by the author in deference to many requests from former pupils, and has been compiled from lectures delivered by him in dental institutions during the past twenty-five years, and notes obtained from the standard works on Materia Medica and Therapeutics, and also from personal experience as a dental practitioner and teacher. While the author claims the credit of the compilation, he does not claim originality in the sources, derivations, medical properties and action of the various articles of dental materia medica which are given in this work. His intention has been to present not alone his own ideas as to the particular application of remedies, but also those of well-known and acknowledged authorities, and in such a manner as may be of service to the dental student in acquiring a knowledge of this important branch of his profession ; hence nothing has been presented in this work that, in the author's opinion, is not applicable to dental practice, and that will not be of benefit to the dental student. The dental formulary comprises many valuable combina- tions, and credit has been given, in every case where it was possible, to the authors of the different preparations. The necessity for an American work of this kind has long been apparent, and after years of delay and promises the author gratefully dedicates this work to his former pupils in the dental institutions with which he has been and is now connected, in the capacity of a teacher. Hamilton Terrace, Bai,timork. CONTENTPS. PAGE Prefaces 5-9 Definition of Subjects 13 Action of Medicinal Substances 13 Inflammation, with Special Reference to Oral Mucous Membrane, Important Points in Diagnosing Affections of the Mouth, with a Synopsis of Treatment 41 Characteristic Indications of the Tongue 71 Digestibility of Foods 71 Abbreviations, with Latin and English Terms 73 Approximate Measurements 75 Fineness of Powder 75 Weights and Measures • 76 Metric or French Decimal System of Weights and Measures ... 76 Rules for Regulating Doses 80 Topical Remedies 82 The Endermic Method 82 The Hypodermic Method 82 Setons and Issues 83 General Bloodletting 84 Local Bloodletting by Leeching, Cupping and Scarifications ... 84 Electricity as a Therapeutic Means in the Treatment of Disease . . 85 Incompatibility 91 Table of Doses of all Officinal Medicines, Expressed in Terms of Both the Apothecaries' and the Decimal Metric System of Weights and Measures 93 Poisons — Symptoms and Antidotes 104 The Pulse in Pulsation per Minute at Various Ages 112 Respiration at Various Ages 114 Thermometers 114 11 12 CONTENTS. PAGE Table of Elementary Substances Ii6 Table of the Solubility of Chemicals in Water and Alcohol .... 117 Classification of Medicinal Substances 121 Definitions of the Various Classes of Medicinal Agents 121 Forms in which Medicinal Substances are employed 151 Source, Derivation, Medical Properties and Action, and Therapeutic Uses of Medicinal Substances Employed in Dental Practice ; Together with their Dental Uses and Application .... 4 155 Administration of General Anaesthetic Agents 210 The Dangers of Anesthesia 220 Preventive Measures Against the Dangers of Anaesthesia 220 Treatment of Dangerous Symptoms of Anaesthesia 220 Methods of Resuscitation — Sylvester's Method — Hall's Ready Method 221 " " Howard's Method, etc 223 Local Anaesthesia 235 Rapid Breathing as a Pain Obtunder 228 Periods for the Eruption of the Teeth 505 Authorities Consulted 506 Index to Dental Formulary and Dental Diseases 507 General Index 513 DENTAL MEDICINE. DEFINITION OF SUBJECTS. Materia Medica is that branch of medical science which re- fers to and describes the methods and substances known as " medicinal agents/' which are employed in the prevention and treatment of disease. Therapeutics is that branch of medical science which com- prises the doctrine of the management of disease. Generally, however, the term is restricted to a description of the modus operandi of medicines, or, in other words, their use, application and effects when applied in the treatment of various morbid conditions. An accurate knowledge of the principles and rules which govern the administration and action of medicinal substances enables the practitioner to restore disordered func- tions, and to so impress the organism as to maintain harmoni- ous conditions, by means of which the various functions, in a state of health, are intimately connected by relation and sympathy. Some medicinal agents exert their influence on primary nourishment, converting food, by digestion, into the substance of organic beings, while other remedies, without interfering with digestion, by a modification of the process of assimilation exert a destructive influence upon the tissues. Some medi- cinal agents affect the nervous system, and others are so irri- tant in their effects as to cause their speedy expulsion ; while others, again, have a particular affinity for certain organs, and are eliminated by them, the effects ceasing as soon as the evacuation is completed. Other medicinal agents prevent septic decomposition and the growth of micro-organisms. What are known as topical or external remedies act directly upon the parts to which they are applied, and their general effects are produced through the nervous system. 13 14 DENTAL MEDICINE. \ INFLAMMATION : WITH SPECIAL REFERENCE TO ORAL MUCOUS MEMBRANE. Definition of Conditions Associated with Disturbances of Nutritiofi. — Hyperczmia signifies superabundance of blood in the blood vessels, but this term is restricted to such a condition existing in a definite organ or portion of an organ ; hence hyperaemia and dilatation of blood vessels are so intimately connected that the one cannot exist without the other. It is also necessary that the capillaries as well as the arteries and veins should be injected, in order that the color of the region so affected should be increased, as the former consti- tute a dense network, which traverses the entire organ, while the latter only form single branches, which occupy limited spaces. The term Plethora, as distinguished from hyperaemia, signi- fies a superabundance of blood in the entire circulatory system. Active hyperaemia in the skin and mucous membranes is char- acterized by a diffuse bright-red coloration, the parts so affected having a higher temperature than those around them. The diffuse coloration is caused by the bright-red arterial blood which fills the capillaries ; and the elevation of the temperature is due to the presence of the blood, which heats the skin or mucous membranes, and the more quickly the blood circulates the warmer the tissue becomes, until at length the highest degree of blood heat is accomplished. Passive hyperaemia denotes a condition of the tissues char- acterized by a diffuse venous, not arterial, coloration and a relatively low temperature. In passive hyperaemia the capil- laries are also dilated, but the blood current through them is retarded ; hence the tissues so affected are of a venous color instead of the bright-red or arterial color of active hyperaemia. The term Ancemia signifies a condition in which there is an abnormal diminution in the amount of blood, and is the opposite to that of Plethora, being characterized by a pale face, lips, gums and mucous membranes. But the normal amount of blood may be present, and yet the characteristic paleness INFLAMMATION. 15 denote an anaemic condition, for the reason that the number of red blood corpuscles are decreased and replaced by white blood corpuscles, or by blood plasma. Again, the paleness of an anaemic condition may be due to a deficiency of the red coloring matter of the red blood cor- puscles. A permanent contraction of the blood vessels may also cause a paleness of the face, lips, gums and mucous membranes. The term IschcBinia is also employed to denote local poverty of the blood, a deficiency of the coloring matter (haemoglobine). The direct cause of hyperaemia, and also of ischaemia, is a change of calibre of the blood vessels, namely, dilatation and contraction. This dilatation and contraction of the blood vessels is due to the elastic and contractile elements of the sheaths and walls of the arteries and veins, and both the dila- tation and contraction are regulated by the spinal cord, through the medium of the vaso -motor nerves. It is a common opinion that hyperaemia cannot exist without the influence of the vaso-motor nerves. Irritation indicates the condition of a tissue in which there exists an excess of vital action, on account of the disordered state of the nerves of the affected part or organ. It is com- monly manifested by such symptoms as increased circulation, warmth and sensibility, and functional disturbance of a greater or less degree. What inflammation is to the vascular system, irritation is to the nervous system, and the difference between these two con- ditions is defined by the explanation that the latter terminates when the former begins. Irritation is generally excited by the action of certain stimuli upon organic tissues, by which the sensibility of such tissues is perverted and the circulation deranged ; such pathological conditions when they are not the precursor of inflammation, soon passing off, and the affected tissue regaining its normal state, when the exciting cause ceases to operate. Irritation may be direct and indirect — direct when the irritation manifests itself at the point where 16 DENTAL MEDICINE. the impression to which it owes its origin is received ; indirect when the irritation, through sympathy and reflex action, is transmitted to more or less remote parts or organs. An example of direct irritation may be adduced by friction upon the skin or mucous membrane of the mouth sufficient to cause redness in the first tissue, and increased coloration in the second; or indirect irritation, in the convulsions attending difficult dentition, the irritation being communicated to the brain by the fifth pair of nerves, and from thence to the nerves of the voluntary muscles, the seat of the spasmodic action. Dental caries also affords another example of indirect irrita- tion, in the form of neuralgic pains of the temple, face, ear, eye, and of even more remote parts, such as the uterus. The effect of irritation upon the vascular system is mani- fested by dilatation of the blood vessels ; but the immediate effect, however, of a slight chemical or mechanical irritant is not at once apparent in the capillaries, but first causes contrac- tion of the smaller arteries, and sometimes of the veins, such contraction being followed by dilatation, the immediate cause of which is yet obscure. It is, however, supposed to be the result of a relaxation or a temporary paralysis of the walls of the vessels, a condition following contraction, and which, as a consequence, causes a decrease of their resistance to the pres- sure of the blood within them. The irritation either perverts the function of the nerves of the vessels, or of the lining cell substance of the capillary walls ; or the disturbance is due to reflex action. Inflammation denotes an abnormal process or condition characterized by certain changes of texture, which, although uniform in type, differ widely in appearance, and terminate in different results, according to the nature and permanency of the causes upon which such a condition depends, or which have given rise to it. The symptoms of inflammation consist of the phenomena which accompany the textural changes characteristic of this condition, and its pathology the textural changes which occur during the continuance of this condition. The essential INFLAMMATION. 17 features of inflammation are an increased afflux of blood to the affected part, with a greatly increased tendency to cell prolifer- ation and tissue formation. The causes of inflammation determine in a great degree its treatment on account of the influence they exert upon its destructive tendency, and they may be classified as those arising — 1st, from mechanical violence; 2d, from irritating and destructive chemical action ; 3d, from poisonous infection, and the effect of injurious micro-organisms — the latter being regarded as " immediate determining causes of the more de- structive phases of the inflammatory process." When inflam- mation owes its origin to an evident injury, or the reverse, it is termed traianatic, or idiopathic, and when no apparent cause can be discovered it is termed spontaneous. The causes of inflammation are divided into predisposing and exciting. Among the more important predisposing causes are im- poverisJied blood — defective in quality — such as may result from a want of proper food and of fresh air, the effects of such deprivations being manifested in the case of a neglected child where a hard swelling occurs in the cheek, which, after a few days, presents a gangrenous condition, constituting the disease known as cancrum oris or gangrcenopsis. On the other hand, an habitual excess of food and drink is also a predisposing cause of inflammation, the blood, as a consequence, being im- paired, and also the tissue which it supplies. Blood poisoning is also another predisposing cause, resulting, it may be, from the presence of certain diseases, such as syphilis, diabetes mel- litus, eczema, etc. A local hyperaemia, constituting the first stage in the development of inflammation, may result from certain poisons in the blood, which cause it to stagnate in limited areas, through an inability to stimulate the heart and blood vessels. Syphilitic ulceration of the mucous membrane of the mouth is an example of such a predisposing cause. Weakened vitality of parts is also a predisposing cause of in- flammation, and may result from habitual ill feeding, protracted illness, over-work, long exposure to extreme cold. Parts such 2 13 DENTAL MEDICINE. as the mucous membrane of the mouth, which have already- been the seat of inflammation, are prone to such a condition subsequently, from slight provocation. Defective or perverted nervous supply may also be regarded as a predisposing cause of inflammation. Certain forms of skin disease, and inflammatory conditions of the mucous membrane of the mouth, furnish examples ; also, of the peri- osteum of the teeth, resulting in severe periodontitis and alveolar abscess. The influence of cliinate is also regarded as a predisposing cause, for, in tropical regions, inflammations of certain organs, often terminating in abscesses, are very prevalent. The mid- summer and fall months are considered to be more favorable for surgical operations, on account of the comparative absence of inflammatory complications at such times. Age has also some influence as a predisposing cause of inflammation. In childhood acute hyperaemia is induced by comparatively slight exciting causes, as then the process of nutrition is at its greatest period of activity, and any interrup- tion of its process is followed by derangement of health. The effects of the irritation of the first dentition may be ad- duced as an example. Old age induces weakness in the tissues and decrease of power of resistance to the exciting causes of inflammation. Exciting Causes of Inflammation. — These causes may all be included in the condition known as irritation of the tissues, resulting from irritants of various kinds, the action of which is immediate in producing the inflammatory condition. Ex- citing causes may be divided into external^ which are easily recognized, and internal, which are more obscure, and are assisted by some predisposition of the organism. Cold is a frequent cause of inflammation, and its effects are due to sudden changes in the constitution of the blood from an arrest of the function of the tissues, temporary in its nature, which interferes with the emunctory action, whereby effete and irritant materials which should be eliminated are retained, and poison the blood. Heat is also a cause of inflammation, INFLAMMATION. 19 its effects varying from a slight redness, denoting transient hyperaemia, to vesication, either superficial or deep. When death of tissue results from such a cause, suppuration ensues on the separation of the eschar ; and when there is a loss of cicatricial power, repair by granulation and suppuration (second intention) is prevented. The inflammation resulting from simple burns and scalds, provided no eschar is formed, and air is excluded, soon subsides. Mechanical violence excites inflammation, yet, under favor- able circumstances, this condition resulting from an incised wound, is soon arrested, owing to its benign form, by the par- ticles of lacerated tissue being carried away by the blood and the subsequent liquid exudation, while those that remain un- dergo liquefaction and absorption by the lymphatics ; hence, when the cut surfaces are brought and retained in proper apposition, speedy union, " by the first intention" results. Union by " first intention" is induced by such changes as cell- proliferation, the formation of new capillaries, and the genera- tion of cicatricial tissue. It is only when the vitality of the tissue is destroyed and foreign matters left in the wound, especially a punctured one, caused by a rough or rusty instru- ment, that there are complications. The tissues themselves, when they lose their vitality, become irritants, even when the dead matter is very minute. A boil furnishes an example, the core of which is composed mainly of yellow, elastic fibres with some* leucocytes or pus cells in the meshes. This mass becomes dead, and while the white fibrous element liquefies and mingles with the pus, the yellow fibres remain unchanged and constitute the irritant body, to the presence of which is due the suppurative inflammation. The presence of a clot of blood in a wound may prevent union, and cause pus formation. Chemical irritants excite inflammation by first causing in- creased redness, which steadily extends and becomes more intense until a considerable diameter is attained. There is also increased heat and fullness of the part affected, and an eschar forms as the result of the action of the chemical agent upon the epidermis in the case of the skin, or the corium in 20 DENTAL MEDICINE. the case of mucous membrane, the depth of the action depend- ing upon the nature of the chemical irritant. After one or two days the narrow circle of redness disappears, and, after one or two weeks, the eschar separates, disclosing an area of smooth cicatricial tissue. When the action of such irritants is slight, repair soon follows, without the formation of an eschar; but when their action is severe enough to devitalize the tissue, the sloughs are thrown off without suppuration, if the parts have been protected from the air, or antiseptic applications have been made. Mineral irritants, such as mercury and arsenic, for example, cause inflammation by a process different from that of chemi- cal irritants. The inflammatory action of mercury and arse- nious acid is developed only after the poison has entered the circulation, and a certain amount has been received by the stomach, when active inflammation of the mouth with saliva- tion (mercurial stomatitis) supervenes, if the agent is mercury, or active gastric hypersemia with vomiting, if the agent is arsenic. There is a specific poisonous action brought about by such irritants, on account of the tissues of the mouth and stomach being more sensitive to the influence of these mineral poisons. The cause of this peculiar susceptibility is as yet obscure. Micro-organisms are capable of exciting inflammation by direct contact with tissues, when the latter are exposed by injury. Many of these low forms of life are indestructible by the most extreme heat and cold, and also by the strongest chem- ical agents. And whenever the oxygen is prevented from entering a wound these micro-organisms generate with great rapidity, and are nourished by the fluids and granulating sur- faces which surround them. The chemical and vital changes which these animal materials undergo bring about putrefac- tion through the agency of fermentation, and certain poison- ous combinations are thus formed. These micro-organisms, therefore, acting as a poison, decompose the materials gener- ated for repair, and thus prevent the constructive process; INFLAMMATION. 21 they also act as a putrefactive ferment, producing septic poisons destructive in their action. It has been definitely determined that these organisms, although present in every destructive inflammation, " do not occur in the blood nor in the tissues of the healthy living body of man or of the lower animals." Diminished vitality, whatever may be the cause, favors the invasion and development of micro-organisms in the form of parasites. Symptoms of Inflammation. — The coexistence of the phe- nomena, redness and heat, with swelling and/«m, the ordinary symptoms of inflammation, may, therefore, be considered as sufficient evidence of the presence of the inflammatory condi- tion. The absence, however, of one or more of these phe- nomena is not incompatible with the existence of inflammation, for the increased redness and heat may disappear before the inflammatory process ceases, and pain be sometimes absent. The redness of an inflamed part is usually the first observ- able phenomenon, and one of the most characteristic symptoms of inflammation, and one also that is rarely absent. It varies in intensity, according to the degree of the inflammatory process, the nature of the part affected, the condition of the system, and the cause of the inflammation. Of a light tint in the early stage, it becomes deeper as the inflammatory process increases in degree, until every grade, almost, of redness is observable, ending in a deep crimson or even purple. It may appear in points, streaks, in minute ramifications, or be quite uniform over the entire surface affected. Usually it is more intense in one spot, gradually fading as it recedes, until lost in the surrounding healthy tissue ; in other cases the redness has an abrupt boundary, and is of equal intensity over its entire area. The brighter hue usually attends ordinary active in- flammation ; the darker hue that form of inflammation pro- ceeding from some specific cause, or associated with a gangre- nous tendency. The redness of inflammation is caused by the increased amount of blood entering the vessels of the part, and remaining there for a longer time than is natural under other conditions. 22 DENTAL MEDICINE. The Heat of an inflamed part is also caused by the unusual quantity of red blood present, and also by an increase of that vital action upon which the evolution of heat depends, namely, superoxidation of the affected tissues, resulting in their de- composition. The increase of temperature is generally more sensible to the sufferer than to the observer, though it may often be detected by the hand, and is very evident by the clinical use of the thermometer ; it is also verified by compari- son with other unaffected parts. The Swelling of an inflamed tissue is c aused in part by the unusual quantity of blood present in the dilated vessels, and also by the matters, both liquid and solid, which exude into the affected tissue through the walls of the dilated vessels, and also to extravasation resulting from rupture of these walls ; for as the vessels are distended their walls become thinner, and permit the blood plasma to escape through them in greater quantity than is required for mere nourishment; hence the inflamed tissue becomes infiltrated with this plasma, the con- sequence of which is an increase of thickness or swelling. The swelling of a part, however, without other symptoms is not an evidence of inflammation, as this phenomenon may occur from other causes. Swelling may also be absent when the other symptoms of inflammation are present, an example of which is afforded in inflammation of mucous membranes, before exudation has occurred in the connective tissue be- neath. The Pain of inflammation is due to the local irritation of the nerves of the' part, caused by the irritant which has excited the condition ; also by the tension which results, together with the injury inflicted upon the nervous filaments. Every tissue is supplied with sensory nerves, and the pain resulting from irritation and injury varies considerably, in accordance with the nature of the part and its supply of nervous filaments. Parts having little sensibility in a normal condition, often become extremely painful when inflamed ; the gums afford a well marked example. When the parts are unyielding, as in periodontitis, the pain becomes very severe ; and a pulsa- INFLAMMATION. 23 tile or throbbing pain is caused by the increased force of the smaller vessels conveying the blood to the focus of inflamma- tion, and also the obstruction of the circulation produced by the swelling and increased by the stasis at the focus of the affected area. When the veins of an inflamed part become obstructed by the swelling, bringing about pressure to such a degree as to prevent the blood from passing through them, the quantity being constantly increased by the supply from the arteries, a condition of strangulation results, in which the pain is very severe. We find an example of this condition of strangulation in pulpitis, or inflammation of the pulps of the teeth. Pain is also generally present, even in the case of soft tissues affected with inflammation, and where every advantage is afforded for their swelling ; the oral mucous membrane is an example. There is also pain of an itching character in certain forms of inflammation of mucous membranes ; also boring pain in the neighborhood of joints. The pain of alveolar abscesses, when they slowly form, is often of a tensive character, and generally becomes lanci- nating when they are about to point ; and in all such cases is useful in determining the seat of the suppurative process. Fever of Inflantmatioti, also known as " traumatic," is very generally present when the inflammation is severe, or the injury occasioning it is extensive and complicated. This inflammatory fever generally makes its appearance in from twelve to twenty-four hours after the injury is received, or when the inflammatory process is at its height; and when the parts have previously been healthy, and the inflammation limited, it is moderate in its character and soon terminates spontaneously. The symptoms of inflammatory fever are a feeling of fatigue, restlessness, thirst, hot and dry mouth, coated tongue, urine scanty but deeper in color, frequent pulse, temperature about ioo° F. ; and the fever usually reaches its climax in about thirty-six hours, when it begins to decline, and by the sixth or seventh day has disappeared. In the case of an abscess, it frequently happens that when suppuration occurs the fever begins to decline. Should the fever continue 24 DENTAL MEDICINE. longer than the time referred to, the cause may generally be due to deeper, suppuration and other complications of the local affection. During the inflammatory process, when putres- cent matter has been absorbed by the blood in greater quantity than can be resisted or gotten rid of by the organism, and there is no escape for it by drainage, the symptoms of inflam- matory fever become more intense, and a condition of septic poisoning takes place, known as septicczmia. When some time has elapsed after the inception of the inflammatory process* and the characteristic fever has almost disappeared, a chill suddenly occurs, followed by profuse perspiration, the condition known as py<2niia is present — pus globules in the blood. Exudation. — The exudation of materials, such as a phos- phatic, saline fluid, and white blood corpuscles and fibrin» through the capillary vessels, is due to inflammation, and such exudations are derived from the blood. The symptom of swelling is in great part due to exudation. The exudation in what is termed " healthy inflammation," and known as plastic or coagidable lymph, seen on the surface of a recent wound or in the form of swelling around a centre of inflammation, is a mild and unirritating product, the function of which is to form new tissues for repair, called at first granulations. Inflam- matory exudations from free surfaces of mucous membranes contain mucus, and a substance known as mucin, in the form of filaments, insoluble in acetic acid. The inflammatory effu- sion known as plastic or coagulable lymph, the true indicator of a healthy constructive process, is soon converted from a jelly- like substance, by the germinal power, into a mass of living cells, through which other minute cells, which are to form the capillaries, make their way like a small stream, the primitive living cells flattening out and making walls, apparently, for the forming vessels. These new capillaries penetrate the mass of germinal cells in large numbers, like delicate connecting threads, and furnish the blood supply to the organizing mass, which becomes converted into new or young connective tissue. This tissue drawing and binding together the opposite sides of the wound, then becomes the cicatricial tissue , which originates INFLAMMATION. 25 from the cement-like material furnished by the inflammatory- exudation. The cicatricial tissue becomes invested, in the case of oral mucous membrane, with epithelium, by a similar process of cell growth and development ; and this is the pro- cess of union by the first intention. The cicatrix or scar is redder than natural, owing to the large number of vessels ; but when the supply of blood is no longer needed in such quantity as is at first necessary, the capillaries diminish and disappear, so that the cicatrix grows paler and of smaller bulk. In the case of an abrasion of the skin, the exuding plastic lymph dries upon the denuded surface when not disturbed, and forms a protecting crust, which at length falls off, exposing a reddish surface covered with epidermis. In the case of the oral mucous membrane, a like result is produced under the protection of the mucous secretions peculiar to such a tissue. Suppuration, — The formation of pus is a result of destructive inflammation, as the presence of such a fluid denotes a loss of substance, which does not occur when a wound heals by the first intention. Under favorable circumstances an inflamed surface heals by the process ol tJie second intention, as follows: A soft, red surface of coagulable lymph becomes organized into embryonic tissue, which is known as granulation tissue, and the yellowish fluid, bland in nature, which is present is pus ; these materials or " products of inflammation " being generated for reparative processes. The granulation tissue is composed of embryonic cells and a network of capillary loops, by which the tissue receives its supply of nutritive matter from the blood, so that it may become what is recognized later as the cicatricial tissue, or one of a higher organism than the granulation tissue. The granulation tissue is of a variable pinkish color, the tint depending upon the quality of the blood which its vessels contain, and is of a jelly-like consistence, and somewhat smooth and firm. Its surface, when in a normal condition, is studded over with small conical prominences called granulations, in which are very minute vessels situated so superficially as to bleed on the slightest touch. Pus of a yellow color is found between the granulations, 26 DENTAL MEDICINE. which vary in size, form and color, a moderate bright-red color being indicative of a healthy healing process. When there is a want of power in the process of forming the cicatricial or repair tissue, the granulations become large and translucent, and the pus which surrounds them is pale and thin. If the affected surface is exposed to friction, or irritation from other causes, the granulations become extremely small and of a deeper red color than is normal, and at length may disappear at points, leaving grayish spots or smooth patches. If the process of cicatrization is prevented in its first stage, the granulations become large and coalesce, protruding and over- hanging the edges of the wound, and forming what is com- monly known as " proud flesh." During the entire healing process a flow of pus is going on from the affected surface as a normal act, and the first appearance of it is indicative of repair. Its appearance is also coincident with the organization of plastic lymph. When the suppuration is well established, the heat, tension and swelling of the inflamed part become less in degree, and the frequency of the pulse and the temperature of the body diminish. Whenever the granulating surface is formed, union by the second iJttention, or second adhesion, as it is termed, will take place, if separated surfaces are brought into apposition. Origin and Characteristics of Pus. — Pus is a secretion fur- nished by the blood at the expense of the tissues, an exuberant quantity of plastic material, for which excess there is no demand in the reparative process. The leucocytes which are brought to the surface of a granulating wound are discharged from it in the form of pus, while those that remain behind develop into tissue. This effect, by which the excess of leu- cocytes is gotten rid of, is accomplished by liquid exudation, the supply of which comes from the newly formed and the old capillaries, and is the same force that carries the nutritive material to the tissues. Healthy pus is of a yellowish-white color, sometimes assuming a pale greenish tint, of cream-like consistence ; a slightly saltish taste, but somewhat sweet ; a faint animal odor, with an alkaline reaction. The presence of INFLAMMATION. 27 bile may give to pus a deep orange color, while all of the other shades are due to the coloring matter of the blood, known as hsematoidine. As long as the air has access to it, there is little tendency to putrefaction ; and even when it is removed from the body and exposed to ordinary temperature, change in it occurs very slowly. Pus consists of two portions — a solid portion known as pus corpuscles, and which consists almost entirely of young pus cells or leucocytes, and a liquid portion known as liquor puris, which is a serous fluid, and con- stitutes about three-fourths of its bulk. When pus is subjected to pressure, as sometimes occurs in abscess of the antrum, and about bones, it may become a yel- lowish, cheesy mass, owing to the compression of the pus cells. The solid portion of pus consists of more than nine- tenths of leucocytes or young pus cells, which, in freshly formed pus, presents under the microscope a granular appear- ance, and also the peculiar movements of active, young and healthy leucocytes ; but pus which has collected in an abscess for several days shows no such movements, thereby indicating that the leucocytes have died. Living and dead pus cells may be found in ordinary pus, mingled together. Pus also contains such micro-organisms as vibrios and bacteria. Varieties of Pus. — The constitution of pus, which is subject to constant change, depends upon the form of the disease, the locality, and the condition of the patient. When it is of a yellowish-white color, of the consistence of cream, and com- posed of a great number of pus globules, it is called " healthy," " pure," or " laudable." " Sanioics," " serous," and " ichorous" pus is almost transparent, of a yellowish, oily, or, reddish color, and very acrid, being the product of unhealthy inflam- mation, and is common to caries of the bones, irritable ulcers, etc., and frequently mixed with blood, particles of fibrin, and dead tissue. In chronic and cold abscesses the pus corpuscles become pale and watery, showing that they are undergoing solution ; the pus from epithelial tumors, indolent ulcers, and phagedenic ulcers, is thin and sanious, and contains more or less dead tissue, which prevents the repair. 28 DENTAL MEDICINE. The term abscess denotes a collection of pus in the substance of the tissues, and the formation of the acute form is as follows : The exciting cause, acting as an irritant, causes an afflux of blood to the centre of the affection, and the distended capilla- ries pour out liquid exudation, which coagulates at this centre into plastic lymph, expanding the meshes of the neighboring surrounding tissues with a more serous fluid. Leucocytes are formed from cell proliferation in the plastic lymph, but, on account of their not being in a proper place for their growth and development into tissue, they become changed into pus, which collects in a cavity formed by it, and the result is an abscess. As these phenomena occur in rather quick succession, pain, heat, redness and swelling are present, and also constitutional disturbance in the form of hectic fever. The increase of an abscess in size is attended with a certain amount of redness on the surface over it and to which it is approaching, this increasing redness being preceded by more or less oedema of the tissue beneath, which is owing to the protruding of the serous exudation surrounding the central collection of pus. The centre of the surface redness then presents a more prominent and elevated point, where the outer tissue becomes thinner, purplish, or livid, and soon the yellow pus within is visible through it — a condition to which the t^rm pointing is applied. Soon after the " pointing," the in- tegument gives way and the pus exudes through the opening thus made. This thinning and weakening of the surface is caused by the stretching and obstruction of the blood vessels, which convey the nutritive supply from beneath, by the pressure of the enlarging abscess to such a degree that the surface integu- ment is deprived of its blood and slowly dies by minute par- ticles, the dead material being added to the contents of the abscess. An abscess unattended with such symptoms as pain, heat, and redness, is termed a cold abscess, and its presence depends upon a low degree of vitality. A cold abscess presents the same phenomena of pus forma- INFLAMMATION. 29 tion as the acute form, but resembles more the growth of a tumor, as all the symptoms may be absent except the swelling. The formation of pus on the surface of a tissue, such as mu- cous membrane, is not so serious as that in an abscess, as the conversion of the leucocytes into pus requires but little more increased activity than in cell germination. The exudation takes place from the network of capillaries which exist beneath every mucous membrane, and which furnishes nourishment for the constant renewal of the epithelium, and any injury received causes a fluxion of blood to the capillaries, which increases the cell proliferation. The effect is, then, to promote an increased discharge from the surface of the membrane, in the form of pus. Suppuration from mucous membrane usu- ally causes pain, heat, increased redness, and swelling of the inflamed surface, owing to the exudation into the meshes of the connective tissue beneath, and recovery is characterized by diminished fluxion of blood to the affected part, and conse- quent lessening of cell production ; the cells resume their func- tion of producing epithelial tissue, the pus becomes thin and more fluid, and finally ceases when the normal conditions again appear. Hectic fever is a symptom of destructive inflammation, and is a persistent, low form of continued fever, characterized by remission and exacerbation morning and night. This form of fever is caused by absorption into the blood of some of the products of inflammation, in such quantities and so gradually as not to produce an immediate fatal result, and inducing a regular succession of chill, fever, and perspiration during the space of every twenty-four hours. Its effect is progressive emaciation and a tendency to fatal termination, if the cause is not removed, through combustion of tissue material to supply the fever heat. The regularity of the night sweats, and the pulse retaining its frequency during the apyrexia, even in the morning, when the temperature is normal, are the diagnostic signs of hectic from typhoid and malarial fevers. The most unfavorable symptoms of hectic fever are the higher fever in the evening, the increase in the frequency of 30 DENTAL MEDICINE. the pulse, the more exhausting night sweats, with the occur- rence of aphthae in the mouth, and diarrhoea. Chronic Inflammation. — Chronic or asthenic inflamma- tion is a process in which all the cardinal symptoms of inflam- mation may be present, but in less degree than in the acute form. In chronic inflammation there is present a permanent local hyperaemia, attended with an exudation into the inter- stices of the inflamed part, or from its surface. The pain in this form is usually slight, or may be intermittent, or even absent, or be no more than an itching sensation ; heat is present, but is not a prominent symptom ; the redness is of a light hue, sometimes livid, from passive hyperaemia and the stretching of the vessels by the over distention to which they had before been subjected, and the diminished force of the circulation; the swelling is in the form of induration, owing to the exudation having become organized into tissue. This latter accounts for the hardness around an indolent ulcer, and an old sinus. Inflammatory induration consists of the new tissue growth in the state of more imperfect organization than the normal cicatricial tissue. In mucous membranes indura- tion is indicative of chronic inflammation, and is caused by exudative infiltration into the substance of the submucous con- nective tissue, and a considerable change of structure in these membranes often occurs. Although the symptoms of chronic inflammation are present in a limited degree, yet they are more persistent, on account of the object for which' the increased nutritive effort was made proving unsuccessful. Ulceration is a passive process, and results from the molecular death caused by insufficient blood supply, insuffi- cient nervous influence, impure quality of blood, or the presence of blood poison. Ulceration is very closely associ- ated with inflammation, although the former may be independ- ent of the latter, and consists of a progressive softening and disintegration of successive layers of the affected tissue. Ulceration generally begins in a process of chronic inflamma- tion, and in such a manner that the death of the tissues only occurs when the tissues themselves have undergone cellular INFLAMMATION. 31 infiltration in consequence of the inflammatory changes. The loss of the integument leaves a red, raw surface, which bleeds easily, and which is covered with a tenacious, slimy matter. Very soon irregular cavities are formed in this surface, sepa- rated by red elevations with ragged edges. A thin, serous, bloody discharge exudes, with severe pain of a gnawing char- acter. The. ulcer then formed, and which has been defined as " a wound surface having no tendency to heal," spreads more or less rapidly, and the surrounding integument is hot and swollen, and the disintegrated tissue is thrown off as extraneous matter. Ulcers also originate from pustules that fail to heal after the pus escapes, but spread and maintain an acute inflam- matory character. An ulcer may be circular, crescentic, irregular, in the form of a shallow or deep ring, or it may be tubular, forming a fistula. The edges of an ulcer are either low or raised, hard (callous), soft, jagged, vertical, everted, or undermined, etc. Ulcers arising from persistent local irritation, as those of the oral mucous membrane, usually heal as soon as the affected parts are placed under favorable external circumstances. As long as the epithelium is preserved, the superficial inflammatory process in mucous membranes may be called catarrh. When suppuration of mucous membranes proceeds so far as to expose the sicbstantia propria or corium, the diseased surface is known as an ulcer. Effects of Micro- Orgajiisms. — While some of the common parasites cause injurious effects by inciting inflammation in tissues and organs, they only act as foreign bodies, while the microscopic fungi and their germs, acting as invisible particles of organized matter, cause the greatest injury. If they are protected from the influence of oxygen, these micro-organisms germinate very rapidly, and derive their sustenance from the fluids of the inflamed tissue and the granulating surface. The form known as vibrio septica generate putrefaction in animal matter by bringing about a process of fermentation — dental caries affords an example. The chemico-vital changes accom- panying the process of putrefactive fermentation give rise 32 DENTAL MEDICINE. to septic poisons^ which, being absorbed in the circulation, result in septiccBinia and pycBinia. Dr. Koch affirms that " bacteria do not occur in the blood nor in the tissues of the healthy living body, either of man or of the lower animals," and the same investigator also says : " When introduced by inoculation into animal tissues, they multiply and excrete soluble substances, which get into the surrounding tissues by diffusion." The tissues, by the contact of the micrococci, lose their vitality, and the parasite growth multiplies and spreads rapidly in the dead tissues, advancing directly toward the parts in which vitality yet remains. Terminations of Inflammation. — According to the present knowledge of this subject, inflammation terminates — ist, By Resolution ; 2d, By Formatioii of New Tissue ; 3d, By Gan- grene, or Local Death — Necrosis. When the inflammatory process terminates by resolution, all of the symptoms gradually diminish and disappear, and the affected tissues resume their normal condition. Such a result is generally due to the mild character of the injury, and the progress of the inflammation. When the inflammatory process terminates by the formation of new tissue, the new growth is produced by inflammation — either by the union by first intention, or by the development of granulations, which become organized into a cicatrix. When the inflammatory process terminates m gangrene, or local death, the effort of the inflammation toward repair has failed, either on account of the functions of the capillaries and the connective tissue becoming impeded to such a degree as to render inoperative the resources of the organisms, or because of certain conditions arising at a later period which have obstructed the reparative effort and caused the parts to lose their vitality. The termination of the inflammatory process by gangrene depends upon the degree and nature of the lesion, and the inability of the capillaries and arteries to maintain the local circulation. The impairment of the vitality of the blood vessels causes stasis and thrombosis to occur, and as soon as INFLAMMATION. 33 actual death takes place, the dead tissue presents a further obstacle to the local circulation, and also adds to the difficulty of elimination, which favors the spread of the gangrene. The earliest symptoms of gangrene are hard swelling, burning and tensive pain, and livid color. The pain then subsides, vesica- tions appear, the part takes on a marbled, purplish-yellow color, afterward becoming brown or grayish, and finally cold and insensible, exhaling a putrid odor. Treatment of Inflammation. — It has already been stated that the causes of inflammation determine in a great measure its treatment, and this is especially true of inflammation of the oral mucous membrane. The indications of treatment are as follows : — Prevention and Removal of Cause. — Prevention may include the removal of a predisposing cause when local, or the lessen- ing of its effects when it is general or constitutional. If malaria is present, quinine is indicated ; if syphilis, iodide of potassium, or minute doses of bichloride of mercury. Irritation, the precursor of inflammation, may often be arrested by the removal of a local cause, such as salivary calcu- lus, for example. The restoration of the secretion of the different organs is also indicated in the treatment of certain forms of inflammation, and also the use of such palliative remedies as will allay the excitement of the nervous system. When the cause is apparent, its removal is, as a general rule, easily accomplished ; but when the cause is obscure, the con- dition of the secretions of the bowels and the diet should receive careful attention. To correct the secretions, purgatives are indispensable ; also such other depletory measures as bleeding, abstinence from food, use of emetics or nauseants to lessen the general circulation and reduce the vascular tension. To allay the nervous excitement and irritability, narcotics or opiates are indicated, their direct effect being relief of pain and spasm, and inducement to rest and tranquillity. The advantage of rest and immobility cannot be over esti- mated, for a simple lesion, if subjected to constant mobility, may become one of a much greater character, destructive 3 34 DENTAL MEDICINE. inflammation often being provoked by friction and undue motion. An qxamxple is furnished in the case of periodon- titis, where a cap or partial interdental splint made of model- ing composition or gutta percha, or vulcanized rubber, will protect the affected tooth from irritation, and materially assist the remedial measures ; also strips of adhesive plaster, collo- dion, etc., will insure immobility in certain cases where such appliances are indicated, as undue motion retards and prevents the process of healing. Position is also to be considered as a means for relieving the irritation and pain, so that no provocation may exist for subsequent inflammation. The best position should be selected for the affected part, which will favor the return of venous blood and retard the arterial current; hence, an elevated position will tend to prevent passive hyperaemia. A favorable position will also secure muscular relaxation, and prevent the involuntary spasmodic action, which may result from muscular tension. The administration of an anaesthetic to secure mus- cular relaxation, in the case of certain injuries, as in fracture or dislocation of the jaw, is often resorted to as a measure against spasmodic contraction, and also to reduce the excessive vascular reaction. Cold, when outwardly applied as a depressor to the inflamed part, reduces the excitement and irritability. The application of the spray of absolute ether, or of rhigolene, will often prove serviceable in the early stage of periodontitis. Cold, whenever moderately applied, is tonic and invigorating, and besides evaporating applications, ice may be employed ; but such local measures to maintain a low temperature must be re- newed at short intervals. Cold, when locally applied, causes the capillaries to contract, thus diminishing the afflux of blood to the affected tissue. The persistent application of cold, how- ever, may cause gangrene; but the employment of the ether or rhigolene spray is attended with less danger in this respect than that of ice applications, A granulating surface, on the other hand, develops better in a warm temperature. Heat and Moisture, — Heat is also, under certain circum- INFLAMMATION. 35 stances, a valuable antiphlogistic. Dry heat will mitigate pain, and heat with moisture, in the form of a poultice, is very com- monly used to relieve the pain and tensive heat of local in- flammation by its soothing and relaxing effect. While cold has an astringent, sedative effect, and constringes the capilla- ries of the inflamed tissue, thus promoting healing by resolu- tion, moist heat is relaxing and promotes exudation, if not suppuration, leading to repair by " the second intention." The use of cold is dispensed with in inflammatory conditions as soon as it is apparent that the termination of the inflammation by resolution is impossible, when resort is had to poultices or warm fomentations, such as flaxseed and slippery-elm bark, to which vaseline, boracic acid, or a weak solution of carbolic acid may be added, to prevent fermentation in the poultice, and putrefaction in the wound. To relieve pain^ tincture of opium may be applied to the surface of the poultice, a water dressing, composed of cloth saturated with warm water or a medicated solution, such as boracic acid or biborate of sodium. The local warm bath is also another method of applying heat and moisture, as the granulations of a surface immersed in tepid water develop favorably ; and an ulcerated surface which has been subjected to a prolonged warm bath, made antiseptic by carbolic acid, or the application of an eight per cent, solution of chloride of zinc, is greatly benefited. Warmth and moisture are especially indicated for parts having a feeble circulation. Warm, moist applications, such as poul- tices, promote the tendency to suppuration ; hence, care should be observed in applying such applications to the surface of the face, in the case of an alveolar abscess, as pointing and the escape of pus may be induced in a position where permanent disfigurement would be very apparent. CojHpression is also of service in the treatment of certain forms of inflammation, especially during the late stages, but it must be uniformly, moderately, and continuously applied. Even in the acute form, compression may prevent the over-dis- tention of the capillaries and limit the exudation ; in the chronic form, compression promotes absorption. It is accomplished by 36 DENTAL MEDICINE. means of bandages, either alone or in conjunction with cotton batting, as the latter prevents irregular constriction and main- tains a uniform temperature. A fine compressed sponge, moistened, after it is applied, with tepid water, is a .painless and effective means for obtaining compression in the treatment of indolent ulcers. Compression by means of sheet lead or tin, and pads of bibulous paper, will often prevent an alveolar abscess from discharging on the surface of the cheek or neck, when such an event is imminent. Bloodletting. — General bloodletting is now rarely employed in the treatment of inflammation ; but the local abstraction of blood by means of leeches, cups, scarification, incisions, and other means, is of great service in reducing vascular action, and lessening inflammatory symptoms. The efficiency of local depletion in relieving hyperaemia is very evident by the cessa- tion of pain caused by strangulation and tension. Periodon- titis and acute gingivitis furnish examples. Leeches should never be applied to a part where it would be difficult to arrest the hemorrhage which may follow their use ; their application is also contraindicated in the case of children, who cannot bear the loss of considerable blood with impunity. Incisions are made for the purpose of relieving tension and pain, evacuating pus, or the escape of dead material, for tension aggravates the inflammation and the retention of pus in an abscess prolongs the pain, and also adds to the destruction of parts by the formation of gangrenous patches. Superficial incisions will relieve the tension of the skin and mucous membrane, and also evacuate the pus of an abscess when it is near the surface. Deeper incisions are necessary when the pus is at a greater distance from the surface, and there is considerable tension. Incisions are also often judicious as a prevention of suppura- tion and ulceration ; also in cases where the presence of pus is suspected, but there is no apparent fluctuation. In making deep incisions, care is necessary to avoid wounding arteries and nerves ; hence the director should precede the use of the knife. In acute abscesses the incisions should be made at an INFLAMMATION. 37 early stage, and of such a size as will permit of the free evacu- ation of the pus, and in the most depending position, to insure its easy discharge. Hence, as soon as fluctuation is detected in an acute .abscess, the incision for the escape of the pus should be made ; while in the case of a chronic or cold abscess, the incision may be delayed, or a puncture with a trocar substituted for it, which may at once be closed. Drainage is employed for the purpose of giving outlet for any matters liable to collect in a wound or abscess which may act as obstacles to the process of repair. Teeth affected with abscess are often relieved and retained by an opening made into the pulp canal or into the abscess sac, sufficiently free to relieve the tension and drain off the accumulated pus ; also in the case of abscess of the antrum, where an opening made through the alveolar cavity of one of the roots of a posterior tooth is kept open by means of a canula, to relieve the tension and permit the pus to escape as it accumulates, and also to afford an easy entrance for the injection of anti- septic and stimulating agents in the treatment of such cases. Drainage can also be made through soft tissues, such as the gum, etc., by strands of floss silk, hemp thread, and horse hair, dipped in a carbolic acid solution before they are inserted into the opening connected with the sac; also by means of caoutchouc tubing. Counter- Irritants, or '' derivatives," are also employed in the treatment of inflammation, for the purpose of inducing an afflux of blood from the locality of the inflammation to another point in close proximity, thus relieving the vessels of the affected part. Such counter-excitement in the case of the oral mucous membrane, is induced by blistering applications, stimulants, escharotics, etc., which excite a new action in a part more or less remote from the focus of inflammation. Cantharidal collodion, tincture of iodine, either alone or in combination with aconite, or with creasote, or with carbolic acid, nitrate of silver, nitric acid, and the actual cautery, may be named as the most common counter-irritants for applica- tion to the oral mucous membrane in the case of deep-seated 38 DENTAL MEDICINE. inflammation and pulpitis ; and are mainly useful in the early- stage of the acute form, and in the chronic form. Mouth Washes and Lotions, such as tincture of myrrh, chlorate of potassa, solutions of carbolic acid, listerine, per- manganate of potash, nitrate of silver, sulphate of copper, sulphate of zinc, oxide of zinc, lead water, tincture of opium, etc., are employed with benefit in superficial inflammations and ulcerations of the oral mucous membrane. When putrefaction is present in the inflamed part, chlorinous washes are serviceable for deodorizing purposes, and also to prevent the entrance of putrid matter into the circulation. The object of cauterizing an inflamed part is to break the continuity of the morbid process. Ancssthetics, such as chloroform, ether, etc., when employed in the treatment of inflammation, exercise an influence as preventives, and also render lax tissues which become very rigid, and enable reductions to be made, as well as temporarily mitigating the pain ; fracture and dislocation of the jaw are examples. When inflammation has devitalized parts, the treatment varies in respect to the nature of such parts. Dead, soft tissues are to be so treated that the putrid matter is prevented from entering the circulation, by the application of antiseptic agents, which have in a great measure replaced antiphlogistics ; hence, antiseptics which possess the power of destroying micro- organisms without the danger of destroying the vitality of the tissues, are considered to be the most active agents of this class. When the hard tissues are devitalized, such as bone, for example, although the living bone becomes sepa- rate from the dead portion as effectually as a living soft part from its slough, yet it is necessary to liberate the bony seques- trum from the overlying texture which may confine it ; hence the removal of dead bone is necessary as soon as the line of demarcation is formed, the time for which may vary from a period of less than three weeks in the case of small sequestra, to more than two months, where the entire bone is involved. Also in cases where the extremity of a part consisting of soft INFLAMMATION. 39 and hard tissues, for example, the alveolar process and tissues over it, become gangrenous, it is best, in most instances, to remove the dead tissues by amputation ; and such an operation may also become necessary in. cases of long-continued ex- haustive suppuration. Many forms of inflammation have their special remedies, such as mercurial inflammation of the mouth, when chlorate of potash is indicated ; periodontitis, when tincture of iodine and tincture of aconite, or creasote, or carbolic acid, in combination with the iodine, etc., are indicated ; gingivitis, where stimulating and antiseptic washes and lotions of tincture of myrrh, biborate of soda, carbolic acid solutions and combinations, etc., are indicated. General Remarks. — In every case, the first object should be to ascertain and, if possible, remove the cause of a disease. It should be remembered that medicinal substances are always more certain in their action when applied directly to the afiected tissue; also, that chemical, physical and vital changes result from the topical action of such substances; and that age modifies the effects, and also determines the dose ; also, sex, owing to the greater susceptibility of the nervous system in females than in males ; also the temperament, as the sanguine, for example, is more susceptible to the influence of medicinal agents than the phlegmatic ; also habit and mode of life, as the habitual use of such agents as stimulants lessens their influ- ence, and the occupation affects the susceptibility to external influence ; also the co?idition of the body, as different diseases exercise considerable influence on the effects of medicinal substances ; also the mind, as a hopeful mind conduces to the beneficial action of medicines; also idiosyncrasy, 2iS some indi- viduals are more susceptible to the action or effects of medi- cinal substances than others ; also the nature of the tissue or organ to which application is made, as some are more suscep- tible to the effect of medicinal agents than others, owing to rapidity of absorption and the degree of decomposition of the substance employed ; also climate, from the recognized influ- ence of climate in modifying the structure and functions of the animal economy, and increasing or diminishing morbid 40 DENTAL MEDICINE. conditions, and by such means influencing the effects of medi- cinal agents. ^ In most acute diseases there is a tendency to recovery after a certain time has elapsed, in case there is no failure in the functions of any of the essential organs ; hence, in all acute diseases, the state of the nervous system should be carefully watched. When the affection is not of a serious character, such symp- toms as are especially troublesome may be relieved; but when the nervous and vascular systems are affected, both locally and generally, then it is necessary that the proper measures for their relief be promptly taken. Where mucous membrane is the seat of the affection, it is often possible to remove the exciting cause. There are also many inflammatory affections met with, where, from the be- ginning, there is a diminished action of the heart, and a depressed state of the nervous centres. In the treatment of such cases, the depressed condition of the general system chiefly requires attention, as the progress and termination of the local affection depend upon the cause from which it has originated. There are also morbid states not necessarily dependent on organic disease. Various acids are produced by the fermenta- tion of substances containing starch or sugar, and there is reason for believing that an increased secretion of acid may take place from the mucous membrane of the stomach and produce symptoms of acidity independently of fermentation, although one of the properties of the gastric fluid is to prevent fermentation. The symptoms of acidity are a sour taste, and the occurrence of acid eructations, often accompanied with heartburn, and sometimes with diarrhoea, and a feeling of sinking at the epigastrium. In these cases the cause must be sought for, and such treat- ment instituted as will neutralize the acidity and stimulate the peptic glands to an increased secretion of the digestive fluid ; also such as will regulate the bowels. Due attention must also be given to the diet, which should consist of such sub- DIAGNOSIS OF MOUTH AFFECTIONS. 41 stances as will not readily ferment, and all food containing starch should be avoided. Although topical remedies are more generally employed in the treatment of dental affections, yet there are many diseases of the oral cavity which are due to remote causes, and require constitutional as well as local treatment. The appearances presented by the mucous membrane of the mouth are valuable, as indicating the state of other parts more remote ; and it is frequently the case that, when the constitu- tional affection is overcome, the local symptoms disappear as a consequence, or become very amenable to local remedies. IMPORTANT POINTS IN DIAGNOSING AFFECTIONS OF THE MOUTH, WITH A SYNOPSIS OF TREATMENT. The Irritation of Teething is indicated by a hot, swollen and tender condition of the gums, fretfulness, irritable temper, refusal of nourishment, fever and thirst, and, if not relieved, diarrhoea with offensive motions, sometimes a troublesome cough, convulsions, and other serious results. An Abnormal Dentition is indicated by a hot, dry mouth, swollen gums, tense, tender and shining, fever, disordered bowels, fretfulness, eruption of skin, diarrhcea, convulsions. Convulsions of Dentitioji are indicated by such premonitory symptoms as irritable temper, unusual brightness of eyes, indisposition to eat or sleep, slight involuntary movements of muscles of face or extremities, grinding of teeth. The par- oxysm is indicated by rigidity of body, utterance of a cry, face turning red or purple, veins of neck turgid, suspension of respiration, loss of consciousness, irregular and intermittent contractions of muscles, protrusion of tongue, frothing at lips, distortion of face, rolling of eyeballs, contracted and rapid pulse. Treatment. — For the relief of the premonitory symptoms of dentition, bromide of potassium in doses of gr. iij to v, accord- ing to age, every ten minutes. Demulcent and soothing lotions to the gums. An aperient if no diarrhoea is present. For more decided symptoms, scarification or lancing of the gums. 42 DENTAL MEDICINE. An enema of soap and water to relieve the digestive canal of irritating substances, or the use of the following combination to abate the fever and allay the irritability of stomach and bowels : — li . Potass, bromidi pulv gr-xv Potass, nit. pulv gr.xij Zincioxidi gr.ij M. Divide in chart., No. vr, SiG. — One powder every four hours, until bedtime. For the diarrhoea : change the diet, adopt hygienic measures ; mild purgatives in small doses. For acid dejections, calcined magnesia; or small doses of sulphate of magnesia and tincture of rhubarb ; or of pulv. ipecac, pulv. rhubarb and bicarbonate of soda ; or castor oil in doses of 5ss. For infancy diarrhoeas Dr. Thomas claims excellent results from the following mix- tures in gastric or gastro-intestinal dyspepsia, characterized by nausea, vomiting, flatulence and diarrhoea with non-slimy, fetid, yellowish or greenish stools, ^i. Lactic acid, 5j ; simple syrup, 5v; water, Siijss. M. Sig. — One drachm every quarter to half hour after meals. (See Dr. James W. White's recipes under opium, chloroform, aromatic sulphuric acid and bromide of potassium.) For convulsions : the administration of an anaesthetic to abort or control the spasmodic movements ; hydrate of chloral, gr. V to X, according to age, dissolved in two or three drachms of water, and injected into the rectum ; or the administration of bromide of potassium ; use of hot foot bath, to which is added a small quantity of mustard ; the warm bath ; and when cere- bral congestion is threatened, cold applications to the head. According to Dr. A. Brothers : i. Dentition is rarely, if ever, a direct cause of death. 2. Precocious or retarded dentition may occur in otherwise healthy children or in entire families. 3. The period of eruption of the first teeth occurs, in healthy, breast-fed children, at six and a half months in the vast majority of cases, and first dentition is usually complete at thirty months. DIAGNOSIS OF MOUTH AFFECTIONS. 43 4. Dentition is distinctly retarded in the first as well as the later teeth in children brought up on a mixed or artificial diet. 5. Congenital diseases — tuberculosis, syphilis, endocarditis — seem to have a retarding influence on dentition. 6. Rachitis has a very pronounced retarding influence on the whole course of dentition. 7. Scrofulosis seems to hasten the eruption of the first teeth, but does not affect the later teeth. 8. In cases of undeveloped brain — idiocy — there is a marked retardation during the entire period of dentition. 9. Chronic diseases have a retarding power over the first teeth, but do not seem to influence the later teeth. 10. Children suffering from marasmus seem to be precocious with the first teeth, but delayed with the later teeth. 11. Cases of epilepsy, developing in early infancy, seem to have their first teeth appear early. Periodofiiitis or Inflammation of the Peridental membrajie is indicated by a sense of uneasiness and fullness, which is at first relieved by pressure, but after active inflammation is established, pressure on the affected tooth causes intense pain, of a dull, heavy, annoying character. The tooth is also protruded, to a slight degree, from the alveolus, and also somewhat loosened, owing to the thickening of the investing membrane ; and the inflammation, which is at first manifested by a red line near the margin of the gum, becomes general over the entire root, sometimes involving the neighboring gum, and even the palate and cheek, and symptoms of febrile disturbance. If not arrested, a suppurative condition, alveolar abscess, ensues. A modification of the symptoms just enumerated, the tooth being tender to pressure, more or less raised in its cavity, and sur- rounded by a reddened and swollen gum, with a varying amount of pain, and the discharge of pus from around the neck, or from a fistulous opening in the gum, and such symp- toms continuing for a long time, indicate the chronic form of an advanced state of periodontitis, which often results from systemic influences. 44 DENTAL MEDICINE. Treatment. — Remove all irritants ; apply counter-irritants, such as equal parts of tinct. iodine and tinct. aconite ; or can- tharidal collodion; or iodine and creasote, or carbolic acid; or capsicum in form of tincture, or in small bags of the powder to surface of gum over root of affected tooth. Depletion by the lancet, leeches or cups. Hypodermic injection of mor- phine, or tinct. of opium. Application of spray of rhigolene or absolute ether until gum is blanched. To relieve pain, a solution of equal parts of tinct. aconite, tinct. opium, and chloroform ; or lead water and tinct. opium. Constitutional treatment: Saline cathartics; bromide of potassium, gr. xxv, combined with gtt. v of tinct. veratrum, every four hours ; or bromide of potassium alone, in doses of gr. xxv or xxx. The tooth protected from irritation during treatment, by a cap over adjoining teeth. The removal of the extremity of the root of a tooth affected with chronic periodontitis, by means of a trepan, has also been suggested. Alveolar Abscess is first indicated by pain of a constant char- acter, which is afterward aggravated at each pulsation ; then swelling about the roots of the affected tooth, which at length becomes defined and prominent, and afterward points and dis- charges pus, when the active symptoms subside. The devel- opment of alveolar abscess is indicated by such constitutional symptoms as foul tongue, offensive breath, hot skin, thirst and headache, and when the suppuration is considerable, symp- tomatic fever and rigors. The characteristic pain of an alveolar abscess is deep-seated and throbbing, and, with the swelling, denotes the formation of pus. A chronic form, of alveolar abscess is indicated by a subsidence of the active symptoms, and a continuance of the discharge of small quantities of pus through a fistulous open- ing opposite the root of the affected tooth, or about its neck. An elastic fluctuating swelling in any part of the face, or for some distance down the neck, may result from abscessed teeth. Treatment. — Remove all irritants. Give free vent for the escape of the pus. Destroy sac of abscess by therapeutic DIAGNOSIS OF MOUTH AFFECTIONS. 45 treatment, or by a surgical operation. Therapeutic treatment: First cleanse the root canal by injections of chloride of sodium or peroxide of hydrogen ; then apply escharotics to destroy the sac, such as creasote, carbolic acid, salicylic acid, nitrate of silver, iodine, dilute aromatic sulphuric acid, to which, in chronic cases, add tinct. of capsicum ; also antiseptics. The surgical method consists in gaining access to the sac, by means of a bis- toury or small trephine, through the fistulous opening, where such exists, and detaching and breaking up the sac by means of suitable nerve instruments and the application of eschar- otic agents. Dr. Brophy, speaking of cases of alveolar abscess where the disease is in the bone, says : " In such cases if the treatment is simply opening into the tooth for drainage with the expectation that nature will effect a cure, we will be disappointed. In such cases an incision should be made down to the diseased bone, packing it with iodoform gauze, or boracic acid gauze. The next day with a bur cut off the affected portion of the roots of the teeth because they are a source of irritation ; then with a bud- bur pass over the bone, and remove the dead portions, and again pack the wound with antiseptic gauze. In a day or two make an examination, and if healthy granulations are begin- ning, insert a wax plug, which is not permeable like the gauze, to prevent the wound from closing, and the consequent trouble from confined pus." Alveolar Abscess about to point Externally is indicated by the skin, for some distance around the central point, becoming red and distended, with a throbbing sensation, succeeded by a change in the appearance of the skin to a thin and scaly sur- face, from which the epidermis scales off. The integument becomes glued down to the bone around the spot where the pus will ultimately appear; the latter following a fistulous track between the diseased tooth and the surface of the cheek, the fistula remaining open and discharging as long as the in- flammatory action continues. Treatment. — Make a free incision in the gum opposite and near the apex of the root of the affected tooth. Apply to the 46 DENTAL MEDICINE. surface of the threatened point of exit of the pus alcohol or spirits of camphor, or paint with collodion, and make gentle pressure by means of a compress of sheet lead or sheet tin, or pads and bandage, to change the direction of the pus. Abscess of the Antrum is indicated by a discharge of pus into the nose, sometimes producing scarcely any discomfort; at other times the severest local and constitutional suffering; an aching pain in the cheek, which is hot, flushed and somewhat swollen ; and as the symptoms increase, greater pain, of a throbbing character, with the rigors and fever peculiar to suppuration; an expansion of the bone of the upper jaw; an elevation of the malar bone, with a very apparent depression beneath it ; the molar teeth on the affected side depressed so as to appear elongated, and to prevent the proper closure of the mouth ; an increase of pus ; the palate losing its concavity and becoming convex ; the nostril of the affected side being encroached upon, and, in protracted cases, the floor of the orbit of the eye so pushed up as to force the eye partly from its socket ; the sight affected by the stretching of the optic nerve ; the walls of the antrum becoming so thin as to afford evidence of fluid-fluctuation on pressure; at length the pus escaping through the cheek, or into the nose, or burrowing along the side of a root of a tooth and discharging into the mouth ; the floor of the orbit giving way and the pus discharging along the lower eyelid. Treatment. — Make an opening into the antrum, either through the alveolar cavity of one of the roots of a superior first or second molar, or through the process about the roots, with a suitable trephine, and thoroughly wash out the cavity with a warm injection of salt 5j to water Oss, and if there is an offensive odor, syringe with a solution of permanganate of potash; then dress daily with a solution composed of carbolic acid one part, and oil of sweet almonds fifteen parts, applied on cotton secured in the cavity. If no improvement, then syringe the antrum with a solution consisting of carbolic acid 5j, tinct. iodine 5j, water Sviij. Where a more powerful stim- lant is required, use an injection of chloride of zinc, gr. x to DIAGNOSIS OF MOUTH AFFECTIONS. 47 the ounce of water. For systemic treatment, administer sulphide of calcium in the form of one-tenth of a grain pill thrbe times a day, after meals, doubling the dose if necessary. {Dr. Frank Abbott. ) Alveolar Ulceration is distinguished from alveolar abscess by the presence of an ulcerated surface of peridental membrane instead of pus confined in a fibrous sac, the purulent matter in alveolar ulceration oozing out through the gum or around the neck of the affected tooth : no new tissue is formed, as in the case of abscess, but the normal tissue is disorganized and wasted, and the matter discharged is watery, translucent, and may be in some cases odorless, while that from an abscess is thick, opaque and offensive. Ulceration causes little or no swelling, and the inflammation is phagedenic in character, de- stroying hard and soft tissues by chemical decomposition. Like alveolar abscess, it may be due to the death of the pulp, and it may begin as abscess, not being a primary disease, but always preceded by some other well established and usually chronic affection. In alveolar ulceration a considerable por- tion of the peridental membrane is destroyed, and there is a wasting away of the alveolus and cementum in the region of the ulcer, whereas in alveolar abscess the peridental membrane may remain in an inflamed and morbid condition and the alveo- lar walls firm and penetrated at one point to permit of the escape of the pus. In long-continued alveolar ulceration, as a result of the disease, calcareous deposits, in the form of gran- ules, collect on the root from the ulcerated area to the margin of the gum. The treatment consists in the thorough removal of the calcic deposit when present, and the scraping of the root of the tooth over the entire ulcerated surface, and the application of anti- septic and astringent remedies. Maxillary Abscess may be due to caries or the diseases of the teeth, or to pathological changes occurring in the structure of the bone itself. Treatment. — The treatment of maxillary abscess consists either in puncture or incision, and the extraction of one or 48 DENTAL MEDICINE. more of the teeth if they are found to be connected with the origin of the disease. If free drainage be established by an early incision, the arrest of the disease is practically secured ; it is sometimes necessary to remove a portion of the alveolar process. The presence of dead bone should be determined, and such removed, with other offending matter. Free drain- age should be maintained until complete recovery is brought about. The abscess may be opened under cocaine anaesthesia, a soft rubber drainage tube be inserted, and the cavity thor- oughly irrigated and disinfected with a i to 2,000 bichloride of mercury solution. A safety pin may be placed at the ex- ternal end of the tube, and a strip of iodoform gauze put between it and the skin ; over this the ordinary bichloride gauze dressing may be secured by a roller bandage. Necrosis of the Alveolar Process is indicated by a dark purple and swollen condition of gum, with offensive purulent discharge from one or more fistulous openings, or from between the gums and the teeth. The gum becomes soft and spongy, very sensitive, bleeds readily, and loses its connection with the ne- crosed bone beneath. Treatment. — (See Necrosis of the Jaws.) Phosphor- Necrosis is indicated by pain in jaw, similar to odontalgia, at first not constant, but soon becoming severe, and extending along side of the head, and to the shoulder, with swelling and great tenderness near the seat of the affec- tion, the integument becoming red and tense, the teeth elon- gated and extremely painful when closed together, and also becoming loose; the gums and mucous membrane of the cheeks swollen and livid ; at length, suppuration ensues, with fever, rigors, etc. ; gums become spongy, with escape of pus around necks of necrosed teeth, and the pus fetid, and the swelling very great, especially when the lower jaw is affected ; a dense plastic exudation encases the under and external sur- face of the bone ; intense glistening redness of the skin, as the pus approaches the surface; at length, intense fever, with delirium and great suffering; the throwing out of a bony deposit of a peculiar appearance, like pumice-stone. DIAGNOSIS OF MOUTH AFFECTIONS. 49 Treatmetit. — Removal of patient from exposure to fumes of phosphorus, and the excision of diseased portion of bone. Fracture of the Alveolar Process is indicated by a swollen, red and painful state of gum and tissues covering maxillary bone, occurring some days after the receipt of the injury, and, if neglected, may result in necrosis of the bone. Treatment. — Antiphlogistic lotions, to reduce the inflamma- tion, such as — R, Plumbi acetatis 3J Tinct. opii 5 ss Aquce ^ x. M. SiG. — Apply on lint. Remove any detached portions of process, and secure loose teeth with waxed sterilized ligatures. Mercurial Poisoning, or Salivation, when of a mild form, is indicated by a red margin of the gum, which eventually be- comes somewhat spongy and tender, with a slight fetor of the breath and a metallic taste. An increased degree of salivation, or mercurial stomatitis, is indicated by a profuse flow of saliva, intense fetor, strong metallic taste, tenderness of the gums, stiffiiess of the jaws, followed by ulceration and sloughing, if the injudicious use of the mercury is persisted in. Treatment. — Discontinue use of mercury. Chlorate of pot- ash, internally, gr. x, in water 5ss : as a gargle, 5j, to water 5j; or iodide of potassium in doses of gr. iij, three times a day. To correct fetor of breath, permanganate of potash solution, gr. ij to x, to the ounce of water; or washes of chlorinated soda ; astringent washes during convalescence. Loose teeth should not be removed, as they will again become firm. Lead Poisoning is indicated by a blue line upon the edge of the gums, and such constitutional symptoms as paralysis and colic attend severe cases. Treatme7it. — Administration of iodide of potassium in gr. iij 4 50 DENTAL MEDICINE. doses, four times a day, after meals, to eliminate the lead ; saline cathartics, electricity, strychnine, etc., for the paralysis, and tonics, such as quinine, to promote the strength. Scurvy is indicated by a general spongy condition of the gums, and, in severe cases, intense fetor, ulceration and slough- ing together with constitutional symptoms of an aggravated character. The premonitory symptoms in the mouth are, gums paler than usual, with a slight tumid or everted line on free margins, and slight tenderness on pressure ; breath offen- sive, and a disagreeable taste ; tongue flabby and larger, though clean and pale. Later, the gums become darkened in color, inflamed, swollen, spongy, bleed readily, and finally separate from the teeth. The gums of edentulous jaws do not present these symptoms. At length, the gums present great, fungous, lacerable excrescences, which are prone to suppurate and be- come a brown, fetid mass, with a very offensive odor. The salivary glands become enlarged and swollen ; tongue indented by the teeth, which latter become coated with a salivary deposit, and finally drop out. Necrosis and extensive exfoliation of the bones of the jaw may occur. Some varieties of salivary calculus will produce similar local symptoms, especially when the general condition of the system is unfavorable. Treatment. — Change of diet, substituting fresh meats, soups, nitrogenous food, and recent vegetable acids, as citric, tartaric, and acetic, and these combined with potassium. Nitrate of potassium, either alone or mixed with vinegar, as an anti- scorbutic. A Simple Form, of Stomatitis is indicated by slightly elevated, reddish, glistening patches on the mucous membrane, which may coalesce, so that the whole surface is involved. Treatment. — Emollient and detergent lotions, such as slip- pery-elm bark, pith of sassafras, or borax, 5j, glycerine, Sj, or, borax, 5j, honey, 5iij, or a weak solution of alum, or acetate of lead, gr. iij to the ounce of water. A few doses of bromide of potassium will relieve the nervous excitement. Chlorate of potash lotion, gr. v to the ounce of water, is also efficacious as a local remedy. DIAGNOSIS OF MOUTH AFFECTIONS. 51 Ulcerous Stomatitis, common to childhood, is indicated by ulceration commencing on or near the gums, more frequently in the lower than in the upper jaw, and usually on one side only, and spreading over the entire mouth. The gum first becomes thickened and congested, and of a deep purple color, and bleeds readily ; ulceration speedily occurs, and exposes the necks of the teeth, and extends to the mucous membrane of the mouth generally, the ulcerated surface being covered with a dirty-white or yellow exudation, leaving exposed numer- ous bright red points on a yellowish ground. The edges of the ulcers are sharp and ragged, and the ulcer, at first super- ficial, becomes gradually deeper. Ulcers of the mouth are often due to syphilis and dyspepsia, and are aggravated by the irritation resulting from the irregular edges of fractured and decayed teeth. When neglected, such ulcers may assume the appearance of epithelioma, especially when induration of the glands beneath the jaw is present. Treatment. — Remove all apparent causes of irritation. Change diet and residence, if at fault, observe cleanliness, administer tonics, as liquor ferri nitratis with tincture of calumba. Local applications of nitrate of silver, gr. j to iij to the ounce of water, or diluted muriatic acid, alternating with a lotion of equal parts of borax and honey, or chloride of lime, 5j, honey, 5j. Chlorate of potash internally, in doses of 5ij or iij, and also as a lotion, is efficacious ; also a strong solution of borax, in obstinate cases, gr. xv to the ounce of water; also a .solution of sulphate of copper. Ulcers of the Month due to Syphilis are indicated when such ulceration is obstinate under any but specific treatment, and when accompanied by symptoms peculiar to syphilis. Treatment. — Constitutional treatment with mercury or iodide of potassium, and such local remedies as are employed in ulcerous stomatitis. Syphilitic Inflammation of the Mucons Membrane of the Month is indicated by a general swelling of the gums, with everted and ulcerated margins, exposing the necks of the teeth, although not affecting, to any great degree, their stability, with 52 DENTAL MEDICINE. a viscid discharge, mixed with blood, from about their necks ; soreness, rendering mastication painful ; the affection slowly spreading, until the bone is exposed and a portion exfoliated ; greater degree of congestion; formation of mucous patches on sides of cheeks ; superficial ulcers inside of cheeks and beneath the tongue ; erosions of the soft palate and tonsils : fissures at corner of the mouth, and eruptions on skin and scalp. Treatment. — (See Ulcers of the Mouth due to Syphilis.) Gangrenous Stomatitis, common to children during the shedding of the temporary teeth, is indicated by a thick swell- ing of the face ; skin tense and shining ; swelling becoming hard and circumscribed, but devoid of tenderness, with a central spot, red and variegated in appearance ; the formation of an ulcer, corresponding to the red spot outside, on the inside of the cheek ; profuse salivation, the ulcerated part becoming gangrenous, with an opening through the cheek ; absence of pain and destruction of parts. Treatment. — Preventive : Pure air, cleanliness, nourishing diet. Sulphate of quinine, internally, in doses of gr. ij to iij ; and as a lotion, sulphate of zinc, 5j to the ounce of water. When the disease is established, the local use of escharotics, as acetic, sulphuric, nitric, hydrochloric acids, nitrate of silver, acid nitrate of mercury, or chloride of antimony, each applied by means of a camel-hair brush to gangrenous part, and at once followed by the application of dry chloride of lime. The mouth to be washed out with tepid water, by means of a syringe. After the separation of the slough, the dry chloride of lime alone may be used. The muriated tincture of iron is also employed ; and after the gangrene is arrested astringent lotions are efificacious. Scrofula. — In early life the characteristics are most appar- ent. Tendency to enlargement of lymphatic glands ; pro- clivity to certain forms of skin eruption ; to disease of the joints and bones ; the efforts necessary for growth and develop- ment overtax the defective vital powers ; defective quality of the blood and tissues, and especially of the vascular tissue ; DIAGNOSIS OF MOUTH AFFECTIONS. 53 injuries such as sprains end in chronic disease of the joint. A scrofulous child may grow finely for several years, and then, without adequate cause, be overtaken by meningitis, or disease of vertebrae : inflammations are prone to take on chronic form. Treatment. — Pure air of country, cod-liver oil and malt, iron and hypophosphites to increase the quantity of nutritious constituents of the blood. A Tumor of the Upper Jaw xs indicated by a gradually in- creasing prominence of the cheek, which more or less involves the mouth, obstructing the nostril, causing double vision by displacing the eyeball. Treatment. — Removal by a surgical operation. A Malignajit Form of Tumor of the Jaws is indicated by a solid prominence, rapid in growth, and having a tendency to invade surrounding structures, and to fungate like a mush- room. Treatment. — Removal by a surgical operation, and the ap- plication of escharotics, as chromic acid, or chloride of zinc, etc., to prevent its reproduction. A Dentigeroiis Cyst. — Cysts of the teeth are of two kinds — those connected with the roots of developed or erupted teeth, and those connected with imperfectly developed or unerupted teeth, and both varieties are common to either jaw; the latter, however, are known as "dentigerous cysts." A dentigerous cyst is indicated by the expansion of the bone of the jaw at some particular spot, with disfigurement of the adjacent parts; a sense of weight and tension in the aflfected part; in some cases, constitutional irritation from pressure; pressure pro- ducing a parchment-like crackle or crepitation ; absence of a tooth, which has never been erupted nor extracted. Heath remarks that "the clinical history of cysts connected with the teeth is that of painless expansion of the alveolus of either jaw, but more frequently of the upper, with crackling of the bone on pressure, and ultimate absorption of the bony wall. The cyst then presents a bluish appearance through the dis- tended mucous membrane, and if large, gives distinct evidence of fluctuation." 54 DENTAL MEDICINE. Treatment. — A free incision, and the removal of the unerupted tooth by destroying the front wall of the cyst, and the cavity filled with lint, so as to induce granulation and gradual oblit- eration. In the case of a cyst of the lower jaw, after the re- moval of the contents and a portion of the wall, the plates of bone should be pressed together as much as is possible. An Unerupted Impacted Tooth is indicated by a hard bony tumor on the alveolar ridge, sometimes extending along the surface of the palate bone, or the body of the maxilla, and in form corresponding to a tooth, the absence of which is noted. Treatment. — Extraction, by first making an incision through the mucous membrane, and then exposing the tooth by the removal of its bony capsule. Necrosis of the Jaw is indicated by inflammation like that of periodontitis in the early stage, but differing as the disease progresses ; gum over affected part thickened, tumid and of a red color; pus oozing from the edge of gum, which soon sep- arates from the alveolus, the margins of which become ex- posed; loosening and loss of the teeth; the detachment of the dead alveoli from the living bone, and remaining loose in the substance of the thickened gum which becomes dark in color, surrounded by pus ; the escape of the pus into the mouth, or pointing below the chin, or beneath the fascia of the neck, as low, at times, as the clavicle. Treatment. — Remove the dead portions from the living bone. Syringe with peroxide of hydrogen to cleanse the part, and use chlorinated washes, such as chloride of soda, or permanganate of potash, to correct the offensive odor and disagreeable taste. Make daily applications of dilute aromatic sulphuric acid, add- ing to the acid a few drops of the tincture of capsicum for its stimulating effect ; diluted carbolic acid, tincture of iodine and chloride of zinc, sulphate of copper, listerine and ethereal solu- tion of iodoform, aristol, etc., are also used as applications. Support the strength by stimulants, tonics and nourishing diet. Dislocation of the Lower Jaw, when double, is indicated by inability to close the mouth ; the mouth widely open ; the chin prominent, with a distinct hollow in front of each ear. DIAGNOSIS OF MOUTH AFFECTIONS. 55 A single dislocation is indicated by the mouth being only par- tially open, the chin displaced to one side, the distinct hollow below the ear being on the opposite side. Treattnent. — Reduction is made by placing the thumbs, protected by napkins, as far back upon the molars as possible, and then depressing the back part of the jaw, and at the same time raising the chin. The jaws should afterward be secured by a bandage extending under the chin and over top of head. Fracture of the Lower Jaiv is indicated by inability to close the mouth, and to speak articulately; laceration of the gums and hemorrhage ; irregularity of the teeth from displacement of the fragments of bone ; crepitation. Fracture of the maxilla may, however, show no displacement, or the fracture extending through the angle or ramus, may be diagnosed by grasping the two sides of the jaw and moving them forcibly. Crepitus, increased flow of saliva, mobility of fragments, and irregularity of the teeth, if the fracture is through the body of the bone, are all signs of fracture. A swollen, red and painful condition of the tissues covering the lower jaw, occurring some days after the accident, denote the possibility of fracture, neglect causing a high degree of inflammation, and in some cases even necrosis of the bone. Treatment. — Reduce by bringing the displaced portions into apposition, being guided by the arch of the teeth, and then securing them by wire, silk, or waxed sterilized ligatures around the teeth, and introducing an interdental splint. Cleft Palate is indicated by a fissure extending through the soft palate alone, or through both soft and hard palates, and which may be combined with single or double hare-lip, in which case the intermaxillary bones are frequently displaced. Treatment. — When the cleft is confined to the soft palate, the operation of staphylorraphy may be performed ; when, however, the cleft is through both soft and hard palates, the construction of an artificial obturator and palate combined will often prove successful in correcting the voice and prevent- ing much inconvenience in partaking of food and drink. Hare-lip is indicated by a congenital fissure of the upper 56 DENTAL MEDICINE. lip, and may be single or double, and may also be complicated with fissure of the hard and soft palates. Treatment. — Pare the surfaces of the edges of the fissure in such a manner as will allow a flap on one to cover the edge of the other when they are brought in apposition, when they are secured by the aid of pins and the figure-of-eight suture, which, in the case of infants, may be preserved from injury by passing a silver wire through the cheeks, having on each pro- truding end a button, to prevent the breaking up of the suture during the act of crying. Cocaine is a useful local anaesthetic for such operations. Facial Paralysis is indicated by distortion of the face, in which the mouth is drawn to one side, being due to paralysis of the facial nerve. The eye may also remain permanently open on the affected side, the saliva escape from the corner of the mouth, and the food collect under the cheek, on account of the paralysis of the buccinator muscle. Treatment. — Electricity, and systemic treatment with strych- nine, phosphorus, iron, quinine, ergot, etc. A Nasal Polypus is indicated by more or less obstruction of one or both nostrils, with occasional watery discharge ; a gray or yellowish mass, like jelly in consistence, can be detected by the finger, if it is passed behind the soft palate, hanging down into the pharynx, and which greatly increases in damp weather ; the nose bulged out on one side by the growth within. Treatment. — Remove either by the snare or by torsion, or by repeated applications of chromic acid. To prevent repro- duction apply to the surface chromic acid or chloride of zinc. Thrush, common to infants and children under eighteen months of age, is indicated by small, white spots, the size of a pin's head, upon the dorsal surface of the tongue, palate, velum, inside of cheek and lips, which increase in size and coalesce, with a tendency to false membrane, the crusts falling off and reappearing ; the mucous membrane beneath redder than nat- ural. Treatment. — Change of diet and residence, if these are at DIAGNOSIS OF MOUTH AFFECTIONS. 57 fault ; the administration of saccharate of lime in milk. Local treatment, mel-boracis, or borax solution, or — R. Sodii borat ,^j GlycerinDe ^ij Aquae ^iv. M. SiG. — Apply with a camel's-hair brush four or five times a day. Or— B . Zinc sulph grij-iv Aquae rosae ^ij. M. Or a weak solution of nitrate of silver. Aphtha or Follicular Ulceration^ common to childhood, is indicated by the mucous membrane becoming inflamed, and the formation of small, round, transparent vesicles on the fraenum, in the sulcus between the lips and gums, and on lower surface of tongue. On the bursting of the vesicles, small, spreading ulcers, with red and swollen margins, appear, which become coated with a layer of o'idium albicans. Treatment. — Demulcent applications, such as mucilage of gum acacia, or flaxseed, Mel-boracis applied with a camel's- hair brush. For constitutional symptoms, administer laxatives and the bromides, with warm foot bath. Epulis is indicated by a growth on the gums, either small and pedunculated, or large and sessile. If it is firm in texture and slow of growth, the epulis is generally fibrous ; but if rapid in growth and dark in color, it is myeloid ; if prone to ulcerate and very painful, it may be an epithelioma. Treatme7it. — Removal of the growth, and its reproduction prevented by the application of nitrate of silver, or chromic acid, or a fire cautery. Generally, it is necessary to remove the periosteum and a thin scale of the bone beneath, as this growth is connected with the periosteum. Extract all roots of carious teeth, and when the epulis is connected with the alve- olar cavity of a tooth and has tendency to the interior of the jaw, it is generally myeloid, and several teeth will have to be sacrificed, so that the alveolus can be thoroughly excavated. 58 DENTAL MEDICINE. When very extensive, a considerable portion of the alveolus and bone of the jaw must be removed. Epithelioma is indicated by a ragged ulcer on the lower lip, commencing as a wart, the skin around being hard and infil- trated, with enlargement of the submaxillary lymphatic glands, which become tender, or even ulcerated. Epithelioma of the gum is in the form of a ragged ulcera- tion, often the result of irritation from diseased teeth ; the pain and inconvenience at first slight ; a tending of the ulceration to spread toward the tongue and cheek, with induration of the base of the ulcer. Treatment. — Removal as soon as its nature is manifest. In slight or doubtful cases the application of the strongest nitric acid, the acid nitrate of mercury, or the actual cautery, to bring about a healthy cicatrization. If the disease has involved the alveolus, as is evident by the swelling of the gum and the looseness of the teeth, a free removal of the bone is necessary. Hypertrophy of the Gtims is indicated by an increase of their substance to such a degree as to cause them to overhang and cover the greater portion of the crowns of the teeth ; tendency to hemorrhage; gums dark and livid ; fetor of breath ; increased flow of saliva. Treatment. — Remove all dead teeth and salivary calculus. Remove the morbid growth by a horizontal incision through the diseased structure to the crowns of the teeth, and freely scarify the gums by passing a lancet between the teeth to the process, and repeat this operation at intervals of four or five days, if necessary. Use detergent and astringent lotions, and occasionally a weak solution of nitrate of silver. Phenate of soda is efficacious as a lotion, also antiseptic. Diet non-irri- tating, and all excess and intemperance avoided. The teeth should be kept perfectly clean. Alveolar Pyorrhoea, or Riggs' Disease, is indicated at first by an uneasy sensation ; then inflammation of margins of gums ; looseness of the gums about the teeth, which form pockets ; and necrosis of edges of alveolar process ; a tendency to hemorrhage ; inflammation extending deeper into gums ; small DIAGNOSIS OF MOUTH AFFECTIONS. 59 sulci filled with pus ; looseness of the teeth and change of posi- tions ; disagreeable taste ; peculiar fetor of breath ; dark livid color of gums, with thick margins, and often extreme sensitive- ness to touch ; in some cases the gums are denuded of their epithelium, with a polished appearance, in others, with a pimpled surface ; the teeth, at length, held in their cavities by a tough, ligamentous attachment, due to the change occurring in the peridental membrane. A simple form of this disease may manifest itself at the margin of the gum, indicating its presence by a congested appearance, beneath which may be found a granule of calcified material. While in many cases there is general congestion of the affected gum, and a proneness to hemorrhage, in other cases the gum may present an anaemic appearance — pale and bloodless. This disease may also be associated with syphilis, mercurial salivation and scurvy. The deposit of salivary cal- culus or other calcified substance is supposed to be secondary to the disease, as a deep-red and denuded gum tissue about the necks of the teeth may be present without any deposit. Dr. Chas. B. Atkinson describes this affection as follows: — " Perhaps the earliest condition presented to us is a tumefac- tion of the margin of the gum — from pearly-red and light lilac to purplish blue in tint — sometimes puffing to such an extent as to be easily confounded with an alveolar abscess. The tumefied gum bleeds readily on brushing. A probe passed carefully under the gum will disclose a pocket embracing more or less the circumference of the root, in some places nearly or quite to its apical end. Sometimes the gum will be found re- ceded, perhaps on one side only. A purulent discharge more or less marked, may be demonstrated by pressure of the finger over the root, from its end towards the crown of the tooth. A further demonstration of the pressure of pus may be secured by injection, about the necks of the teeth, of peroxide of hy- drogen. A general hypertrophy of the oral tissues may be noticed. Suppuration, perhaps preceding, perhaps following, a solution of the dental ligament, which permits the pocket to be formed, and is the antecedent usually responsible for the 60 DENTAL MEDICINE. loosening of the teeth. This loosening may, however, be pre- sent as a result of inflammation before suppuration has suc- ceeded. The loosening may be attended with recession of the gum or not, and with or without pain. Locally, aside from the gingival congestions already noticed, the teeth may be found elongated, the breath fetid, tartar freely present (although many cases progress to disaster with no appreciable deposit of tartar), pus sometimes oozing from the sockets, putrid taste in the mouth, tenderness of the teeth, already noted, and many times considerable irregularities, the natural result of the loosening of the teeth. Observation may disclose such sys- temic conditions as stomach dyspepsia, catarrh (as nasal ca- tarrh or other mucous surface debility), constipation, phthisis, adenoid growths, general congestion due to intemperance, kidney disease, rheumatism, cold feet and other extremities, indicating poor circulation and malassimilation. Dr. Rhein has truly said that incurable systemic disorders make only palliation of pyorrhoea disorders." Treatment. — The first and most important matter is to remove all deposits from the roots of the teeth, and all necrosed bone from the margins of the alveolar processes. This can be accomplished with what are known as Riggs' instruments. An acquired and acute sense of touch is necessary to determine the thoroughness of the cleansing operation. The pockets formed in the gum may then be treated with iodoform and eucalyptus, iodoform and oil of cinnamon, or with injections of chloride of alumina, gr. iij to the ounce of water, also strong tincture of myrrh, aromatic sulphuric acid. Peroxide of hydrogen, and also a solution of iodide of zinc, gr. xii-xiv to the ounce of water, are also recommended by Dr. Harlan, in the form of injections ; and for chronic cases the latter in a solution composed of gr. xxiv to the ounce of water, after the parts are cleansed by injections of the peroxide of hydrogen. Another method : After thorough removal of deposits, syringe with aromatic sulphuric acid, diluted with one-half water, and apply night and morning a powder composed of creta prepar- atse, Sj; acidum boricum, Sj. The use of" Robinson's Reme- DIAGNOSIS OF MOUTH AFFECTIONS. 61 dy " is also recommended, following the use of bichloride of mercury i to 500. Dr. Chas, B. Atkinson recommends first returning loose teeth to place laterally, and securing them with waxed steril- ized ligatures. Then, beginning with the upper jaw, such seal- ing as may be indicated should be performed, after which the pockets should be carefully investigated with proper instru- ments, all foreign matter removed from them and from about the teeth, having recourse frequently to a sirs or ts'ss solution of HgClj in H2O2. This preparation of peroxide should be first allowed to remain in the pockets and about the teeth for perhaps even three minutes. It may be necessary to reduce the length of elongated teeth, but if direct pressure will an- swer, this should be resorted to and shortening of the bite avoided. See the patient daily for two weeks. Sometimes no application of medicaments will be indicated — perhaps a little scaling or scraping of overlooked deposit, from time to time. The appearances of the abnormal conditions seem to be best indicated by color, size and texture. A dark blue color of soft and spongy gum should be lanced to relieve the venous congestion, and then injected with aromatic sulphuric acid, full officinal strength. Should suppuration be imminent or present, the pus should be evacuated by incision, or by the in- jection of peroxide of hydrogen as a first step, followed by a delicate application of "caustic paste" (potassa fusa ^, car- bolic acid, cryst. }^). A cherry-red color of slightly puffed gum calls for salicylic acid solution saturated in 95 per cent, al- cohol. The constant exhibition of antiseptic and stimulant mouth-washes is necessary, such as combinations of bichloride of mercury, tincture of calendula and distilled water, or hy- dronaphthol, tincture of calendula and distilled water; or per- oxide of hydrogen and tincture of calendula. Systemic remedies are also indicated, such as tonics and cathartics, the latter in the beginning of the treatment; also digestive stimu- lation. Dr. E. C. Kirk recommends a ten per cent, solution of aris- tol, rubbed up with oil of cinnamon, or oil of gaultheria and 62 DENTAL MEDICINE. introduced into each suppurating pocket, and around the roots of the teeth a!t the base of each pocket, on wisps of absorbent cotton, saturated with the solution. Irritation of the Dental Pulp is indicated by an uneasy sen- sation, which develops into pain of a gnawing or burning char- acter, the affected tooth being sensitive to changes of temper- ature, painful in mastication, but exhibiting no symptoms of inflammation of the gum or peridental membrane. Treatment. — The treatment must vary with the condition producing the affection. First remove all irritants. If the cause is systemic, constitutional treatment for the condition present is indicated. Saline cathartics, as the sulphate or carbonate of magnesia; diaphoretics, as spts, mindererus, or Dover's powder; diuretics, as preparations of nitre, often prove efficacious ; also bromide of potassium. If the fluids of the mouth are irritative, they must be corrected. If a carious cavity exists, all foreign substances and the softer parts of carious dentine should be removed, and the cavity syringed with a tepid solution of bicarbonate of soda, potash or ammonia. Dilute car- bolic acid, or wood creasote, may then be applied, and a non- conducting filling of a solution of gutta perchaand chloroform be introduced. (See Dental Formulse for Odontalgia and Pulpitis.) Acute Inflammation of the Dental Pulp is indicated by acute pain in the affected tooth, which frequently extends to neigh- boring teeth and to the side of the face, but is more intense in the tooth itself; pain may subside after a few hours' duration, to return again on the slightest provocation, or on patient assuming a horizontal position ; the pain may also assume a throbbing character. Treatment. — The treatment of this condition of pulp is indi- cated in that of " irritation of the pulp." For soothing appli- cations, solution of gutta percha and chloroform, tincture of hamamelis applied warm, oil of cloves, dilute creasote, equal parts of chloroform, aconite and tincture of opium, may be employed. (See Dental Formulae for Pulpitis and Odontalgia.) Chronic Inflammation of the Dental Pulp is indicated by pain, less severe than in the acute form, and of less duration; coming DIAGNOSIS OF MOUTH AFFECTIONS. 63 on at irregular intervals, and wandering, like neuralgic pains, and incited by changes of temperature, and the application of irritants. (See Irritation of Dental Pulp.) Fungous Groii'th of Pulp is indicated by the organ, as a result of continued irritation, assuming the form of a small vascular tumor, or granular mass, attached by means of a pedicle, which, in some cases, completely fills the cavity of decay in the crown of the tooth, and is often extremely sensitive and prone to hemorrhage. Treat)ne7it. — When a tendency to fungous growth is dis- covered, the free application of carbolic acid or tincture of aconite followed by the use of chromic acid, will obtund the sensibility, when the entire tumor should be excised, and its reproduction prevented by application of nitric acid on a disc of card-board. Ossification of the Dciital Pulp is indicated by pain of a neuralgic character, which commences in an uneasy feeling, and changes to what has been described as a gnawing sensa- tion, similar to that which attends the knitting together of the fractured parts of a bone. It may be continuous, but not constantly severe, and frequently amounts to no more than an uneasy sensation ; at other times it may be sharp and darting, affecting the side of the head, and all the branches of the supe- rior maxillary division of the fifth pair of nerves. The affected tooth is free from soreness and discoloration. Treatment. — Apply anodynes, such as lead water, and those indicated in " acute inflammation of pulp " to relieve the pain. Open the pulp chamber, and completely extirpate the pulp. Abnormal Sensibility of De^itine is indicated by pain resulting from irritation of dentinal structure, being of shorter duration and less acute in character than that from an inflamed dental pulp; the pain of sensitive dentine soon subsides on the removal of the irritating cause. Treatment. — Apply obtunding agents, as chloride of zinc, chloroform and aconite equal parts, carvacrol, oil of cloves, oil of cedar, oil of eucalyptus, tannin combined with glycerine or camphor, chloral, camphorized ether, oxide of calcium, car- 64 DENTAL MEDICINE. bonate of sodium, menthol, thymol, sesquichloride of chromium, sulphate of morphine and gum camphor equal parts, ethylate of sodium, carbonate of potash and glycerine, carbolized potash, campho-phenique, etc. Ottolengui's method : Apply the rubber- dam, dry cavity with bibulous paper, then insert a pledget of cotton saturated with absolute alcohol, then apply intermittingly a series of blasts of hot air to produce evaporation, until parts become whitened or thoroughly dry, then throw on a con- tinuous spray of ether. A jet of nitrous oxide gas directed into the cavity of the tooth by a piece of tubing ; also the vapor of alcohol, produced by heating the alcohol in a metal apparatus, and conducting the vapor into the cavity through a fine metal tube, have also been employed for the relief of the pain arising from hyper-sensitive dentine. The application of cocaine and alcohol by electrolysis has also given satisfactory results. (See Therapeutics of Electricity.) Abrasion of the Teeth is indicated by a loss of structure, due to friction, to such an extent at times as to destroy the entire crowns. Treatment. — Gold caps or partial crowns, either in the form of ferrules or contour fillings, or fillings of other metals, will often arrest the process of abrasion, and render much worn teeth useful organs. Also the insertion of artificial posterior teeth will often prevent natural front teeth from being abraded from unnatural use. Hypertrophy of the Alveolar Processes is indicated by an osseous deposit, either at the apex of the alveolar cavity, in which case the affected tooth is protruded from its cavity, or by a deposit of osseous matter on the wall of the alveolar cavity, in which case the tooth is forced to one side. Treatment. — When the osseous deposit is in the bottom of the alveolar cavity, the length of the tooth may be reduced from time to time until a certain degree is reached, when the loss of the tooth is inevitable. When the deposit is upon the side of the cavity, the effect is irregularity or malposition, for which there is often no remedy but the removal of the devi- ating tooth. DIAGNOSIS OF MOUTH AFFECTIONS. 65 Hypercementosis or Dental Exostosis is indicated by an uneasy sensation in the affected tooth, followed by a gnawing pain, which in some cases, assumes a severe neuralgic character, especially when the deposit of cementum on the root is of considerable size, in which case there is a prominence appar- ent on the side of the alveolar ridge. Treatntefit. — During the early stages of this affection, the administration of large doses of iodide of potassium, and the application of counter-irritants, such as a saturated tincture of iodine or cantharidal collodion, have been suggested, to arrest the deposit and cause absorption. When the deposit is large and productive of pain and inconvenience, the removal of the affected tooth is inevitable. Organic Defects of Structure, indicated by defects in the enamel, in the form of opaque spots, grooves or pits, congenital in origin, and due to altered functions from impaired nutrition. Treatment. — Preventive by mitigating severity of diseases producing the condition, by the administration of proper remedies. For the pitting variety, properly inserted fillings. Odontomes are indicated by irregular masses of dental tis- sues, which result from morbid conditions of the formative pulp, such as nodules of enamel and dentine, hypertrophy of cementum, etc., some being congenital, others induced. Treatment. — Extraction, when they are a source of irritation, or an injury to the normal teeth, or are unsightly. Syphilitic Teeth are indicated by notches, generally crescentic, in the cutting edges of the incisors, and peg-like shaped cust pids ; also, a dark color and soft consistence are characteristic of such teeth. Treatment. — The most skillful treatment by properly intro- duced fillings and constant attention, are necessary for their preservation. Erosion of the Teeth is indicated by the gradual destruction of the enamel of the labial surfaces of the incisors, canines,, and sometimes of the bicuspids, generally in the form of a continuous horizontal groove, smooth and regular;, in some cases it may extend over nearly the whole of the labial, surface, 5 66 DENTAL MEDICINE. the color of the enamel being rarely changed. Erosion is the smooth removal of the surface of the enamel, a smooth sur- face remaining ; corrosion is the destruction of the enamel in the form of pits and irregularities due to an acid condition of the fluids of the mouth, lactic acid being a prominent factor in promoting fermentative action. Treatment. — In advanced stages, arrest its progress by fill- ings of durable material. Absoi'-ption of Process and Recession of Gum is indicated by a slight increase of redness, some congestion and a shrinkage of the margins of the gums, and may be accompanied with a slight purulent discharge about the neck of the affected tooth. The symptoms resemble those of chronic inflammation of the gums. The progress of the affection is generally slow, and is often first observed about the necks of the canine teeth. Teeth so aflected become more susceptible to impressions of heat, cold, acids, etc., and eventually loose. Treatment. — To arrest the progress of this affection, first remove all irritants, and cleanse thoroughly, polishing the ex- posed surfaces. Correct the nature of the fluids of the mouth, if at fault, by constitutional treatment, the use of alkahne lotions, such, as lime water, and detergent dentifrices. Such agents as a weak solution of chloride of zinc, to produce healthy granulation, carbolic acid, nitrate ofsilver, and judicious pressure, may be employed with advantage. A moderately stiff brush and floss silk are useful adjuncts to the treatment. Necrosed Teeth. — The term "necrosed" is applied to a tooth when the vitality of its pulp and lining membrane is destroyed, the peridental membrane, however, maintaining a degree of vitality which prevents the tooth from becoming an irritant, so as to insure its loss as an effete organ. Treatment. — When a necrosed tooth is not productive of injury to the adjacent structures, and there is a probability of rendering it a useful organ, the pulp canal should be thoroughly exposed, cleansed, and treated, if necessary, with disinfectants, antiseptics, etc., and then filled, together with the crown cavity, with a suitable material As necrosed teeth are frequently DIAGNOSIS OF MOUTH AFFECTIONS. 67 considerably discolored, on account of the tubuli of the den- tine absorbing coloring matter from the dead pulp, such bleaching agents as chloride of lime, chloride of alumina, oxalic acid, chloride of soda, sulphite of soda combined with boracic acid, cyanide of potassium, tartaric acid in combination with chloride of lime, chloride of zinc, also alum in combination with liq. sodae chlorinatae, may be employed to improve their appearance, also use of nitrous oxide in combination with chloride of sodium, also peroxide of hydrogen. Infantile Paralysis Diiring the Period of Teething. — Infantile paralysis, or poliomyelitis, is an obscure affection peculiar to a certain season, which has given to it at the hands of some the name of " warm weather spinal disease." It comes on suddenly, but seldom after the age of four years. According to Gowers, of all cases under ten years, three-fifths occur in the first two years of life, and he claims that a considerable number of cases are congenital. There is usually a febrile ini- tial stage followed by the sudden onset of paralysis in one leg or arm. In more than half the cases the lower limbs are affected ; of the remainder, the majority represent implications of the arms, notably the deltoid muscles, and legs, or, perhaps, arm and leg, and very seldom the upper extremity alone. The cause of infantile paralysis is generally assigned to teeth- ing, cold or damp, injuries to the spine, measles, scarlatina, malarial or other fevers, convulsions or concussion. Dr. Rot at the Fourth Prussian Congress, declared that heredity is the only etiological factor that has been proven. " The primary cause of the affection must be sought for in the modifications of that part of the fecundated ovum which enters into the formation of the nervous system." During the period of denti- tion, children are liable to disorders of the cerebro-spinal sys- tem, and as from such causes we find convulsions the cause of the death of numberless infants seemingly robust, so we see the same cause producing paralysis. There is loss of heat and atrophy in the affected limbs, and the latter may be a feature of the disease dependent upon the morbid changes in the nerve-centres. The atrophy extends to the bony system, 68 DENTAL MEDICINE. the nutrition of which is involved ; and it is evident that the atrophic degeneration, if not inherent, is a real sequence of in- flammatory process in the spinal cord. Treatment. — The treatment of infantile paralysis consists in the application of mild galvanic stimulation by the uninter- rupted current conveyed through the affected cord out through the nerves of the flabby muscles; the skin may also be stimu- lated with salt and sulphur baths. In the early stage Dr. Althaus advises the injection of ergotine ^ gr., for a child a year old, in order to contract the arterioles of the part to de- plete the blood supply. He stimulates the muscles as they become affected with injections of strychnine. Conium and chloral may be used to calm nervous excitement. Dr. Sequin recommends counter-irritation over the spine, bromides and arsenic, while others use cupping, leeches, and iodide of po- tassium. Brown-Sequard recommended belladonna to control the inflammatory process of the spinal cord. If pain or fever are present, ether spray to the spine, ice, gelsemium, aconite, antipyrine internally. Rubbing, muscle-beating and massage, have also been employed as adjuncts. Chemical Bleaching of Teeth. — Prof Truman's method con- sists in liberating chlorine from calcium, hydrochlorite or chlo- ride of lime, in the cavity of decay and pulp canal by a dilute acid. He recommends a fifty per cent, solution of acetic acid, although oxalic, citric, or tartaric acid may be used, or indeed any dilute acid to liberate the chlorine. The upper third of the pulp canal should be filled with gutta-percha, and the cavity in all cases should be washed out with ammonia or borax, to remove the fatty matter, previous to the introduction of the bleaching agent. Labarraque's solution of soda has also been used as a medium from which to liberate the chlorine. Dr. A. W. Harlan uses aluminum chloride in the cavity, from which he liberates the chlorine by means of peroxide of hy- drogen. Dr. Edw. C. Kirk's method consists of liberating sulphurous acid, SO2, from sodium sulphite, NagSOs, by means ofboracic acid. The two substances, in the proportion of 100 grains of sodium sulphite and 70 grains ofboracic acid, DIAGNOSIS OF MOUTH AFFECTIONS. 69 are desiccated separately, and then intimately ground together in a warm dry mortar. In using this powder, the tooth is carefully dried under the dam, and the powder is packed into the pulp-cavity and cavity until both are full ; the reaction which hberates the sulphurous acid is then brought about by moist- ening the powder in the tooth with a drop of water, and the ori- fice of the cavity is immediately closed with warm gutta percha. Herpes Zoster of Mouth and Gums. — An acute circumscribed inflammatory affection, characterized by an eruption of vesicles of herpes on a red, inflamed basis, the vesicles being disposed in groups and follow the group of the adjacent nerve. The eruption is preceded and accompanied by a very severe neu- ralgia of the fifth nerve. The period of invasion (three days) is accompanied by a well-defined fever and other general symptoms. The period of eruption begins on the third day, and lasts about three weeks to one month, the pain being per- sistent. It is probably of an infectious origin, and is due to a neuritis of the affected region which leads to trophic changes. Treatment. — Dr. Harlan recommends a palliative treatment, which consists of placing cotton-wool between the cheek and teeth to prevent friction, and on it an ointment consisting of cocaine and morphine. Merck's Bulletin gives the following new treatment for herpes zoster : MIXTURE. R . Extract gelsemium, 1 ^ , . ^ ° ' V of each 4 grammes. Sodium sulpho-carbolate, J Distilled water 90 grammes. M. Sig. One teaspoonful every two hours. At the same time five drops tincture of belladonna are ad- ministered every two hours until a slight dryness of the pharynx is experienced. LOTION. R . Lead acetate, "I ,- , „ , , , > of each 4 grammes. I'owdered alum, J Distilled water, . . . .120 grammes. M. Sig. Externally. Compresses moistened with this solution are applied to the 70 DENTAL MEDICINE. affected parts, and renewed every two hours. It is claimed that the pain" disappears within a few hours, and that the dis- ease is considerably shortened by this treatment. De7ital Caries is indicated by a process of gradual softening and disintegration of the tooth tissues by deleterious agents, the progress being hastened, primarily, by certain structural defects in the enamel and dentine, and secondarily, by certain diseases of the mucous membrane, and some derangement of the general health. Incipient dental caries is indicated by an opaque, whitish or gray appearance of the enamel. A pale brown varying to a nearly black color indicates the existence and progress of dental caries in the tooth tissues ; the deeper the color the slower the progress of the caries, and the paler the color the more rapid the progress. The softening and de- calcifying of the bones, and the proneness of the teeth to caries during pregnancy, is ascribed to faulty nutrition and the lack of the supply of the proper elements to the system, and the waste going on during this period. But the principal ex- citing cause of caries of the teeth during pregnancy is the lactic acid fermentation present, its action being greatly aug- mented by the changed condition of the fluids of the mouth, such acids existing in the secretions of the mouth as hydro- chloric, acetic, oxalic and uric. Treatment. — Incipient caries should be removed with great care, and the exposed surface of tooth structure prepared to resist further attacks by giving to it as high a polish as is pos- sible, and the patient warned in regard to its future cleanli- ness. Deep-seated caries should be removed, and its further progress arrested by thoroughly sterilizing or disinfecting the cavity by antiseptics and disinfectants, and the careful insertion of fillings of a durable material. During pregnancy all oper- ations on the teeth should be painless, and long, wearying sit- tings be avoided. Caries of the teeth of pregnant women can be arrested by plastic fillings until such time as the patient can the better endure more permanent operations. The pre- ventive measures consist in the thorough and frequent. use of the tooth-brush and its adjunct, floss silk, at least three times a day, assisted by a proper dentifrice and antacid mouth-wash. DIGESTIBILITY OF FOODS. 71 CHARACTERISTIC INDICATIONS OF THE TONGUE. A White Coated To7igiie indicates febrile disturbance. A Brown Moist Tongue indicates digestive disorder and an overloaded stomach. A Brown Dry Tongue indicates depressed vital power. A Red Moist Tongue indicates feebleness, especially from exhaustive discharges. A Red Dry Tongue indicates inflammatory fever or pyrexia. A Red Glazed Tongue indicates debility and inability to di- gest food and stimulants. A Treniulous, Moist and Flabby Tongue indicates feebleness and nervousness. A Glased Bluish Tongue, with loss of epithelium in patches, and in severe cases, cracks and scars, indicates tertiary syphilis. DIGESTIBILITY OF FOODS. Giving the time required for the digestion in the stomach of various alimentary substances, derived from actual experi- ments. Article. Mode of Prep. Hrs. Min. Aponeurosis (gristle) Boiled, 3 00 Apples, sour, mellow Raw 2 00 Apples, sour, hard Raw 2 50 Apples, sweet, mellow Raw I 30 Bass, striped . Broiled 3 00 Beans, pod Boiled 2 30 Beans and green corn Boiled 3 45 Beef Fried 4 00 Beefsteak Broiled 3 00 Beef, fresh, lean, dry Roasted 3 30 Beef, fresh, lean, rare Roasted 3 00 Beef, with mustard, &c Boiled 3 10 Beef, with salt only Boiled 3 36 Beets Boiled 3 45 Brains, animal . . Boiled i 45 Bread, corn Baked 3 15 Bread, wheat, fresh Baked 3 30 Cabbage Raw 2 30 Cabbage with vinegar Raw 2 00 72 DENTAL MEDICINE. Article. Mode of Prep. Hrs. Min. Cabbage Boiled 4 30 Carrot, orange . .^ Boiled 3 13 Cartilage Boiled 4 15 Catfish • • Fried 3 30 Cheese, old and strong Raw 3 30 Chicken, full-grown Fricaseed 2 45 Codfish, cured, dry Boiled 2 00 Custard Baked 2 45 Duck, tame Roasted 4 00 Duck, wild Roasted 4 30 Eggs, fresh Raw 2 00 Eggs, fresh Whipped I 30 Eggs, fresh Roasted 2 15 Eggs, fresh Soft Boiled, 3 00 Eggs, fresh Hard boiled .... 3 30 Eggs, fresh Fried 3 30 Fowls, domestic Roasted 4 00 Fowls, domestic Boiled 4 00 Gelatine Boiled 2 30 Goose, wild . Roasted 2 30 Hashed meat and vegetables Warmed 2 30 Heart, animal Fried 4 00 Lamb, fresh Broiled 2 30 Liver, beeves', fresh Broiled 2 00 Marrow, spinal, animal Boiled 2 40 Milk Boiled 2 00 Milk Raw 2 15 Mutton, fresh Broiled 3 00 Mutton, fresh Boiled 3 00 Mutton, fresh Roasted 3 15 Oysters, fresh Raw 2 55 Oysters, fresh Roasted 3 15 Oysters, fresh Stewed 3 30 Parsnips Boiled 2 30 Pig, Sucking, Roasted 2 30 Pig's feet, soused Boiled i 00 Porksteak Broiled 3 15 Pork, fat and lean Roasted 5 15 Pork, recently salted Stewed 3 00 Pork, recently salted Broiled 3 15 Pork, recently salted Fried 4 15 Pork, recently salted Boiled 4 30 Potatoes, Irish Roasted 2 30 Potatoes, Irish Baked 2 30 Potatoes, Irish Boiled 3 30 ABBREVIATIONS FOR PRESCRIPTIONS. 73 Articlb. Mode of Prep. Hrs. Salmon, salted Boiled 4 Sausage, fresh Broiled 3 Soup, barley Boiled I Soup, bean Boiled 3 Soup, chicken Boiled 3 Soup, mutton Boiled 3 Soup, oyster Boiled 3 Soup, beef, vegetables and bread Boiled 4 Soup, marrow bones Boiled 4 Tripe, soused Boiled i Trout, Salmon, fresh Boiled I Trout, Salmon, fresh Fried i Turkey, wild Roasted 2 Turkey, domesticated Roasted 2 Turkey, domesticated Boiled 2 Turnips Boiled 3 Veal, fresh Boiled 4 Veal, fresh Fried 4 Venison steaks Broiled i MiN. 00 20 30 CO 00 30 50 00 IS 00 30 30 18 30 25 30 00 30 35 ABBREVIATIONS. In medical prescriptions, letters, parts of words, or certain symbols, are employed as abbreviations, to designate the sub- stance, quantity, etc., as follows : — ABBREVIATION. LATIN WORD. ENGLISH WORD. aa, Ana (G.), Of each. Ad Saturand., Ad saturandum, Until saturated. Ad lib., Ad libitum, At pleasure. Aq., Aqua, Water. Aq. tepid., Aqua tepida. Warm water. Aq. ferv., Aqua fervens. Hot water. Aq. dest.. Aqua destillata, Distilled water. C. or Cong., Congius, A gallon. Chart., Chartula, A small paper. Coch., Cochlear, A spoonful. Coch. mag., Cochlear magnum, A tablespoon ful. Coch. parv.. Cochlear parvum. A teaspoonful. Colent., Colentur, Let them be strained. Collyr., Collyrium, An eye-water. Comp., Compositus, Compound. Contus., Contusus, Bruised or broken. Cort., Cortex, Bark. Ext., Extractum, An extract. F. or Ft., Fiat vel fiant, Let there be made. 74 DENTAL MEDICINE. ABBREVIATION. LATIN WORD. ENGLISH WORD. Fol., Folium vel folia, A leaf or leaves. Garg., Gargarysma, A gargle. Gr., Granum vel grana. A grain or grains. Gtt., Gutta vel guttse. A drop or drops. Haust., Haustus, A draught. Infus., Infusum, An infusion. M., Misce, Mix. Mass., Massa, A mass. Mist., Mistura, A mixture. 0., Octarius, A pint. Pil., Pilula vel pilulse, A pill or pills. Pulv., Pulvis vel pulveres, A powder or powders. q. s., Quantum sufficit, A sufficient quantity. R., Recipe, Take. Rad., Radix, A root. S., Signa, Write or give directions. Spts., Spiritus, Spirits. ss., Semis, The half. Syr., Syrupus, Syrup. Tinct., Tinctura, A tincture. m., Libra, A pound. g, Uncia, An ounce. 5. Drachma, A drachm. .9. Scrupulus, A scruple. fg, Fluiduncia, A fluid ounce. f5. Fluidrachma, A fluid drachm. m. Minim, A drop. Although the symbol (ITL) is adopted in the United States Pharmacopoeia to designate a drop, it should be remembered that the size of a drop varies according to the greater or less fluidity and gravity of the liquid, and the shape of the mouth of the bottle from which it is dropped. It is best to use a small vial with a thin edge of mouth, when great precision is necessary, and to dilute the active medicine and administer it in the form of a mixture ; for in some preparations, one hun- dred and fifty drops would measure but a fluidrachm, while in others the same number of drops would be somewhat more than three fluidrachms. A tablespoonfid of any liquid is regarded as equal to half an ounce by measure; and a teaspoo7iful equal to 2. fluidrachm ; FINENESS OF POWDER. 75 and such measures are sufficiently accurate where no great precision is requisite. A gallon contains eight pints. A pirjt contains sixteen fluidounces. A fluid ounce contains eight fluidrachms. A fluidrachm contains sixty minims (TTt). A wine glass (approximate measurement) contains two fluid- ounces. A teacup (approximate measurement) contains four fluid- ounces. A tablespoon of powder (approximate measurement) con- tains two drachms. A teaspoon of powder (approximate measurement) contains one-half drachm. One drop of water (small drop, approximate measurement) contains one minim. One drop of essential oils (approximate measurement) con- tains one-half minim. A graduated measure glass is the most accurate measure, as spoons, glasses, etc., vary greatly in size. FINENESS OF POWDER. The fineness of powder is denoted either by descriptive words (as in the case of brittle and easily pulverizable sub- stances), or in terms expressing the number of meshes to a linear inch in the sieve. The following degrees of fineness will prove serviceable in the preparation of dentifrices, polish- ing powders, etc. : — ("Should pass through a I A very fifie powder . . . vievehaving8oormoreV = No. 80 Powder. ^ (meshes to linear inch. J ("Should pass through a~| A fine powder ^ sieve having 60 meshes V = No. 60 PowdCf. ( 'o the linear inch. J ("Should pass through a) - - t-> i A moderately fine powder \ sieve having 50 meshes \ = No. ^o Powder. "' ^ ( to the linear inch. ) •' f. J 1 1 ("Should pass through a") A moderately coarse powders sieve having 40 meshes \ = No. 40 Powder. (.to 'he linear inch. ) . (Should pass through a") A coarse powder .... ^ sieve having 20 meshes ^ = No. 20 Powder. (, to the linear inch. ) 76 DENTAL MEDICINE. WEIGHTS AND MEASURES. APOTHECARIES' WEIGHT. 20 grains (gr.) make I scruple sc. or ^ 3 scruples make I drachm dr. or ^^^ 8 drachms make i ounce • oz. or ^ 12 ounces make I pound lb. or lb SCALE OF COMPARISON. R) oz. dr. sc. gr. I = 12 ^ 96 = 288 = 5760 I = 8 = 24 ^ 480 I = 3 = 60 I ^ 20 TROY WEIGHT. 24 grains (gr.) make I pennyweight dwt. 20 pennyweights make I ounce oz. 12 ounces make i pound R). Z}2 grains make i carat (diamond weight) k. SCALE OF COMPARISON. R). oz. dwt. gr. I ^ 12 == 240 = 5760 I = 20 ^ 480 I ^ 24 I k. = zyi AVOIRDUPOIS WEIGHT. 16 drachms (dr.) make I ounce oz, 16 ounces make I pound lb. 25 pounds make i quarter qr. 4 quarters make I hundred weight cwt. 20 hundredweight make I ton T. ICO pounds make i central C. SCALE OF COMPARISON. T. cwt. qr. R). oz. dr. I = 20 = So = 2000 = 32000 = 512000 I = 4 = 100 =r 4000 = 25600 I = 25 = 400 =: 6400 I = 16 = 256 I = 16 THE METRIC OR FRENCH DECIMAL SYSTEM OF WEIGHTS AND MEASURES. The metric system is based upon the meter, which is the Standard unit oi length of that system, and equal to 39.370432 inches, or about 10 per cent, longer than the yard. The metric unit oi fluid measure is the liter — the cube of WEIGHTS AND MEASURES. 77 iV meter, or looo cubic-centimeters — equal to about 34 fluid ounces. The metric unit of weight is the gram, which represents the weight of one cubic-centimeter of water as its maximum density. It is equal to I5(.43234874) troy grains. One CUBIC-CENTIMETER is equal to 16,231 minims. In writing prescriptions it is sufficiently accurate and safe to consider i gram as exactly equal to i 5 troy grains, and to consider i cubic-centimeter as equal to i 5 MINIMS. We accordingly have — I gram equal ^- troy grains. I troy grain equal to -^ gram. I cubic-centimeter equal to 4" fluidrachm. I fluidrachm equal to y cubic-centimeter. Hence — 1. To CONVERT TROY GRAINS INTO GRAMS, OR MINIMS INTO CUBIC-CENTIMETERS — a. Divide by 10, and from the quotient subtract one-third; or, b. Divide by i^ ; and 2. To CONVERT apothecaries' DRACHMS INTO GRAMS, OR FLUIDRACHMS INTO CUBIC-CENTIMETERS, IHldtiply by 4. In writing prescriptions, the "gram" (abbreviated "Gm.") and "cubic-centimeter" (abbreviated "C.C," which may be called "fluigram," and written "fGm") only, should be used. The centigram, which is a very convenient unit to refer to in medicine and pharmacy, is used in books and in speaking, but not in writing prescriptions. All other terms, and units, and prefixes, used in the metric system, may be wholly ignored by the physician and the pharmacist.* ♦"^he prefixes are simply numerals, as follows : — deci, which means o.l. centi, " " 0.0 1. mitU, " " o.ooi. myria, which means 10,000. kilo, " " 1,000. Aecto, " " 100. deka, " " 10. and are quite unnecessary in the writing of prescriptions (if not in all cases), English numerals being more convenient, and at least equally explicit. 78 DENTAL MEDICINE. EXAMPLE OF A METRIC PRESCRIPTION. R. Hydrarg. chloridi. corros . o Potassi iodidi lo Aquae lOO Tinct. cinch, comp loo Mix. 25 Gm. 00 Gm. 00 C.C. 00 C.C. The use of a decimal line prevents possible errors. To write a prescription for fifteen doses of any medicine, write it first for one dose in grains and minims, and then substitute the same number of "grams" and "cube-cents," thus : — H. Opii gr. j Camphoras gJ"- y Make one pill. and to get fifteen such doses in metric terms, write — R. Opii I Gm. Camphorse 2 Gm. Make fifteen pills. The gram and the cubic-centimeter {Jlidgram), when refer- ring to liquids, may be considered as equal quantities, except the liquids be very heavy (as in the case of chloroform), or very light (as in the case of ether). Measures may be discarded and weights exclusively em- ployed, if preferred. All quantities in a prescription would then be expressed in grams.* The average "drop" (water) may be considered equal to 0.05 C.C, or 0.05 Gm. An average teaspoon holds 5 C.C. *As any liquid medicine must necessarily be administered to the patient in measured, and not in weighed, doses, it will, of course, be more convenient to the physician to continue to make use of fluid measures in writing prescriptions, especially as he is already accustomed to this, and would not then have to bear in mind the specific gravity of any liquid ingredient in the prescription. To the pharmacist it makes but little difference, as he will have both weights and meas- ures, and can use one or the other, as may be directed. If the physician discards measures, he must, of necessity, so adjust the proportion in his formula as to pro- duce a mixture of which, after all, the dose must be a "teaspoonful," or some other convenient measure, and this is as unnecessary as it is difficult. — Oscar Oldherg, Phar. D., in Blakiston's Phys. Visiting List. WEIGHTS AND MEASURES. 79 and an average tablespoon 20 C.C. Decimal numbers should be used as far as practicable without sacrifice of ac- curacy as to strength and dose of the preparation. It is safe to prescribe 30 Gin. for one troy ounce, and 250 C.C. for eight fluidounces. The above contains all that is necessary to know or LEARN of the metric system, in order to write metric pre- scriptions, without a metric posological table, or with one. To become familiar with the system, the rules given above for the conversion of apothecaries' weights and measures into the corresponding metric quantities, may be profitably used, the results to be verified by comparison with the following — TABLE OF equivalents. apothecaries weights (and measures). Troy grains {or tiiznims). 1 6¥ 1 SI 1 T^ I 2 5 10 15 20 30 Drachms (or JIuidrachms). I 2 4 6 Troy ounces {or fluidounces). I 2 4 6 8 12 16 METRIC WEIGHTS (and measures). Grams {or cubic-centivteters) 0.00 1 (toVt ) 0.002 (xTS^Ty) 0.004 (xTJffo) 0.008 (too¥/ 0.016 (.V) 0.033 (s'o) 0.066 (tV) 0-I33 (ft) 0.333 a) 0.666 (t) 1. 000 (0 ^■i>y:> (li) 2.000 (2) Grams {or cubic-centimeters.) 4 8 16 24 32 64 128 192 256 384 512 The adoption of the metric system of weights and measures 80 DENTAL MEDICINE. is a matter of time only. Its advantages over other systems are well recognized. RULES FOR REGULATING DOSES. The doses given in this work are applicable to adult age unless the contrary is specified; and for the convenience of students, the rules of Gaubins and Young for determining the proper dose of medicines for children are furnished below. Take the dose for an adult as unity, and for other ages as follows : — The dose for a person of middle age being I, or i drachm, — That for a person from 14 to 21 years will be %, or 2 scruples. « 7 to 14 " ' /^> or ^ a drachm. (( 4 to 7 " ^, or I scruple. a child of 4 " X, or 15 grains. « 3 " i/^, or 10 grains. « 2 « ' y%,ox 8 grains. (( I year ' T2' ^^ S grains. The following simple rule by Dr. Young will be found to be convenient : " For children under twelve years, the doses of most medicines must be diminished in the proportion of the age to the age increased by 1 2 ; thus, at two years to \ ; viz. : ?^ = i. At twenty-one the full dose may be given." Hence For one year, For two years, For three years. For four years. For six years. At twelve years the dose is one-half that of the adult. The U. S. Dispensatory states that " To the above rules some excep- tions are offered, in particular medicines, which require to be given to children in much larger proportional doses than those I = I 1 + 2 12 13 I 2 + 3 12 7 I 3 + 4 12 5 I 4 + 6 12 4 I 6 + 12 3 RULES FOR REGULATING DOSES. 81 above stated. Such are castor oil and calomel, a certain quantity of which will, in general, not produce a greater effect in a child two or three years old than double the quantity in an adult." " Females usually require smaller doses than males, and persons of sanguine temperament than the phlegmatic." The influence of constitutional peculiarities, such as are known as idiosyncrasies, often exist and render patients more than usually susceptible, or the opposite, to the action of medicines, the doses of which must be regulated accordingly. It should also be remembered that the susceptibility to the action of medicines is diminished by frequent and continued use. In advancing age, the dose is gradually lessened. Opiates affect children to a greater degree than adults, but children bear larger doses of calomel than adults. Females are more rapidly affected by purgatives than males, and the condition of the uterine system is very important. Medicinal substances act differently on the same person in summer and in winter, and in different climates. Narcotics act more energetically in hot than in cold climates, and, as a consequence, smaller doses are required in hot climates ; the opposite is the case with regard to calomel. Owing to a pecu- liarity of stomach, or rather disposition of body, unconnected with temperament, comparatively mild remedies operate very violently on some individuals. When administering remedies, the intervals between the doses should be so regulated that the second dose may be taken before the effect produced by the first is entirely effaced. Some medicinal substances, such as mercurial salts, arsenic, etc., are prone to accumulate in the system; and dangerous .symptoms may arise if the doses rapidly succeed one another. The action of some remedies, such as digitalis, elaterium, etc., may continue long after the discontinuance of the 3gent, and a too powerful effect occur, even by a repetition in dimin- ished doses. Some remedies, such as castor oil, aloes, etc., acquire activity by continued use, hence the dose requires to be diminished. 82 DENTAL MEDICINE. TOPICAL REMEDIES. Medicinal substances are applied to the mucous membrane of the mouth and to the dental structures almost exclusively for local effects. In dental practice antiseptic remedies are extensively employed to arrest fermentative and putrefactive processes, as every kind of fermentation depends upon the growth and increase of a living organism. Various diseases of the dental structures have a close relationship with low organisms in the morbid processes which result during their progress, and which are maintained and developed by the presence of living matter. The remedies recognized as be- longing to the group of antiseptics, when brought into con- tact with the disease germs, which are constituted of these organized forms of life, have the power of destroying their vitality and of arresting the fermentative or putrefactive pro- cess which they either develop or promote. The effect of escharotics when applied to a part of which the structure and vitality are to be destroyed, is to produce an eschar and incite inflammation and suppuration of the adjacent tissues, by which the slough is separated from the living parts. Medicinal substances are applied to the mucous membrane of the mouth in the form of gargles or mouth washes, lotions and injections, and generally for a local effect. Medicinal substances are applied to the skin for both a local and general effect, either by friction, by the endermic, or by the hypodermic methods. In the endermic method, the cuticle is usually removed by the action of a blister, and the medicinal agent is applied to the denuded surface in the form of a powder or ointment, and is a useful method when the irritability of the stomach or difficult deglutition prevents medicines from being taken through the mouth. The hypodermic method consists in injecting medicines by means of a graduated syringe with a sharp-pointed nozzle, and constructed for the purpose, into a subcutaneous cellular tissue, thus producing both a local and general effect, and an impression is made much more rapidly than when the medicine TOPICAL REMEDIES. S3 is taken into the stomach. It is necessary that the remedy- should be appHed beneath the skin, and that it should not be injected into any large vessel ; hence for hypodermic injections a locality should be selected free from nerves and large ves- sels. The medicinal agents used for hypodermic injections are now prepared in the form of tablets which are perfectly soluble, and of considerable strength in small bulk. They are dissolved in pure water at the time the injection is to be made and great accuracy is thus obtained. Anodynes thus used are more rapid in their effect, and the general rule as re- gards the quantity is, that in first injections the dose should be, for males, two thirds of the ordinary dose by the stomach and for females, about one-half It is very necessary that a vein or large vessel should not be punctured when introducing the point of the syringe. The insertion of the deltoid muscle in the arm is generally selected as the place of injection, and the needle-point of the syringe should not be inserted too deep nor at the same point in subsequent injections. Hypodermic injections may also be made in the back, front or thigh — ^just in front of trochanters, and in the calf of the leg. Medicinal substances of the classes of rubefacients and epispastics are employed as counter-irritants, their effect being to establish external or artificial irritation for the relief or cure of internal inflammation existing in a part or in the body. The extent and character of the counter-irritation thus es- tablished should be, in a great measure, regulated by the character of the disease which it is intended to relieve ; a rubefacient being indicated in irritation of mucous membrane, a seton or issue when the disease is of a suppurative character, and a vesicant in inflammation of serous membranes. Setons and Issues are employed to produce permanent counter-irritant effects. A seton consists of a skein of silk or a piece of tape or other substance passed through the in- tegument by means of a seton-needle, and allowed to remain, so that a discharge is maintained. A simple seton in the case of an incision into an alveolar abscess, is composed of a single or double strand of floss silk introduced into a wound 84 DENTAL MEDICINE. made by the lancet, or into the orijfice of a fistulous opening, after the pus of the abscess has been evacuated, to maintain a free exit for the pus which may be secreted after the first operation ; fine silver wire is also employed for the same purpose. An issue is generally some irritating substance such as caustic potassa, or a small pea, or piece of orris root introduced to maintain a discharge. Bloodletting is performed for the purposeof lessening vascu- lar excitement, reducing inflammatory action, relieving con- gestive pain and spasm, promoting absorption, relaxing the muscles and arresting hemorrhage. It is divided into general and local, general bloodletting consisting of venesection or phlebotomy, the median cephalic or basilic veins of the arm, and occasionally the external jugular and other veins, being the ones selected from which to draw the blood. But it should be resorted to with caution, as it is a powerful and exhausting agent. Local Bloodletting is chiefly employed for the relief of local inflammations and congestions, and is accomplished by means of leeches, cups, and scarifications. The leech — Jiirudo — is commonly employed as an agent for local bloodletting, and is preferable to " cupping " in many local and chronic forms of inflammation ; also in infantile affections which require such an operation, when the Ameri- can leech is used, and it makes a smaller incision than the European leech, and draws less blood. A leech is supposed to draw, on an average, about a drachm and a half to two drachms of blood before it is removed, and the quantity which subsequently flows will generally equal that drawn by the leech. Leeches are often applied to the gum over the root of a tooth affected with acute periodontitis, to relieve the inflamma- tion and congestion. To make the leech bite readily, the surface to which it is to be applied may be smeared with cream or sweet milk, or a puncture may be made in it, so as to draw blood, and, to isolate the part of the surface on which it is desired to apply the leech, a small hole may be made in a piece of bibulous paper, which will adhere to a dry surface of the THERAPEUTICS OF ELECTRICITY. 85 gum, and afford an opening for the mouth of the leech to ap- proach the surface. To remove a leech, if it does not drop off of its own accord, which they will generally do in from fifteen to twenty minutes, it may be sprinkled with a little cold water or diluted vinegar, or powdered sugar. To promote bleeding from leech bites, fomentations or warm dry cloths, or a cupping glass, may be used. To check the hemorrhage from leech bites, which is sometimes excessive, firm pressure may be made with the finger, or exposure to cold air, or the application of such styp- tics as alum or matico. Cupping is employed when it is desired to draw blood rap- idly, or to ascertain the exact quantity of blood drawn, or when it is desirable to make an impression on the system. Cupping is performed by means of cupping glasses and a scar- ificator. The glasses are applied after being partially exhausted of air, when the removal of the atmospheric pressure produces a determination of blood to the capillaries of the part, and it is afterwards easily drawn by scarification. Scarifications consist of small incisions made in inflamed and congested parts, to relieve the engorged condition of the capillary vessels, and are sometimes employed to relieve acute inflammation of the gums and mucous membrane of the mouth. ELECTRICITY AS A THERAPEUTIC MEANS IN THE TREAT- MENT OF DISEASE. Electricity is a powerful agent in many forms of nervous disease, especially in the treatment of paralysis and neuralgia. Three forms of electricity are employed, viz. : The induced current, the galvanic current, both of which are dynamical, and the static current, which is frictional. Galvanic electricity — galvanism, and induced electricity — faradism, are the two forms generally employed, frictional electricity being but seldom applied. What is known as electo- magnetism is a form of induced current, generated by the rotary in.strument, and is not reliable. Faradism, so called from its discoverer, is generated by an instrument which is 86 DENTAL MEDICINE. Capable of applying slow or rapid shocks, and giving what is denominated ^a fine, strong, induced current. It consists of coils of wire ; a small hammer of soft iron, attached to a spring ; a pole, containing a platinum-pointed screw ; the hammer breaking the current in the coil of wire, and by rapid vibration producing shocks. "The galvanic current is generated by a series of cells, suf- ficient in number to cause a current of tension, which is the resistance offered to the passage of a current. " One cell supplies a current, the poles of other cells being alternately joined, and there are finally but two terminal poles." As the current from the first cell passes through the remaining cells, its power is increased and the effect is gov- erned by the number of cells belonging to the circuit. There is also what is denominated a current of " quantity," which is generated by a large metallic surface in the battery cell, the tension current being generated by a number of small metal plates. The " tension current " serves the best purpose for medical use, while the ^' quantity current " furnishes heat, and is, therefore, adapted to purposes of electro-surgery. The modified Bunsen galvanic cell is the best for medical pur- poses, although what is known as the Siemens and Halske cell is extensively used ; " it consists of an outer cell of glass, with elements of zinc and copper, a diaphragm of porous earthenware, and a diaphragm of papier mache, between the solutions." The Holtz electric instrument furnishes the best static current. The Ruhmkorff coil is also employed, in the use of which but one wire is brought in contact with the patient, the other conductor being formed by the air, and a spark, similar to the ordinary spark from the friction machine, being produced. When electricity is applied to the body, sponges of differ- ent sizes, or polished metallic surfaces, known as "electrodes," the metallic being the best, are employed, the effect upon the skin being similar to what is caused by puncturing with many small needles. The theory of electro-therapeutics is dependent upon the following effects ; — THERAPEUTICS OF ELECTRICITY. 87 " If a portion of a motor nerve is included between the poles of a galvanic battery, it is said to be polarized, and in a , state of electrotonus. At the positive pole, the irritability of the nerve is diminished, while at the negative it is excited and more susceptible to stimulation. The condition at the posi- tive pole is called anelectrotoyius, and that at the negative cate- Iccu-otoniis. The positive pole is known as the anode ; the negative, the cathode, and these give the name to the states described. A nerve is said to be tetanized when the muscle supplied is thrown into a state of permanent tetanic contrac- tion by a rapidly intermitting current. The passage of a number of these shocks for some time will diminish the irri- tability of the nerve to such an extent that, finally there will be no further response. An ascending current causes a greater irritability in a nerve than a descending one ; a de- scending one depresses excitability. The stimulus is felt at the negative pole when the current commences, and when it is broken it is felt at the positive pole. A shock is felt at the opening of the weak currents ; with moderately strong ones it is felt both at the opening and the closure. With very strong currents, it is impossible to tell the points of sensation, as the power of the nerve is impaired." The action upon involun- tary muscles is less than upon the voluntary, and, as regards the latter, it is the same, or nearly so, as long as the integrity of their immediate nerve supply is concerned. Degenerations and atrophies of muscles interfere to a con- siderable extent with their susceptibility to electric currents ; hence, it is better, in diseased conditions, to pass the current through the nerve trunk which supplies them. The faradic current has but a local effect, the deeper muscles and nerves escaping. When a metallic or sponge electrode is applied to the moistened skin, a pricking sensation follows, attended with redness and tingling, and this impression on the cutaneous nerves and muscles is known as electro-muscular sensibility. The galvanic current occasions a sensation of warmth, like that produced by a local stimulant, such as a mustard pla.ster, DENTAL MEDICINE. and when the faradic current is appHed to the dry skin, or when the elec^trodes are but Hghtly applied, there is produced a sensation of pain, and the pain is the greater when caused by rapidly succeeding shocks than by slow ones. The galvanic current causes deeper impressions than the faradic, and also electrolytic changes different from the faradfc, producing absorption and changing the structure of the dif- ferent tissues, and beneficial results have resulted from its application in diseases of the brain. The physical effects of the galvanic current upon the sympathetic nerve are dilatation followed by contraction of the pupil, diminished frequency of the pulse, and a lowering of the tension of the carotid arteries. When electricity is used for the purpose of diagnosis, the existence of local tenderness, exalted sensibility, anaesthesia, paralysis, diseases of the brain, spinal cord, etc., may be as- certained. It has also been used to determine the question of doubtful death, whether certain affections are recent or of long standing, and to detect malingering. As various nervous dis- eases are associated with the loss of such functions of muscles as contraction and sensation, or the reverse, electricity deter- mines the extent of such changes. When applying the electric current, the anatomy of the part affected should be well understood ; for example, for neuralgia of the fifth pair of nerves one pole should be applied as near as possible to the point of exit of the nerve from the cranium, and the other pole to the remote parts of distribution. Galvanism and faradism are employed for the relief of pain and spasm, to improve the nutritive processes, and to restore deficient muscular power, to stimulate sensation in nerves, to stimulate secretion, to influence circulation, to cause absorption of fluids, to bring about the absorption of morbid growths and deposits, to induce sleep, and in surgery, in the form of the galvanic cautery. The galvanic current is con- sidered to be the most useful for the mediate, and the faradic current for the immediate application, the former proving serviceable in all forms of neuralgia, and especially in facial THERAPEUTICS OF ELECTRICITY. 89 neuralgia, and the latter in headaches, especially those of a rheumatic nature. Galvanism is also employed with advantage in sciatica, spinal irritation and hysteria, also tumors, such as aneurisms and goitre, these morbid products being dispersed by con- necting the two poles of a galvanic battery with needles, which are thrust into the morbid growth and generate a process known as electrolysis. In such operations bubbles of hydrogen gas are disengaged at the negative pole, which separate mechanically the adjacent tissues, breaking them up in such a manner that the disintegrated particles may be taken up by the circulation. Oxygen is disengaged at the positive pole, which forms an acid with certain elements of the tissue, and the albumen is coagulated, forming a clot if this occurs in a cavity filled with blood. For obtunding sensitive dentine and controlling peridental inflammation by electrolysis, Dr. F. McGraw suggests the following method : "To a 12 per cent, solution of cocaine add an equal amount of absolute alcohol. In connection with this use the galvanic current, varying the power as the needs of each case may indicate." The method of application is as follows: "After applying the rubber-dam, wet a pledget of cotton in the solution ; place it in the cavity of the tooth ; press the point of the positive pole on to the cotton, and the negative pole, with sponge attachment, to the cheek, turning on the current. An application of three minutes, with an interval of like duration, and then another three-minute ap- plication, is sufficient in the majority of cases, although it is occasionally necessary to make the third application. Then dry the cavity thoroughly and begin excavating." In case of peridental inflammation use a stronger current, which tetanizes the vessels and causes a diminished flow of blood to the parts and thus lessens congestion. The same current longer con- tinued will cause electrolytic decomposition. "The medicinal agents he uses for peridental inflammation and for blind abscesses are a saturated solution of the chloride of sodium, seven ounces, tincture of ergot, one ounce. The treatment of 90 DENTAL MEDICINE. blind abscesses requires a stronger battery power in order to obtain the full effect of the electrolysis. Dr. Weeks has used this method successfully in the painless removal of pulps. " Galvaiio- Cautery . — For surgical operations, as a substitute for the knife or ecraseur, a platinum wire is placed between the poles of a powerful battery, the wire being adjusted in a handle, which in a few minutes becomes red hot, and is espe- cially serviceable for operations in deep cavities where it would be impossible to use the knife, the application of such a galvanic cautery being unattended by pain or hemorrhage. The Galvano-Cautery consists of a platinum wire loop heated by passing a current of electricity through it, the heat being maintained as long as the current passes. Such an appliance will cut through the tissue to which it is applied without causing much hemorrhage. Electric portable lamps are also employed for illuminating the mouth and examining the teeth, and carious cavities in them. Strong currents of electricity should not be applied to the head, nor its use be persevered in for more than fifteen minutes at a time. Electro-magnetism has been employed for relieving pain during the extraction of teeth, one pole of an ordinary battery being attached to the forceps and the other to a handle which is grasped by the patient. The susceptibility to the current is first ascertained by the patient holding both the forceps and the handle in his hands, and a feeble shock applied, which is gradually increased until the sensation is felt at or just beyond the elbows, when the current is somewhat reduced in power. After the gum has been lanced, the connection is made as before described, by the patient holding the handle and the operator the forceps in contact with the tooth to be removed, the handles of the instrument being isolated, when the opera- tion is at once completed. Great diversity of opinion, however, exists as to the efficiency of this method, which has its advo- cates and opponents. INCOMPATIBILITY. 91 INCOMPATIBILITY* "IncoDipatibility gives rise to many dangers which may in a great measure be avoided by the use of the utmost simpHcity in prescribing. ' The tendency of the present age is toward mono- rather than poly-pharmacy, and prescriptions with the orthodox adjuvans and corrigcns are less frequehtly seen than formerly.' (Piffard.) " This subject can only be glanced at here. The following simple rules may help the burdened memory of the practi- tioner : — " Never use more than one remedy at a time, if one will serve the purpose. " Never use strong mineral acids in combination with other agents, unless you know exactly what reaction will ensue. They decompose salts of the weaker acids and form ethers with alcohol. " Select the simplest solvent, diluent or excipient, you know of, remembering that the solvent power of alcohol and water, for their particular substances, decreases in proportion to the quantity of the other added. " Never combine Free Acids with hydrates or carbonates. "Generally do not combine two or more soluble salts. " The following more or less insoluble salts will be formed whenever the materials of which they are composed are brought together in solutions : the Hydrates, Carbonates, Phosphates, Borates, Arseniates and Tannates of most earthy and heavy metals and alkaloids, and the metallic Sulphides ; the Sulphates of Calcium, of Lead and of the subsalts of Mercury: the Chlorides, Iodides and Bromides of Bismuth, Silver, Lead and subsalts of Mercury; the Iodides of Quinine, Morphine and most alkaloids. ^'Alkalies precipitate the alkaloids and the soluble non- alkaline metallic salts, and (as also metallic Hydrates and Carbonates) neutralize free acids. "Silver Nitrate, Lead Acetate, Corrosive Sublimate, Potassium * S. O. L. Potter, M.D. 92 DENTAL MEDICINE. Iodide should nearly always be prescribed alone. The first with Creasote forms an explosive compound. Aconite should never be given in any vehicle except water. ^^ Silver Nitrate, and Lead Acetate and Subacetate, although incompatible with almost everything, may be combined with Opium : the latter forming with Opium a compound which, although insoluble, is therapeutically active as a lotion. " Corrosive Sublimate is incompatible with almost everything, and should be given in Simple Syrup; even the Compound Syrup of Sarsaparilla is said to decompose it. "Tannic Acid, 2ind substances containing it, are incompatible with albumen and gelatin. Tannic Acid, Iodine and the soluble Iodides are incompatible with the alkaloids and substances containing them, and with most soluble m.etallic salts. Vege- table Infusions are generally incompatible with metallic salts. " Glucosides, such as Santonin and Colocynthin, should not be prescribed with free acids or Emulsin. ^^ Dangerous Compounds, because poisonous, are : Potassic Iodide with Potassic Chlorate; Hydrocyanic acid or Potassium Cyanide with metallic Hydrates, Carbonates, Sub-nitrates or Sub-chlorides, as Bismuth, Carbonate or Nitrate or Calomel. ^^ Explosions would result from the combination of powerful oxidizers with readily oxidizable substances, as Potassium Chlorate or Permanganate with Tannin, Sugar, Sulphur, Sulphides, Vegetable powders, Glycerine, Alcohol, Tinctures or Ether." POSOLOGICAL TABLES. 93 TABLE OF THE DOSES OF MEDICINES. Arranged in Alphabetical Order, and Expressed in terms of both the Apothecaries' and the Decimal Metric System of Weights and Measures. Revised and Corrected according to the New Pharmacopcjeial Standard. BY OSCAR OLDBERG, PH. D. Remedies. Abstract, aconiti Abstract, aspidospermas . . Abstract, belladonna . . . Abstract, cannab. ind. . . . Abstract, conii Abstract, coto Abstract, digitalis .... Abstract, gelsemii .... Abstract, hyoscyami . . . Abstract, ignatioe Abstract, ipecac Abstract, jalaps Abstract, nuc. vom Abstract, phytolaccse . . . Abstract, pilocarpi .... Abstract, podophylli . . . Abstract, sanguin. alterat. . Abstract, sanguin. emet. . . Abstract, senegre. . . . Abstract, valerianee .... Abstract, veratr. vir. . . . Acet. lobeliae Acet. opii Acet. sanguinar Acet. scilke Acid. acet. dil Acid, arsenics Acid, benzoic Acid, carbolic Acid, citrici Acid, gallic Acid. gall, in albuminuria . Acid, hydrobrom. dil. . . . Acid, hydrochlor. dil. . . . Acid, hydrocyaii. dil. . . . Acid, lactic Acid. nitr. dil Acid, nitro-hydrochlor. dil. Acid, phosphoric dil. . . . Acid, salicyl Dose in metric weights or measures. 3 to lo centigrams 0.30 to 1.20 grams 3 to 10 centigrams 6 to 20 centigrams 6 to 20 centigrams 6 to 20 centigrams 6 to 20 centigrams 6 to 20 centigrams 12 to 40 centigrams 6 to 20 centigrams 0.20 to 2 grams . 0.40 to 2 grams . 6 to 20 centigrams 0.30 to I gram . . 0.40 to 2 grams . 25 to 60 centigrams 6 to 20 centigrams, 0.60 to 1.20 Gm. . 25 to 60 centigrams 0.60 to 1.20 Gm. . 6 to 20 centigrams I to 4 C. c. . . . 0.30 to I C. c. . . I to 2 C. c. . . . 0.60 to 2 C. c. . . 4 to 6 C. c. . . . 1 to 5 milligrams 0.30 to I Gm. . . 2 to 6 centigrams 0.60 to 2 Gm. . . 0.20 to I Gm. . . 0.60 to 4 Gm. . . I to 2.50 C. c. . . 0.60 to 2 C. c. . . o.io to 0.30 C. c. . I to 4 C. c. . . . 0.60 to 2 C. c. . . 0.30 to 1.30 C. c. . 0.30 to 2 C. c. . . 0.30 to I Gm. . . Dose in apothecaries' weights or measures. l>^ grains. 20 grains. i^ grains. grains. grains. grains. grains. grains. 6 grains. 3 grains. 30 grains. 30 grains. 3 grains. 15 grains. 30 grains. 10 grains. 3 grains. 15 grains. 10 grains. 15 grains. 3 grains. 60 minims. 16 minims. 30 minims. 30 minims. 90 minims. T2 grain. 15 grains. I grain. 30 grains. 15 grains. 60 grains. 40 minims. 30 minims. 6 minims. 60 minims. 30 minims. 20 minims. 30 minims. 15 grains. 94 DENTAL MEDICINE. DOSE TABLE CONTINUED. Remedies. Acid, sulphuric dil. . . . Acid, sulphuric arom. . . Acid, sulphuros .... Acid, tannic Aconitina (white crystals) Aconitina (Duquesnel's) . yEther Aloe Alonium Alumen Ammonii benzoas . . . Ammonii bromid. . . . Ammonii carb Ammonii chlorid. . . . Ammonii iodid Ammonii phosph. . . . Ammonii valer Ammonii valer. elixir . . Amyl nitris Amylum iodatum . . . Ant. et pot. tartr. ; diaph. Ant. et pot. tartr. ; emetic. Apomorph. hydrochlor. . Aqua ammoai£e .... Aqua amygd. amar. . . Aqua camphoras .... Aqua chlori Aqua creasoti Aqua laurocerasi .... Argenti nitras Argenti oxid Asafcetida Atropinse sulph Auri et sodii chlorid. . . Bebeerinse sulph Berberina and its salts , Bismuthi et ammon. citr. Bismuthi subcarb. . . . Bismuthi subnitr Caffeinse citras Calcii carb Calcii hypophosphis . . Calcii phosphas .... Calumba Camphora Cam ph. monobrom . . . Capsicum Cerii oxalas Chinoidinum Chloral Chloroformum Cinchona Dose in metric weights or measures. 0.36 to 2 C. C. . . 0.30 to 2 C. C. . . 2 to 4 C. C. . . . 10 to 60 centigrams 0.15 to 0.30 milligr. 0.30 to 0.50 milligr. 2 to 4 C. c. . . , 10 to 30 centigrams 6 to 20 centigrams 0.50 to I Gm. . . 0.50 to 1.30 Gm. . 0.30 to 2 Gm. . . 20 to 60 centigrams 1 to 2 Gm. . . . 0.20 to I Gm. . . 0.30 to 1.30 Gm. . o.io to 0.50 Gm. . 2 to 4 C. c. . . . 0.10 to 0.40 C. c. . 0.20 to 2 Gm. . . 4 to 10 milligrams 6 to 10 centigrams 3 to 6 milligrams 0.30 to 2 C. c 10 to 15 C. c. 15 to 60 C. c. 4 to 15 C. c. 4 to 15 C. c. 0.30 to C. c. . 1 to 2 centigrams 3 to 10 centigrams 0.30 to 1.30 Gm. . 0.50 to 2 milligrams 2 to 4 milligrams 20 to 60 centigrams 0.20 to I Gm. . . 0.10 to I Gm. . . 0.40 to 2 Gm. . . 0.40 to 2 Gm. . . 6 to 30 centigrams I to 4 Gm. . . . 0.20 to I Gm. . . I to 2 Gm. . . . 0.60 to 2 Gm. . . 20 to 60 centigrams 10 to 30 centigrams 6 to 60 centigrams 6 to 30 centigrams 0.20 to 2 Gm. 0.20 to I Gm. . . 0.05 to 0.30 C. c. I to 4 Gm. . . Dose in apothecaries' weights or measures. ?00 1_ "200 I I 6 5 1 1 32 3 3 I 6 6 I 15 3 15 10 3 2 I I 3 3 I 15 o 30 minims, o 30 minims, o 60 minims, o 10 grains, to 2^0 grain. to T-20 gi"3-in- o I fi. drachm, o 5 grains, o 3 grains. 15 grains, o 20 grains. 30 grains, o 10 grains, o 30 grams. 015 grains. 20 grains, o 8 grains, o 60 minims, o 5 minims. 30 grains. rain, o 2 grains, o tV gi^ain. o 30 minims, o 4 fl. drachms, o 2 fl. oz. o 4 fl. drachms, o 4 fl. drachms. 30 minims, o /i grain, o 2 grains, o 20 grains, to 3^^ grain, o j\ grain. 10 grains, o 15 grains, o 15 grains, o 30 grains, o 30 grains. 5 grains, o 60 grains, o 15 grains, o 30 grains, o 30 grains, o 10 grains, o 5 grains, o 10 grains, o 5 grains, o 30 grains. 15 grains, o 5 minims. ;o 60 grains. POSOLOGICAL TABLES. 95 DOSE TABLE CONTINUED. Remedies. Cinchonidina, and its salts . Cinchonina, and its salts . Cinnamomum Codeina Confeciio sennje . . . . Convallamarin Copaiba Creasotum Creta prrepar Croton chloral Cubeba Cupri sulphas Decoct, hoematoxylon . . . Digitalinum Digitalis Duboisina, and its salts . . Elaterinum; U.S. P., l88o Elaterium; U.S. P., 1870 . Ergotinum Eserina and its salts . . . Eserina muriat Eucalyptus Eupatorium Extr. aconiti rad., U.S.P., 18 Extr. aromat. fl Extr. bellad. fol. (Eng.) . . Extr. bellad. alcohol . . . Extr. bellad. fol. fl Extr. bellad. rad Extr. bellad. rad. fl. . . . Extr. berber. aquifol. fl. . . Extr. buchu fl Extr. calami fl Extr. calumbce Extr. calumbse fl Extr. cannab. Amer. fl. . , Extr. cannab. ind. . . . Extr. cannab. ind. fl. . . . Extr. cantharidis fl Extr. capsici fl Extr. cardam. comp. fl. . , Extr. carnis Extr. cascarillse fl Extr. catechu liquid , . , Extr. chimaph. fl. . , . , Extr. chiratae fl Extr. cimicifugae fl. . . . Extr. cinchona; . , . . Extr. cinchonae fl. . . . Extr. cinchonjE arom. fl. Extr. cinchona; comp. fl. Extr. colch. rad , Dose in metric weights or measures. 0.06 to 2 Gm. . . 0.06 to 2 Gm, . . 40 to 2 Gm. . . 3 to 10 centigrams 4 to 10 grams . . 1 to 2 milligrams I to 4 C. c. . . 0.05 to 0.20 C. c. I to 5 Gm. . . 5 to 60 centigrams I to 4 Gm. . . 3 to 60 centigrams 32 to 64 C. c. . . I to 2 milligrams 3 to 10 centigrams 0.50 to I milligram I to 4 milligrams 4 to 30 milligrams 10 to 50 centigrams I to 3 milligrams I to 6 milligrams 4 to 16 Gm. . . 1 to 4 Gm. . . 5 to 15 milligrams 2 to 4 C. c. . . I to 4 centigrams 1 to 3 centigrams 0.20 to 0.40 C. c. 8 to 15 milligrams o.io to 0.20 C. c. 1 to 2 C. c. . . 2 to 10 C. c. . . I to 4 C. c. . . to 60 centigrams 1 to 4 C. c. . . 0.20 to I C. c. I to 3 centigrams 0.20 to 0.40 C. c 0.06 to 0.20 C. c 0.06 to 0.20 C. c I to 3 C. c. . 1 to 4 Gm. . 3 to 10 C. c. . 0.50 to 2 C. c. 3 to 5 C. c. . 2 to 5 C. c. . 0.50 to 2 C. c 1 to 2 Gm. 2 to 4 C. c. 2 to 4 C. c. 2 to 5 C. c. 2 to 10 centigrams Dose in apothecaries' weights or measures. I to 30 grains. I to 30 grains. 6 to 30 grains. ^ to 2 grains. 60 to 120 gi-ains. ^V to sV grain- is to 16 minims. 1 to 3 minims. 15 to 75 grains. I to 10 grains. 15 to 60 grains. y^, to 10 grains. 1 to 2 fl. ounces. ^ to 2 grains. x\j to ^V grain. ~h to T6 grain. tV to yi. grain. 2 to 6 grains. 6¥ to 5L grain. A to tV grain. I to 4 drachms. 20 to 60 grains. T2 to % grain. 30 to 60 minims. yeto % grain. ye to y2 grain. 3 to 6 minims. y^io % grain. I to 3 minims. 15 to 30 minims. y to 2)^ fl. drachms. 15 to 60 minims. 3 to 10 grains. 15 to 60 minims. 3 to 15 minims. yeto y grain. 3 to 6 minims. I to 3 minims. I to 3 minims. 15 to 45 minims. 15 to 60 grains. ^ to 2)4 fl. drachms. 8 to 30 minims. ^ to iX fl. drachms. X to ly fl. drachms. 8 to 30 minims. 15 to 30 grains. 30 to 60 minims. 30 to 60 minims. y to iX fl- drachms. y lo ly grains. 96 DENTAL MEDICINE. DOSE TABLE CONTINUED. Dose in metric weights Dose in apothecaries' or measures. weights or measures. Extr. colch. rad. fl o.io to 0.30 C. c. . . 2 to 5 minims. Extr. colch. sem. fl 0. 10 to 0.60 C. c. . . lyi to 10 minims. Extr. colocynth comp. . . . 10 to 30 centigrams . . 1^2 to 5 grains. Extr. conii fol. ale; u.s.p , 70 5 to 10 centigrams . . I to 1)4 grains. Extr. con. [fr.] ale. u.s.p., 80 2 to 6 centigrams . . ^ to I grain. Extr. conii fol. fl 0.20 to I C. c. ... 3 to 15 minims. Extr. con. [fr.] fl.; U.S.P., 80 0.10 to 0.30 C. e. . . I^ to 5 minims. Extr. convallarise rad. fl. . . I to 2 C. c 15 to 30 minims. Extr. coptidis fl 2 to 4 C. c 30 to 60 minims. Extr. corn. flor. fl 2 to 4 C. c 30 to 60 minims. Extr. cubebse fl I to 2 C. c 1 5 to 30 minims. Extr. digitalis I to 3 centigrams . . yeto }4 grain. Extr. digitalis fl 0.10 to 0.40 C. c. . . I to 6 minims. Extr. ergotse lo to 50 centigrams . . 1)4 io 8 grains. Extr. ergotee fl I to 4 C. c 15 to 60 minims. Extr. erythroxyli fl 2 to 8 C. c ^ to 2 fl. drachms. Extr. eucalypti . 0.06 to I Gm. . . . I to 20 grains. Extr. eucalypti fl I to 4 C. c 15 to 60 minims. Extr. eupatorii fl 2 to 4 C. e 30 to 60 minims. Extr. gelseniii fl 0.10 to 0.50 C. e. . . I to 8 minims. Extr. gent 6 to 30 centigrams . . I to 5 grains. Extr. gent, fl 2 to 4 C. c 30 to 60 minims. Extr. geranii fl I to 2 C. c 15 to 30 minims. Extr. gossypii fl I to 3 C. c 15 to 45 minims. Extr. granati rad. cort. fl. , . 3 to 8 C. c 3^ to 2 fl. drachms. Extr. grind, rob. fl 2 to 4 C. e 30 to 60 minims. Extr. guaranas fl I to 2 C. c 15 to 30 minims. Extr. hcemotoxyli 0.50 to 2 Gm. . . . 8 to 30 grains. Extr. helleb. nigris 3 to 20 centigrams . . ^ to 3 grains. Extr. humuli fl 2 to 4 C. c 30 to 60 minims. Extr. hydrastis fl 0.50 to 2 C. c. ... 8 to 30 minims. Extr. hyoscyami (Engl.) . . 5 to 25 centigrams . . I to 4 grains. Extr. hyoscyami ale 5 to 10 centigrams . . I to 2 grains. Extr. hyoscyami fol. fl. . . . 0.20 to I C. c. ... 3 to 15 minims. Extr. hyoscyami sem. fl. . . . 0.10 to 0.50 C. c. . . 2 to 8 minims. Extr. ignatiae 2 to 8 centigrams . . >^ to IX grains. Extr. ignatiae fl 0.05 to 0.30 C. c. . . I to 6 minims. Extr. ipecac fl 0.20 to 4 C. c. . . . 3 to 60 minims. Extr. jaborandi fl 2 to 8 C. c ^ to 2 fl. drachms. Extr. jalapse; U.S.P., 1870 . 30 to 60 centigrams . . 5 to 10 grains. Extr. jalapjE ale 20 to 40 centigrams . . 3 to 6 grains. Extr. jalapse fl I to 4 C. c 15 to 60 minims. Extr. junip. fl 2 to 4 C. c 30 to 60 minims. Extr. kamali fl 2 to 4 C. c 30 to 60 minims. Extr. kino, liquid ..... I to 2 C. c 15 to 30 minims. Extr. kramerise 0.30 to I Gra .... 5 to 15 grains. Extr. kramerise fl 2 to 4 C. c 30 to 60 minims. Extr. lactucarii fl 0.50 to 2 C. c. ... 8 to 30 minims. Extr. lupulini fl 0.30 to I C. c. ... 5 to 15 minims. Extr. malti 5 to 10 Gm I to 2)4 drachms. Extr. marrubii fl 4 to 8 C. c I to 2 fl. drachms. Extr. matico fl 2 to 4 C. c 30 to 60 minims. POSOLOGICAL TABLES. 97 DOSE TABLE CONTINUED. Remedies. Extr. nuc. vom. alcohol . . Extr. opii Extr. papaveris Extr. papaveris fl Extr. pareirje fl Extr. physostigmae . . . . Extr. piper nigr. fl Extr. podophylii Extr. prun. virg. fl Extr. pulsatillae fl Extr. quassise Extr. quassije fl Extr. quercus fl Extr. rhei Extr. rhei fl Extr. ricini fol. fl Extr. rubi fl Extr. rutae fl Extr. sabbatiae fl Extr. sabinae fl Extr. sarsap. fl Extr. sassafras fl Extr. scoparii fl Extr. Scutellariae fl Extr. senegae fl Extr. sennae fl Extr. serpent, fl Extr. spigeliae fl Extr. spigeliae et sennae fl. . Extr. stillingiae fl Extr. stillingiae comp. fl. . Extr. stramonii (Engl.) . . Extr. stramonii fol. ale. . . Extr. stramonii sem. . . . Extr. sumbul fl Extr. taraxaci Extr. taraxaci fl Extr. ustilag. maid. fl. . , Extr. uvae ursi fl Extr. valer Extr. valer. fl Extr. veratr. vir. fl Extr. viburni opuli fl. . . . Extr. viburni [prunifol.] fl. Extr. zingiberis fl Fel bovis purif. Ferri arsen Ferri carb. sacch Ferri chloric! Ferri citr Ferri et ammon. citr. . . . Ferri et ammon. sulph. . , 7 Dose in metric weights or measures. I to 3 centigrams , I to 3 centigrams , 3 to 12 centigrams . 1 to 3 C. c 2 to 4 C. c. . . . 4 to lo milligrams . 1 to 3 C. c. . . . , 3 to lo centigrams , 2 to 4 C. c o.io to 0.30 C. c. . 6 to 30 centigrams , 2 to 4 C. c 2 to 4 C. c 0.30 to I Gm. . . , 1 to 3 C. c. . . , , 2 to 8 C. c. . . . , I to 4 C. c. . . . , 1 to 2 C. c. . . . , 2 to 4 C. c. , . . , 0.30 to I C. c. . . , 2 to 8 C. c. . . , . 2 to 8 C. c 2 to 4 C. c. . . . , 2 to 8 C. c. . . , 0.50 to I C. c. . . 4 to 15 C. c. . . 2 to 4 C. c. . . 1 to 4 C. c. . . 2 to 8 C. c. . , 2 to 8 C. c. , . 2 to 8 C. c. . , 3 to 6 centigrams 2 to 4 centigrams , I to 3 centigrams 1 to 4 C. c. . . 0.30 to 1 Gm, . . 2 to 8 C. c. . . , 1 to 4 C. c. . . . 2 to 4 C. c. . . . 0.30 to I Gm. . . 2 to 4 C. c. . . . 0.6 to 0.30 C. c. . 4 to 8 C. c. . . . 4 to 8 C. c. . . . 0.50 to 2 C. c. . . 20 to 40 centigrams 6 to 12 milligrams 0.25 to I Gm. . . 5 to 20 centigrams 30 to 60 centigrams 30 to 60 centigrams 30 to 60 centigrams Dose in apothecaries' weights or measures. 'A yi grain. A grain. 2 grains. 45 minims. 60 minims. Ve grain. 45 minims. l}4 grains, i 60 minims. 5 minims. 5 grains. 60 minims. 60 minims. 15 grains. ' 45 minims, 2 fl. drachms. 60 minims. 30 minims. 60 minims. I 15 minims. ' 2 fl. drachms, 2 fl. drachms, I I fl. drachm. I 2 fl. drachms, 1 15 minims. 1 4 fl. drachms, 1 60 minims, 1 60 minims. 1 2 fl. drachms. I 2 fl. drachms. I 2 fl. drachms, I I grain. > % grain, 1 yi. grain. 1 60 minims. I 15 grains. I 2 fl. drachms. I 60 minims. > 60 minims, p 15 grains. I 60 minims. I 5 minims. I 2 fl. drachms. I 2 fl. drachms. I 30 minims. • 6 grains. ( ^ grain. I 15 grains. ( 3 grains. I 10 grains. ( 10 grains. I 10 grains. 98 DENTAL MEDICINE. DOSE TABLE CONTINUED. Dose in metric weights Dose in apothecaries' or measures. wei ghts or measures. Ferri et ammon. tartr 0.30 to I Gm Sto 15 grains. Ferri et cinchonid. citr. . . . 30 to 60 centigrams . . 5 to 10 grains. Ferri et pot. tartr I to 4 Gm 15 to 60 grains. Ferri et quin. citr 30 to 60 centigrams . . Sto 10 grains. Ferri et strychn. citr 5 to 30 centigrams . . I to 5 grains. Ferri ferrocyanid 20 to 30 centigrams . . 3 to 5 grains. Ferri hypophosphis 30 to 60 centigrams . . 5 to 10 grains. Ferri lactas 5 to 20 centigrams . . I to 3 grains. Ferri oxalas 5 to 20 centigrams . . I to 3 grains. Ferri oxid. hydrat 1 5 to 60 Gm Y7A0 2 ounces. Ferri phosphas ...... 5 to 30 centigrams . . I to 5 grains. Ferri pyrophosphas 5 to 30 centigrams . . I to 5 gi-ams. Ferri subcarb 0.30 to 2 Gm 5 to I to 30 grains. 3 grains. Ferri sulphas 5 to 20 centigrams . . Ferri sulplias exsiccat. , . . 3 to 10 centigrams . . ^to 1)4 grains. Ferri valer 5 to 20 centigrams , . I to 3 grams. Ferrum dialys 0.60 to 4 C. c 10 to I to 6c minims. Ferrum reduct 6 to 30 centigrams . . 5 grains. Gentiana 0.60 to 2 Gm 10 to 30 grains. tV grain. Hydrarg. chlorid. corros. . . I to 6 milligrams . . l^TtO Hydrarg. chlorid. mite. . , . I to 50 centigrams . . ■/^to 8 grains. Hydrarg. cyanid 3 to 6 milligrams . . yVto j\ grain. Hydrarg. iodid. rubr 4 to 30 milligrams . . xVto Y grain. Hydrarg. iodid. vir. . . . I to 6 centigrams . . /6to I grain. Hydrarg. subsulphas flav. . . 15 to 60 milligrams . . 5is- SiGNA. — Dilute the above solution with ease). equal parts of water, which will make R . Acidi carix)lici . . tlXxxv it equal to i part of the acid to 40 Potassii iodidi . . . gr.v parts of water ; for use in disinfecting Zinci chloridi . . . gr.xxv instruments and sponges. CARBOLIC ACID. 181 For Dry Month. H. J. Fish. R . Acidi carbolic! . . . gtt.x Glycerini ^j. M. SiGNA. — Apply on palate or mouth with a soft brush three times a day. For Inhalation in Syphilitic Ulcera- tions. B . Acidi carbolici ... 5 xxj Aqua destillatiE . . 3 iij. M. SiGNA. — Inhale the vapor. Antiseptic. A Stimulant and Antiseptic Injection. R. Acidi carbolici ... I part Glycerini 30 parts. M. Useful as an injection in chronic forms of alveolar abscess. For Odontalgia. B . Acidi carbolici, Chloroform, Liquid opii Vel morphine hydro- chloratis . . aa . . 3 ij Tincturse benzoini . . ^j. M. Apply to exposed surface of pulp, on cotton. A Stimulant and Antiseptic Lotion or Injection. Percy Boulton. R . Acidi carbolici . . . TTt^j Tincture iodi . . . tTLxlv Glycerini ^j Aquse destillatae . , ^ v. M. For inflamed mucous membrane, and an injection for chronic alveolar ab- scess ; also useful in acute abscess after the use of more powerful escharotic and antiseptic agents. For Itching of the Skin. R . Acidi carbolici . , . 3 ij Glycerini ^j Aquae rosae .... J viij. M. Slo.NA. — To be applied by means of a sponge. The following preparation is recom- mended for the relief of odontalgia, by Dr. K. W. Millican :— " Melt white wax or spermaceti, two parts, and when melted add carbolic acid crystals, one part, and chloral hy- drate crystals, two parts ; stir well till dissolved. While still liquid, immerse thin layers of carbolized absorbent cotton-wool, and allow them to dry. When required for use, a small piece may be cut off and slightly warmed, when it can be inserted into the carious cavity of the tooth, where it will solidify." For Alveolar Pyorrhoea {^Riggs' Disease.) R. Acidi carbolici . . . ttl^v Spts. vini rectif. . . 3 vj Aq. menthse pip . . -^ij 01. anisi fllj 01. cinnamon . . . Tllss. M. SiGNA. — Apply to gum with camel's- hair brush. An Antiseptic and Disinfectant Dentifrice. J. Stocken. R. Acidi carbolici . . . IflX'^'^x Pulvis ossis sepise . . jij Pulvis radicis iridis . ^ij Creta preparatse , . . ^ iij Olei caryophylli . . . gtt. iij. M. R. For a Carbolized Styptic. Acidi carbolici . . . x parts Collodii c parts Acidi tannici . . . . v parts Acidi benzoic! . . . v parts. M. It coagulates blood and albumen, and cicatrizes the tissues. For Chilblains. R. Acidi carbolici . • • ?,) Tincture iodi 3 ij 182 DENTAL MEDICINE. Acidi tannici .... .^ij Cereat simplicis . . . giv. M. Fiat unguentum. For Odontalgia. R . Collodii (flexile) . . . .^j Acidi carbolici . . . 3y- M. SiGNA. — Apply to surface of exposed and painful pulp. Dressing for Root-Canals and Abscesses. Dr. G. V. Black. R . Acidi carbolici . . . i part Oleum cassise .... 2 parts Oleum gaultheriae . . 3 parts M, Dressing for Children's Teeth. Dr. L. L. Davis. R. Acidi carbolici (cryst.)^j For Odontalgia. r\^ •„ ^• * Oleum cassiae . . . . 3J R. Acidi carbolici . . . ^ij Glycerini ^j Morphinse acetatis . . gr. xx. Alcoholis ..... ^^^ij. M. Solve. — ^Applied to surface of exposed It quickly relieves pain, and does not pulp, on cotton. nauseate. ACIDUM CHROMICUM— CHROMIC ACID. Formula. — CrOg. Derivation. — Chromic Acid is obtained in the form of bril- Hant, deep red, acicular crystals, by the reaction of strong sul- phuric acid upon a solution of bichromate of potash. It is deliquescent, and very soluble in water and alcohol, forming an orange-yellow solution. Medical Properties and Action. — It is a powerful caustic, de- composing the tissues by rapid oxidation ; and although it is very slow and gradual in its action, yet it is deeply penetrat- ing and when action ceases, sesquioxide of chromium remains. So destructive is its effect, that small animals are dissolved entirely, bones and all, by it, in fifteen or twenty minutes. On account of its penetrating deeply, without much pain, care is necessary in its use ; and when used as a caustic, the surrounding tissues should be well protected. The part on which it acts first becomes yellow, then brown, and ultimately black, and the eschar is detached in from twenty- four to forty-eight hours. It is a powerful oxidizer, and gives up its oxygen readily to organic matter, which it thus dis- solves. When in solution, more or less diluted, its action can be modified, according to the effect desired. Therapeutic Uses. — Chromic acid is not given internally. In the form of paste, or solution with water, it is a valuable ACIDUM CRESYLICUM. 183 caustic in cancerous and other ulcerations, malignant growths, hemorrhoids, warts, etc. Chromic acid has been employed with good effect in syphilitic sores, cases of secondary syphilis, deep and jagged ulcers of the tongue, and ulceration of inside of the cheek, mucous tubercles and condylomata. It has also been employed in the treatment of granular ophthalmia, uterine hemorrhage, uterine catarrh, etc. It causes less pain than nitric acid and other caustics, and should never be applied to a surface to be cauterized in a layer deeper than a line in thickness. For removal of warts, etc., it is employed in a solution of lOO grains to the ounce of distilled water. Dental Uses. — In dental practice chromic acid has been employed for obtunding sensitive dentine; but its most val- uable application is for the removal of tumors and morbid growths upon the gums, fungous growths of tooth pulp, etc. When applied to any part of the mouth, the surrounding parts should be carefully protected by folds of lint or strips of adhesive plaster. A glass rod, or a gold or platinum wire should be used for its application. It is also useful in ulcera- tion and recession of the gums, beginning the treatment with a weak solution, and gradually increasing the strength. It is sometimes combined with glycerine, in which case the latter must be added to the acid drop by drop, in order to avoid explosion. DENTAL FORMULA. For Secondary Syphilitic Ulcers, and Ulceration of Mucous Afem- brane of Aiouth and Tongue. R. Acidi chromici gr- x Aqure SJ. Misce solut. SiG. — Paint the diseased parts three or four times a day, with a camel's-hair brush dipped in the solution. CRESYLIC ACID— ACIDUM CRESYLICUM. Cresylic Acid is an antiseptic and germicide upon the different kinds of pathogenic organisms. It is a colorless liquid having the odor of creasote. It boils at 203° and is slightly caustic. It is soluble in water, quite soluble in alcohol, glycerine, and 184 DENTAL MEDICINE. water of ammonia and very soluble in ether. When injected into rabbit? it produced toxic symptoms, but to cause death a dose four times greater than that of carbolic acid was required. It has a marked effect in retarding the fermentation of urine and milk. Experiments on cultures of the various pathogenic micro-organisms demonstrated that cresylic acid is a power- ful antiseptic and germicide, and quicker in its action than car- bolic acid or its congeners. ACIDUM GALLICUM— GALLIC ACID. Formula. — C^ HgOj. Derivation. — Gallic Acid is obtained from galls by exposing the powder, in water, to the action of the air, at a tempera- ture of between 60° and 70° F., when the acid is deposited in the form of small, silky, almost colorless crystals, possessing a slightly acid and astringent taste. Gallic acid is slightly soluble in cold water, and freely soluble in hot water, gly- cerine or alcohol. Galls, from which gallic acid is prepared, are the excres- cences caused by the punctures and deposited ova of a hy- menopterous insect on the twigs of the gall oak {Quercus Infectorid). Source. — Galls are obtained from Asia Minor and Persia. Medical Properties and Action of Galls. — Powerfully astrin- gent, this property depending upon the presence of tannic and gallic acids, as they contain 35 per cent, of tannic and 5 per cent, of gallic acids. The powder, which is obtained from the small, round, dark-blue or lead-colored excrescences^ is of a light yellowish-gray color, inodorous and of a bitter taste. Galls are used in various forms, such as powder, tincture, infusion, ointment, etc. Therapeutic Uses. — Galls are employed in the treatment of chronic diarrhoea, dysentery, leucorrhoea, chronic gonorrhoea and gleet, diseases of the uterus and intermittent fevers, and externally in hemorrhagic disorders, hemorrhoids, relaxation of uvula, hypertrophy of the tonsils, etc. Gallic acid is given directly for internal hemorrhage. GALLIC ACID. 185 Dose. — Of powdered galls, gr. x to gr. xx. The ointment is composed of: powdered galls, gr. Ixxx; benzoated lard, 5j. It is combined with opium in the proportion of ointment of galls, 5j ; powdered opium, gr. xxxij. Medical Properties and ActioTi. — Gallic acid is a powerful astringent for arresting hemorrhage in which the bleeding vessels must be reached through the circulation. It is also a valuable styptic in cases of hemorrhage depending on a hemorrhagic diathesis, and in the form of a gargle it is very serviceable in acute inflammations of mucous membranes. It is also a strongly deodorizing agent; and, like tannic acid, it is capable of taking oxygen from the globules. Internally employed it produces constipation, which may be prevented by an occasional aperient. Although it is weaker than tannic acid, yet its properties are very similar. It is supposed to be converted into tannic acid in the blood. Therapeutic Uses. — Gallic acid is employed in the treatment of hemorrhagic diseases, in their chronic stages especially, such as haemoptysis, hemorrhage from ulcer of the stomach, haematemesis and haematuria, atonic menorrhagia ; also, for the profuse perspirations and excessive expectoration of phthisis, for albuminuria, dyspepsia, chronic diarrhoea and gastric irri- tation in children, gonorrhoea, gleet, etc. Dose. — Of gallic acid, gr. ij to gr. v, in pill, every two or three hours. Glycerite of gallic acid {Glyceritiim Acidi Gallici), for ex- ternal use, is composed of gallic acid, 5j ; glycerine, .5iv. Ointment of galls ( Ungiientiwi Gallce) is composed of galls in fine powder, 5j ; lard, 420 grains. Dental Uses. — Powdered galls is useful as a styptic in super- ficial hemorrhages from the gums and mucous membrane; also in inflamed and ulcerated conditions of mucous membrane, and in relaxation of the uvula. Gallic acid, in the form of a gargle, is employed in acute inflammations of mucous mem- brane, as astringent and antiseptic, and in hemorrhages from mucous surfaces depending upon a hemorrhagic diathesis. For hemorrhage following the extraction of teeth, Dr. Bar- 186 DENTAL MEDICINE. tholomew claims that one teaspoonful of gallic acid in a glass of water, iaternally administered, never fails. DENTAL FORMULA. For Acute Tonsillitis and Inflamma- An Internal Astringent in Hemor- tion of the Mucous Membrane of rhagic Affections. the Mouth. R. Acidi gallici . . . ^j R . Acidi gallici .... gr.xl Glycerini .... ,^ iv Liq. sodse chlorinatse ^ij Aquae destillatae • §vj. M. Glycerini ^^ij SiGNA. — Take ^j as a dose. Aquae destillatse . . §viij M. SiGNA. — To be used as an antiseptic and astringent gargle. An Internal Astringent for Dental Hemorrhage. For Relaxation of Uvula and Hypertro- Otto ARNOLD. phy of Tonsils. R , Acidi gallici . . • ^ j R. Infusi gallse ^vj Aquse cinnamon . . ^ij. M. Aluminis gr.xl. M. SiGNA. — A teaspoonful every hour un- SlGNA. — Use as a gargle. til bleeding is arrested. For an Astringent Gargle or Lotion. R . Pulveris gallse ^ ss Aquse Oj. M. SiGNA. — As a gargle or lotion in inflamed or ulcerated condition of mucous membrane and gums. ACIDUM HYDROBROMICUM— HYDROBROMIC ACID. Formula. — H Br. Derivation. — Diluted Hydrobromic Acid is prepared by add- ing ten per cent, of absolute hydrobromic acid to ninety per cent, of water. It is a clear, colorless liquid, having no odor, but a decidedly acid taste and an acid reaction. Medical Properties and Therapeutic Uses. — Hydrobromic acid is often substituted for the bromides on account of its pos- sessing many of their properties. It is employed in cerebral disorders from over-exertion, epilepsy, spasmodic cough, an- gina pectoris, affections of the heart, as it diminishes its action, to relieve the symptoms of quinine, and also of morphine, mi- graine or sick headache, neuralgia, spasmodic asthma, etc. Dose. — TTlxx to 5ij. Dental Uses. — Diluted Hydrobromic Acid may be employed in facial neuralgia, infantile convulsions due to teething, and HYDROCHLORIC ACID. 187 to lessen the irritability of the fauces when impressions for obturators and artificial palates are being taken. ACIDUM HYDROCHLORICUM— HYDROCHLORIC ACID. MURIATIC ACID=ACIDUM MURIATICUM. Formula. — HCl. Sp. gr. 1.16. Derivation. — Hydrochloric or Muriatic Acid is obtained by the action of sulphuric acid on a solution of chloride of sodium or common salt. When pure, it is a transparent, colorless liquid, but when contaminated with chlorine, iron and other substances, it has a yellow color. It emits a dense, white vapor, with a pungent odor and a corrosive taste, being an ac- tive poison. The antidote is magnesia or soap. Medical Propej'ties and Action. — The strong acid is a power- ful caustic and escharotic; also disinfectant and fumigant, but inferior in its disinfectant properties to those of chlorine. For internal use the dilute acid, which is tonic, refrigerant and as- tringent, is employed, acidum hydrochloricum dilutum — diluted hydrochloric acid, which is prepared by diluting the strong acid so that four ounces of the acid are contained in a pint of diluted acid. It is of a deep yellow color, and emits the odor of chlorine, which is its principal constituent. Therapeutic Uses. — The dilute hydrochloric acid is internally employed in the treatment of calculous affections, gout, atonic dyspepsia, typhus and typhoid fevers, continued fevers of child- hood, syphilis, chronic whooping cough, phthisis, etc., and externally in diphtheria, ulcerated sore throat, cynanche ma- ligna, etc. Dose.—0( dilute hydrochloric acid, TTLx to ITLxxx, freely diluted ; otherwise, when swallowed, it is highly irritant and corrosive. Dental Uses. — The strong acid is employed in the dental laboratory for dissolving zinc, in the preparation of flux for soldering certain metals. The strong acid is also employed as a local application in gangrenous stomatitis or cancrum oris, forarresting the ulcera- tive process ; but care is necessary in its use, on account of its 188 DENTAL MEDICINE. powerful action, in order to limit its application to the parts on which il; is to act. In mild cases it should be diluted with an equal weight of honey. In aphthous ulcerations of the mouth, in children, it is often a useful application. DENTAL FORMULAE. For ApkthcB. For Ulceration of Mucous Membrane. R . Acidi hydrochlorici l part R . Acidi hydrochlorici Mellis 8 parts. M. diluti ^'i] SiGNA. — Apply with a camel-hair pen- Glycerini _^iv cil Aquae destillatse . . ^x. M. SiGNA. — To be used as a gargle. For Chronic Inflammation of Mucous For Scorbutic Gums. Membrane and Gums. R . Acidi hydrochlorici R . Acidi hydrochlorici dilut ...... 3 ss dilut TTlx Mellis, Infusi cinchonse . . f.^iv Aquae rosas . aa . . f^j. M. Mellis f gj. M. SiGNA. — Apply with a camel-hair pen- Fiat gargarysma. cil three or four times a day. ACIDUM NITRICUM— NITRIC ACID. AQUA FORTIS. Formula. — HNO3. Sp. gr. 1.420. Derivation. — Nitric acid is obtained by the action of sul- phuric acid upon nitrate of potash or soda. When strong and pure it is colorless, but on account of the presence of nitric peroxide it is generally of a yellow color, and emits acrid, corrosive fumes. Medical Properties and Action. — Pure nitric acid is a power- ful caustic and escharotic. and leaves a permanent stain on the cuticle. It is not employed in its concentrated form internally, but externally, as an escharotic to destroy warts and stimulate sluggish sinuses; in a diluted form it is employed as an as- tringent wash or gargle. The antidotes in cases of poisoning are magnesia or soap, and mucilaginous drinks. Therapeutic Uses. — The strong acid is employed externally in hospital gangrene, and phagedenic ulcerations ; hemor- rhoids and painful hemorrhoidal tumors, syphilitic condylo- mata, syphilitic sore throat, malignant ulcers, obstinate skin diseases, etc. NITRIC ACID. 189 Diluted Nitric Acid. — Acidum Nitricum Di/uttim contains three ounces of acid in a pint of the diluted acid. JMcdical Properties and Action. — It is an antalkaline, al- terative, tonic and refrigerant, and has a very direct action on the liver, and if its use is continued for a long time it causes saliv^ation. Like all mineral acids, it injures the teeth ; hence, proper care should be taken to prevent such action, such as the use of alkaline gargles before and after taking the acid into the mouth, which should be done through a glass tube or quill. As a tonic it is advantageously employed during con- valescence and inflammation, and in cachexia following acute disease or habits of intemperance. It is also employed as an alterative after a long use of mercury, as it increases the strength and improves the tone of the system. It is also val- uable as a disinfectant, but inferior to chlorine. It is not as agreeable to the stomach as diluted sulphuric acid. Therapeutic Uses. — Dilute nitric acid is employed in the treatment of calculous disease, syphilis, chronic hepatitis, chronic diarrhoea, constipation, chronic affections of the spleen, chronic rheumatism, cardialgia, whooping cough, intermittent fevers, etc. Dose. — Of diluted nitric acid, gtt. ij-xv, three times a day, diluted with water. Dental Uses. — The strong acid, when mixed with two parts of hydrochloric acid, is a solvent for gold, and is known as aqua regia. It is also employed as one of the most effectual caustics in cancrum oris, the constitution being supported and quinine given at the same time ; also for malignant ulcers of the mouth, and for devitalizing pulps of teeth when nearly ex- posed by mechanical abrasion, care being observed that the part of the surface immediately over the pulp is touched with the acid, and the neighboring parts protected. DENTAL FORMULA. For Sloughing and 11 1- Conditioned Ulcers. R. Acidi nitrici lUllx- Aquae Oj. M. SiGNA. — Apply with a camel-hair brush. 190 DENTAL MEDICINE. ACIDUM PHOSPHORICUM— PHOSPHORIC ACID. AciDUM Phosphoricum Dilutum — Diluted Phosphoric Acid, is the principal form in which phosphoric acid is employed in medicine. Formula. — H3PO4. Sp. gr. 1.056. Derivation. — Phosphorus, a non-metallic element, obtained from bones, is a translucent, nearly colorless, wax-like solid, without taste, and emitting white vapors when exposed to the air. Sp. gr, 1.8. It is insoluble in water, but soluble in ether and in hot oil of turpentine, and has a peculiar smell. It is nervine, tonic and stimulant and in over-doses, poisonous. The vapor is irritat- ing to the conjunctiva and bronchial mucous membrane. Derivation. — Diluted Phosphoric Acid is prepared by boiling phosphorus with nitric acid and distilled water until it is dis- solved, evaporating and re-diluting it. It may also be obtained by dissolving an ounce of glacial phosphoric acid in three ounces of distilled water, afterwards adding forty grains of nitric acid, boiling to a syrup, and diluting with water until the solution measures twelve and a half ounces. Medical Properties and Action. — It is tonic and refrigerant, and, in large doses, is a powerful stimulant to the nervous and vascular systems. It can be detected in the blood, owing to its absorption, and, in large doses, is an irritant poison. Therapeutic Uses. — Diluted phosphoric acid is employed in scrofula, dropsy, haemoptysis, calculous disease, diabetes and cardialgia. Externally it has been employed as a local appli- cation in the treatment of caries of the bones and osseous tumors. Dose. — Of dilute phosphoric acid, gtt. ij-xv, diluted in sugar and water. Dental Uses. — As a local application in the treatment of caries of the maxillary bones and osseous tumors of the jaws. Internally, it has been administered with a view of supplying a deficiency of phosphoric acid in the teeth. ( See Hypophos- phites of Lime.) PHOSPHORIC ACID. 191 DENTAL FORMULAE. For Caries of the Maxillary Bones and For Ulcers over Carious Bones. Osseous Tumors of the Jaw. g , Acidi phosphorici gla- R. Acidi phosphor, dilut. . I part cialis ^:^j Aquae destillatae . 8 to lo parts. M. Aquae destillatse . . f5viij. SlGN.\. — Apply as a lotion or injection. Fiat solutio. SiGNA. — To be applied on compresses to ulcers situated over carious bones. Phosphoric Acid in the anhydrous state consists of one equivalent of phosphorus to five equivalents of oxygen (PO5), and it is obtained by the direct union of its constituents, which takes place when phosphorus is burned in perfectly dry oxy- gen gas. Thus procured it is in the form of a white amorphous powder, extremely deliquescent, volatilizable at a red heat, and assumes, when it cools, after fusion, a vitreous appearance. Glacial Phosphoric Acid, or monohydrated phosphoric acid, is readily obtained from calcined bones, by first heating them with sulphuric acid, which produces an insoluble superphos- phate of lime ; then dissolving out the latter salt, and saturating it with carbonate of ammonia, which generates phosphate of ammonia in solution, and finally obtaining the phosphate of ammonia by evaporating it 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, the formula of which is HO,P05, and contains 1 1.2 per cent, of water. It is a white, transparent fusible solid, generally in the form of sticks, inodor- ous and sour to the ta.ste. It slowly deliquesces, and is spar- ingly soluble in water, but freely soluble in alcohol. Dental Uses. — Glacial phosphoric acid and white oxide of zinc formed into an anhydrate, give the plastic material for filling teeth, known as oxy-phosphate of zinc. The powder or solid portion of this preparation is prepared by packing pure oxide of zinc in a clay crucible and subjecting it to almost a white heat for two hours, when it will have been reduced in bulk fifty per cent. It is then pulverized in a mortar to an almost impalpable powder. The burning of the oxide of zinc 192 DENTAL MEDICINE. colors it to a light yellow, and it is now in a condition for use, and may be kept in a covered vessel for any length of time. The liquid portion of this filling material being glacial phos- phoric acid, is prepared by dissolving the acid in pure water until a saturated solution is obtained, when it is reduced by boiling in a glass vessel until it is of the consistency of glycerine, in which operation it loses one-third in bulk. It is now ready for use, and must be kept in a close glass-stoppered bottle. Formula for Fletcher's and Weston's preparations of oxy- phosphate of zinc filling materials : — Fletcher's. Fluid. Solid. Phosphoric acid. Basic oxide of zinc. Phosphate of alumina. weston's. Fluid. Solid. Phosphoric acid. Basic oxide of zinc — 80 per cent. {^See Oxide of Zinc ^ SiUcate of alumina — 20 " " Medicated Oxy phosphate Fillings. — Dr. Chas. B. Atkinson claims the following advantages for such filling material : First. — A remedial agent in constant contact with the walls of the cavity. Second. — Germicidal action of the filling on the tissue with which it comes in contact. Third. — A neutral influence resisting solution. Fourth. — Increased hardness, varying somewhat with the agent used. The medicaments for oxyphosphate fillings are ; I. Creasote and oil of cloves, equal parts; 2. Eugenol ; 3. Deliquesced Carbolic acid; 4. Oil of cinnamon; 5. Oil of cloves ; 6. Creasote, pure; 7. Creasote, oil of cloves and iodo- form; 8. Creolin; 9. Campho-phenique ; 10. Potassium chlo- rate (powdered) ; II. Salicylic acid; 12. Camphor (pulverized); 13. Stick sulphur (pulverized) ; 14. Iodoform; 15. Oilofwin- tergreen. The first seven have been fairly tested by Dr. At- kinson and were found to be equal in durability, manipulative qualities and time of setting. He employs them also in re- taining inlays, in setting retaining-fixtures in pyorrhoea cases, in setting crowns, etc. In capping pulps he always employs SALICYLIC ACID. 193 a mixture of oxide of zinc, creasote and oil of cloves, and adds a remedial agent to the oxy-phosphate filling. He employs mostly the first-named on the list. If the medicament is a liquid he adds about an equal quantity of the medicament and phosphoric acid; if a powder, about equal parts of the medica- ment and oxide. The proportions may be varied as required. The average time of setting is about ten minutes. ACIDUM SALT CYLICUM— SALICYLIC ACID. Fortmila. — HC7H5O3 or QH^j^^g^jj}. Derivation. — Salicylic Acid is obtained by combining car- bolic acid with caustic soda, and subjecting this compound to dry carbonic acid under the influence of heat, the portion of salicylate of sodium remaining behind after the carbolic acid distills over being saturated, m the form of a hot, aqueous solution, with muriatic acid, which liberates the salicylic acid in small crystals. The crystals are washed, dissolved in hot water, and by re-crystalization, obtained in the form of a powder of a light brown color, which is then bleached until it is quite white ; but most of that sold is of a light cream- color, with a reddish tinge. The coloring matter, however, which is present, does not interfere with its efficacy. It has no smell, a slight taste and is soluble in alcohol and ether and in hot water and glycerine. It can also be obtained from salicin, the vegetable principle existing in willow, poplar, etc., and from oil of gaultheria (winter green) and from spiraea ulmariae (meadow sweet). Medical Properties and Action. — Salicylic acid is a powerful antiseptic, and is said to be as effective in small quantities as any other antiseptic, in arresting the putrefactive and fermen- tative process. When properly reduced in strength, it causes no pain or irritation in the parts to which it is applied. It will destroy minute organisms, and a small quantity will arrest vinous fermentation and prevent the decomposition of animal fluids. Although free from any poisonous action when ad- ministered in a reasonable quantity, yet in large doses it will cause nausea and vomiting. It is thought to combine with 13 194 DENTAL MEDICINE. the soda of the blood, where it is present as a salicylate. It has little or no affinity for cold water, but the addition of cer- tain alkaline salts, such as sodium phosphate, increases its solubility. Combined with sulphite of sodium, which is also antiseptic, and water, a solution is formed which is free from irritating properties, and especially applicable to the treatment of zymotic diseases. Glycerine warmed will dissolve -^ its weight of salicylic acid, and the solution may then be diluted with water to any desirable extent. Therapeutic Uses. — It is employed in fevers as an antipyretic or febrifuge ; also for the same purpose in acute rheumatism, pneumonia, phthisis, diphtheria, etc. Externally it is employed as a disinfectant and deodorizer, many preferring it, on account of its freedom from odor, to carbolic acid. It is also em- ployed as a local application in eczema of the head and face, syphilitic ulcers, and to cancer, gangrenous and sloughing wounds, in the form of powder, and as an ointment for burns. Salipyrme. — Prof. Dr. von Hosengeil (Bonn, Germany) claims that the action of antipyrine in such cases of influenza which show no rise of temperature is that of a cardiac poison. Salicyl and quinine have also such action. By combining sali- cylic acid and antipyrine he claims to have found a prepara- tion which he names salipyrine, which has proven itself to be a most excellent specific anti-influenzic remedy in just such cases. The dose he employs is from 15 to 30 grains. Dose. — Of salicylic acid, gr. x to gr. xx or xxx. Dental Uses. — Salicylic acid is employed in the treatment of suppurating and gangrenous pulps of teeth, in the form of the dry powder introduced into the pulp canals and permitted to remain for several days. An ethereal solution of salicylic acid, introduced on a small piece of punk, has also been em- ployed for the same purpose, where it is difficult to introduce the dry powder ; the ether volatilizes in a few minutes. Sali- cylic acid is also employed with advantage in inflamed condi- tions of the mucous membrane of the mouth and gums, and in the treatment of aphthae, thrush and other ulcers, in the form of a solution. For such purposes its combination with SULPHURIC ACID. 195 powdered cassia or cinnamon, equal parts, is recommended, to be applied with a soft brush. Salicylic acid has also been found efficacious in all inflammatory conditions resulting from decayed and dead teeth and roots. It has also been rec- ommended as a dentifrice, in the form of an alcoholic solution of the acid perfumed with oil of gaultheria, but its use for such a purpose is questioned, on account of its softening effect upon the tooth structure. As tannic acid interferes with the action of salicylic acid, these agents should not be used in combination. DENTAL FORMULA. A Disinfectant Mouth Wash. SiGNA. — Add one or two drachms to B . Acidi salicylici . . . i part half a pint of warm water. Sodii phosphate ... 3 parts Aquae destillatse ... 30 parts. M. SiGNA. — Use as a gargle. A Disinfectant and Stimulant Mouth Wash. B . Acidi salicylici . . 5 ij Spiriti vini rectificati ^x. M. SiGNA. — Use as a gargle. For Perspiration of Hands and Feet. R . Acidi salicylici . . 3 parts Magnesii silicat . . 87 parts. M. SiGNA. — Use in the form of a powder. An Emollient and Antiseptic Gargle. For Alveolar Pyorrhoea. R. Acidi salicyli • • ^ij R- Acidi salicylici . . . ^j Sodii boratis . . . ^iij Eucalyptol . . . . ^^vi. M. Glycerini . . . . ^ iiss Signa. — Apply to pockets by means of Aquae destillatae . . ^ iij M. cotton or a broach. ACIDUM SULPHURICUM— SULPHURIC ACID. OIL OF VITRIOL. Formula, H2SO4. Sp. gr. 1.843. Derivation. — Sulphuric Acid is obtained by burning sulphur, mixed with one-eighth of its weight of nitre, over a stratum of water contained in a chamber lined with lead. It is a dense, colorless liquid, inodorous, with an acrid taste, oily consistence and very corrosive. On the addition of water, with which it unites in all proportions, there is an evolution of heat. In the For Warts. UNNA. R . Acidi salicylici . . g iij Creasoti _:^vj Cerre, or Adipis . aa . q.s. to make a firm ointment that ^ will ad- here to the skin. For Burns. R . Acidi salicylici . . ^j Olei Olivse . . . 1^ viij SiGNA. — Apply as a lotion. 196 DENTAL MEDICINE. concentrated form it is only used externally as a caustic. Being an apid, corrosive poison, it causes death from asphyxia. The antidote is magnesia or chalk, or solution of soap, and mucilaginous drinks freely administered. Medical Properties and Action. — It is a powerful escharotic, and when applied to living tissue, the parts first become white, and subsequently a brownish-black color. It is not used in- ternally, on account of its corrosive action. It is considered to be one of the most effective caustics in the bites of rabid animals. Diluted Sulphuric Acid — Acidum Sulphwricum Dilutum. Derivation. — It is prepared by diluting sulphuric acid fSvij with distilled water folxxvij, and when the mixture has cooled to 60°, add more water Slxxxiiiss. Sp. gr. 1.094. ■ Medical Properties and Action. — It is refrigerant, astringent and tonic. It is employed as a refrigerant in fevers ; as an astringent for arresting hemorrhage and passive mucous dis- charges ; and as a tonic to improve digestion. As it is very injurious to the teeth, the proper precautions should be ob- served, as in the case of all acids administered as medicines — such as alkaline gargles used before as well as after their intro- duction in the mouth, and the use of a glass tube or quill. Therapeutic Uses. — Diluted sulphuric acid is employed as an internal remedy in hemorrhage from the lungs, bowels and uterus, in calculous affections, certain skin diseases, diarrhoea, profuse perspiration of phthisis, in the advanced stages of typhus and typhoid fevers, scarlatina, lead poisoning, etc. Externally as a gargle and wash to ulcers. Dose. — Of diluted sulphuric acid, ITlv to 1TLxx, three times a day, in water. Aromatic Sulphuric Acid — Acidum Sulphuricum Aromati- cum — Elixir of Vitriol. Derivation. — Aromatic sulphuric acid is prepared by mixing sulphuric acid fSiij, with rectified spirit Oij, and adding cin- namon §ij, and ginger Si^^^. It is a reddish-brown liquid, with an aromatic odor and a pleasant taste. Medical Properties and Action. — It is tonic and astringent, SULPHURIC ACID. I97 and is the most agreeable form of sulphuric acid for internal use. Therapeiitic Uses. — Aromatic sulphuric acid is employed as a substitute for the diluted form in debility with night sweats, loss of appetite during convalescence from fevers, haemoptysis and other hemorrhages, and epidemic dysentery. Externally it is applied to carious bone, ulcers, in the treatment of pyorrhoea alveolaris, especially where there is necrosis of the alveolar walls, when it is applied on cotton packed in the pockets ; also in chronic alveolar abscesses. For such pur- poses it must be kept in the pockets, sinuses and abscesses for several hours in order to insure its full effects. It is also employed locally in cancrum oris and gangrene of the mouth, and largely diluted, it forms an efficient astringent mouth- wash in simple stomatitis, etc. Dose. — Of aromatic sulphuric acid, TTlv to Tllxxx, three times a day, in water. Dental Uses of the Different Forms of Snlphiiric Acid. — The concentrated sulphuric acid is employed as a caustic in malig- nant ulcers, cancrum oris, gangrene, etc., in the form of a paste, made by mixing it with powdered sulphate of sine. The concentrated sulphuric acid is also used in the dental labora- tory, to cleanse metal plates, preparatory to and after solder- ing, for which purpose it is generally diluted with one-third of water, its action being greater when it is in a warm state. The concentrated acid is also used in combination with nitric acid to reduce hemp paper to pyroxylin, in the preparation of the celluloid base. The aromatic sulphuric acid is similar in its action to the diluted form, and is more agreeable for use about the mouth. It is a valuable application in pyorrhoea alveolaris (Riggs' disease), and in caries and necrosis of the maxillary bones, as an injection or lotion, as it stimulates the parts to healthy action by favoring granulation. It may be applied to parts about the teeth, in cases of recession of the gums and absorp- tion of the processes, on a properly-shaped piece of orange wood. It is also valuable in alveolar abscesses as an injection, 198 DENTAL MEDICINE. especially in sluggish cases, when the addition of a few drops of tincture "of capsicum will prove serviceable. It has the power of dissolving the thin, carious portions of the bones, such as the margins of the alveolar cavities, and can be applied on cotton saturated with it and permitted to remain for several hours, when the parts should be perfectly cleansed with warm water. It is also employed as a gargle, properly diluted, in mercurial inflammation of the mouth and other forms of sto- matitis, which do not yield to the influence of milder astrin- gent washes. It is also employed in the treatment of aphthae and other ulcers of the mouth. Dr. W. H. Atkinson speaks very favorably of the action of aromatic sulphuric acid upon morbid growths and ulcerating surfaces, especially in pockets where the connective tissue has been destroyed and deep chasms exist along the line of teeth, between the cementum and alveolar walls. After drying out such pockets with bibulous paper, drops of sulphuric acid, in full strength, should be dropped into the open mouth of the pocket until it stands full, on a level with the surface of the gum and teeth. This is repeated when the contents of the pocket is absorbed, again and again ; after which the mouth is washed with a saturated solution of bicarbonate of soda in distilled water. After drying the pocket with bibulous paper, a paste of tannin and glycerine, smoothly spread upon several folds of the same paper, is laid over the surface, and the patient directed to use hydronaphthol solution as a mouth-wash, fre- quently during the day. The following day, the pocket is washed out with Chas. Marchand's peroxide of hydrogen, fif- teen volume medicinal, until it ceases to bubble ; then repeat the application of the aromatic sulphuric acid in the same manner as first described. The hydronaphthol solution should be used frequently, and also a bichloride of mercury solution, three or four times a day, until there is no longer any evidence of pus when the peroxide is injected. SULPHUROUS ACID. 199 DENTAL FORMULA. For Mercurial and Ulcerative Sto- For Aphthce and other Ulcers of matitis — (THOMAS). Mucous Membrane and Gums. R. Acidi sulphurici . , • TTt'^ R- Acidi sulphuric! . . . . f5ss Decocti hordei . . . . f5iv Mellis f^j. M. Mellis f^ss. M. Signa. — To be applied with a camel- SiGNA. — Use as a gargle. hair brush. For Alveolar Pyorrhoea. For DiarrhcBa during Dentition. Dr. a. W. Harlan. - If the stools are serous and alkaline. R. Acidi sulphurici . . . TTLxxx Dr. James W. White. Essence cinnamon. . . ^ss R. Acidi sulph. aromat. . . gtt. viij Aquse ^ss. M. Spt. vini gallici . . . . f^ij SiGNA. — Inject with a sjTinge one or Syr. acacije two minims in each pocket if Aquae menth. pip. aa. . f^ss. M. they are deep and sinuous, or Signa. — A teaspoonful every two hours carious ; repeat every 4th day. in a little water. For Carious Bone, Riggs' Disease, etc. R. Acidi sulphurici aromat f<5"i Tinctura capsici gtt.x Aquae fgii. M. SiGNA. — To be used as an injection or lotion. ACIDUM SULPHUROSUM— SULPHUROUS ACID. Formula. — HjSOg. Derivation. — Sulphurous Acid is made by dissolving sul- phurous anhydride (SOo) in water, The latter is made by burning sulphur. It is a colorless liquid, having the suffo- cating odor of burning sulphur, and a sour, astringent taste* Medical Properties and Action. — It is a deodorizer and dis- infectant, and destructive to micro-organisms, such as bacteria, fungi, etc. Owing to its affinity for oxygen it acts upon organic matter with great energy. Therapeutic Uses. — The diluted acid is locally applied to ulcers of the tonsils in diphtheria, syphilitic and tuberculous laryngitis, chilblains, parasitic skin diseases, ill-conditioned, sloughing or gangrenous wounds; also used in pyrosis, indi- gestion, etc. Also, in the form of inhalations of the sulphurous-acid gas, in cases of chronic bronchitis, etc. In the form of spray, it is used as a local application in diseases of air passages. 200 DENTAL MEDICINE. Dose. — Of sulphurous acid, TTL v to 5j. Dental Uses. — Dilute sulphurous acid is efficacious in mer- curial stomatitis, aphthae, and mucous patches, gangrene of the mouth, cancrum oris, ulcers of mucous membrane, and sloughing wounds. It is an efficient and convenient disin- fectant. For Chilblains. For Destroying Parasites in Skin Diseases. Bartholow. Startin. R . Acidi sulphurosi . . . 3 iij R . Acidi sulphurosi, dil. . . ^ ss Elycecint ^^j Sodii hyposulphitis . . . ^iij Aquse §iss. M. Aquse, q. s. ad ^xvjM. SiGNA. — ^Apply as a lotion. Signa. — Apply as a lotion. ACIDUM TANNICUM— TANNIC ACID. TANNIN. Formula. — (Z^W^^j. Derivation. — Tannic Acid is obtained by exposing powdered galls to a damp atmosphere for several days, when sufficient ether is added to form a soft paste, which is allowed to stand for twenty-four hours. It is then subjected to pressure as quickly as possible, and the mass again treated with ether, to which y^g- of its bulk of water has been added ; this is allowed to stand as before, and is again subjected to pressure. The expressed liquids are now combined and allowed to evaporate spontaneously ; then, by the aid of a little heat, brought to a syrupy consistence, when it is dried . on plates in a hot air chamber, at a temperature not exceeding 212° F. Pure tannic acid is solid, uncrystallizable, either white or slightly yellow- ish, inodorous, astringent to the taste, but without bitterness, and with an acid reaction. It is obtained in the form of vesic- ular masses, or thin, glistening scales, or in the shape of fine threads of a pseudo-crystalline appearance. Tannic acid exists also in rhatany, catechu, and other vegetable astrin- gents, as it is their chief principle. Medical Properties and Action. — Tannic acid is considered to be the most active of all vegetable astringents and styptics, and especially powerful on albumen, gelatin and fibrin. It is very soluble in water, and less so in alcohol and ether. Taken TANNIC ACID. 201 internally, it produces no nausea, is perfectly safe, and its use may be continued for a long time without any ill effects. It may also be administered before and after meals, at all times, and be combined with many other remedies, such as iron, cod-liver oil, bitters, etc. Like gallic acid, it is capable of taking oxygen even from the blood globules, when in contact with alkalies. Tannic acid is converted into gallic acid in the blood, by absorbing oxygen from the red corpuscles ; this absorption does not occur in the stomach. Tannic acid unites with albumen, fibrin and gelatin, forming insoluble tannates, thus preserving the parts beneath from the influence of irritating agents until resolution occurs. Its solution reddens litmus paper, and it is decomposed and entirely dissipated when thrown upon red-hot iron. Therapeutic Uses. — Internally it is administered in hemor- rhages of the lungs, stomach, kidneys or uterus, chronic bronchial catarrh, phthisis, after softening has taken place, intermittent fever, whooping cough, chronic diarrhoea, diseases of the genito-urinary organs, dyspepsia, diphtheria, nervous diseases, etc. Externally it is applied to hemorrhages and profuse secretions, mercurial salivation, diseases of the eye, nasal polypus, gonorrhoea and gleet, bed sores, relaxation of uvula, skin diseases, ulcers, etc. Dose. — Of tannic acid, gr. j to 3j, in pill. Dental Uses. — In dental practice tannic acid is a valuable agent for local use in the treatment of such diseases as mer- curial stomatitis, ulceration of the gums and mucous mem- brane of the mouth, hypertrophy of the gums, hemorrhage following the extraction of teeth and wounds of mucous mem- brane, fungous growth of pulp, sensitive dentine, sponginess of the gums, for the temporary relief of odontalgia, disease of the antrum. In mercurial salivation tannic acid, in the form of powder, moistened with water, will render the spongy gums firmer and more comfortable, causing contraction of the ves- sels and checking a tendency to absorption and the conse- quent loosening of the teeth. A strong solution of tannin in 202 DENTAL MEDICINE. alcohol is beneficial in obtunding the sensitiveness of dentine, or the tannin may be, in the form of a powder, combined with morphine and creasote. Tannic acid, in the form of a paste or ointment, made by rubbing two scruples of tannin with twenty drops of glycerine, and then with an ounce of lard, makes a good astringent application. A gargle composed of tannic acid and glycerine is a useful application for abrasions caused by artificial teeth and other irritants. A preparation known as Elixir of Vitriol and Tannin, saturated solution, is a powerful astringent and haemostatic when applied to bleed- ing surfaces, fungous growths, etc. An English preparation known as Styptic Colloid, is a satu- rated solution of tannin and gun cotton, and is highly recom- mended for its styptic and deodorizing properties, as it solidifies blood and albumen by mere contact, and can be applied directly by means of a camel-hair brush, or, mixed with an equal quantity of ether, in the form of spray. No irritation follows its use, and for hemorrhage from the extraction of teeth, or in the treatment of necrosed or carious maxillary bones, it is very efficient. Cold or warm water will not dis- solve it, but an ether and alcohol solution may be used to remove the dressing. Tannic acid, as an internal remedy, has also been success- fully administered for checking hemorrhage after tooth-extrac- tion. Dr. W. L. Roberts says : Tannic acid, administered internally in proper doses, will stop, I believe, any case of such hemorrhage, in from thirty minutes to one and one-half hours' time. He recommends three grains of tannic acid in one-third glass of water, giving as a dose two teaspoonfuls of the solution every five minutes until three doses are taken ; then two teaspoonfuls every fifteen minutes if required. Dr. Roberts further says, that such treatment has never failed him. A styptic and antiseptic cotton can be prepared by saturat- ing purified cotton with tannic acid 5 parts ; carbolic acid 4 parts ; alcohol 50 parts. The cotton should be dried and preserved air-tight. TANNIC ACID. 203 Glycerite of tannic acid — Glyceritum Acidi Tannici, for ex- ternal use, is made of tannin, 5ij ; glycerine, 5viij. Ointment of tannic acid — Uiiguenhim Acidi Tannici, is made of tannin, 5j ; lard, Sj. Useful for a local application to ulcers. DENTAL FORMULAE. For an Astringent Dentifrice. R. Acidi tannici gr. xxx Cretse preparatae . . . . ^ ij Pulveris ossis sepioe . . . 3 ij Olei caryophylli . . . gtt. iij. M. For Inflamed Mucous Membrane, Abra- sions, Ulcers and Sensitive Dentine, R . Acidi tannici "T^x) Tincture amicse . . . . 3 ij Tincture myrrhae . . . §j. M. SiGNA. — To be used as a lotion. For same as above. R. Acidi tannici , , . . 3Jto ^ij Spiriti rectificati . . . . ^j Aquae destillatre . . . . ^x. M. SiGNA. — To be used as a gargle. For Inflamed and Ulcerated Mucous Membrane, R. Acidi tannici zss Spiriti vini rectificati . . 5 ss Aquae camphorse . . . . f^v. M. SiGNA. — To be used as a gargle. For Inflamed and Ulcerated Gums, R . Acidi tannici 3 iv Glycerini gij. M. SiGNA. — To be used as a gargle or mouth-wash. For same as above. R . Acidi tannici Tinct. iodinii , Potassii iodidi Tinct. myrrhae Aqua rosae . SiGNA. — A dessert-spoonful in a wine- gla.ss of water as a mouth- wash or gargle. . gr. XX f.^viij. M. For Inflamed Mucous Membrane of Alouth. R. Acidi tannici . . . . ^ij Pulveris aluminis . . gr.xxx Aquae destillatae . . ^ v. M. SiGNA. — To be used as a gargle. For Sensitiveness following the Removal of Salivary Calculus. Coleman. R . Acidi tannici ... ^^ ss Eau de Cologne . . f 5 iv. M. SiGNA. — Add 10 or 12 gtts. of above solution to a teaspoonful of tepid water, and use as a gargle 3 or 4 times a day. For Loose Teeth and Spongy Gums, R. Acidi tannici . Potassii iodidi Tinct. iodi Tinct. myrrhas Aquae rosas . 3JSS gr.xii I) M. Dissolve the tannic acid and iodide of potassium in the rose water and add the tinctures and strain. SiGNA. — A teaspoonful in a wine-glass of warm water, used every morning as a mouth wash. For an Astringent Mouth Wash in In- flamed and Ulcerated Conditions of Gum and Mucous Membrane. R . Acidi tannici . . . . gr. xx Tincturae pyrethri . . ^iij Aquae rosae . . . ^vj. M. SiGNA. — To be used as a gargle. For Ulcerations and Abrasions. R . Acidi tannici . . . . gr. xv Glycerini f^j. M. SiG.N'A. — To be used as a lotion. 204 DENTAL MEDICINE. R. For Inflamed Mucous Membrane of Mouth. Acidi tannic! . . . • ^ ss Sodii boratis . . . . ^iij For Alveolar Hemorrhage. R . Acidi tannici . . . . gr. xl Liq. plumb, subacet. dilut f ^ iss Vin. opii f^^s. M. SiGNA. — Apply on cotton or lint, or as an injection. For Chronic Ulcers and Abscesses. Berel. R. Acidi tannici . . . gr. xxxij Aquae destillatse . . f ^viij. M. SiGNA. — To be used as a lotion. Astringent and Antiseptic Gargle. R. Tannin 5 grammes. Tincture iodine . . Tincture myrrh . aa 2^ grammes. Iodide of potassium i gramme. Rose water . . .180 grammes. M. SiGNA. — A teaspooonful in a glass of water. ACIDUM TARTARICUM— TARTARIC ACID. Formula. — HgQH^Og. Derivation. — Tartaric Acid is obtained from ''tartar" (a peculiar substance which concentrates on the inside of wine casks, being deposited during the process of fermentation), or from crude cream of tartar. It is in the form of white or colorless crystals, irregular, six-sided prisms, and is soluble in water and alcohol, and wholly dissipated by heat. Medical Properties and Action. — It is refrigerant, and dis- solved in water and sweetened, is a good substitute for lem- onade. In large doses it is an irritant poison, and when its internal use is followed by a red and dry tongue, it should be discon- tinued. It is often administered in the form of effervescing powders. Therapeutic Uses. — Internally it is employed as a refriger- ant in inflammatory and febrile diseases, irritability of the \_riyceiuii ^ ij Aquse destillatae . . §iv. M. SiGNA. — Use as a gargle. For Inflamed Mucous Membrane of Mouth and Fauces. R . Acidi tannici . . . , gj Tinctura myrrhse . . g iij Pulv. acacise . . . . ^ij Glycerini ^ij Aq. destil. q.s.ad . . ^vj. M. SiGNA. — Use as a gargle. For Odontalgia. Druitt. R . Acidi tannici . . . . gr. xx Gum mastich . . . . gr. x Spt. aether sulph . . f^ss. M. SiGNA. — To be applied to carious cavity, on a pellet of cotton. ACONITE. 205 stomach, nausea and vomiting, dyspepsia, and diseases at- tended with copious secretion of mucus, dysentery, etc., etc. Dose. — Of tartaric acid, gr x to gr. xx, dissolved in water and sweetened. Dental Uses. — In combination with an equal quantity of chloride of lime, it is employed for bleaching discolored teeth. ACONITUM— ACONITE. WOLFSBANE. MONKSHOOD. Source. — Aconite is obtained from the dried, tuberous root of Aconitum Napellus, a perennial plant abounding in the mountains of Europe and Asia. The leaves and root are both used, but the latter is the most powerful. The alkaloid Aconitia or Aconitme, a sedative poison, is obtained from the root, and is externally employed for neuralgic affections, pro- ducing a sensation of heat and pricking, succeeded by a feel- ing of numbness and constriction in the part on which it is rubbed ; and very satisfactory results have been obtained from the internal administration of Duquesnel's Aconitia, in neuralgia of the fifth pair of nerves. Another principle of aconite, suggested by Duquesnel, is known as Napelline, which is less powerful than aconitia, but possesses important hypnotic properties, and is substituted for opium and chloral, especially in cases of wakefulness and mental excitement during neuralgic attacks. Medical Properties and Action. — Aconite is a powerful seda- tive to the nervous system, and reduces the force of the circulation. In large doses it is an active poison, lessening the heart's action, affecting its ganglia and muscle, and par- alyzing the muscles of respiration. In moderate doses it pro- duces warmth in the stomach, general warmth of the body, and sometimes nausea, numbness and tingling in the limbs and fingers, muscular weakness, diminished force and fre- quency of the pulse and diminished respiration. It proves fatal, in poisonous doses, by its powerfully sedative impression on the nervous system, by suspension of the respiratory func- tion and by syncope. 206 DENTAL MEDICINE. Therapeutic Uses. — Aconite, in the form of an extract pre- pared from the leaves, and a tincture prepared from the root, is administered in all inflammatory and febrile affections, acute rheumatism, neuralgia, especially in chronic cases of neuralgia, where all the signs of active disease are absent, or have been relieved by other remedies ; tetanus, sciatica, diseases of the heart, erysipelas, amenorrhoea, tonsillitis, acute congestion of liver, peritonitis, eruptive fevers, etc., etc. It is contra-indi- cated in inflammatory conditions of the gastro-intestinal mu- cous membrane. It is locally applied to painful sprains and bruises, and chronic arthritic swellings. Dose. — Of the tincture of aconite — tinctura aconiti—^\X. j to gtt. v ; of the extract of aconite — extractum aconiti — gr. j to gr. ij. The tincture of the root is composed of twelve troy- ounces to alcohol Oij. Dose of aconitia, gr. yto- Dental Uses. — Aconite, in the form of the tincture, is a val- uable agent in 'dental practice. When locally applied it checks inflammation in its early stages, by paralyzing the nerves of the part and lessening the excitement to the local afflux of blood, favoring resolution and limiting the extent of an abscess where pus is already formed. Combined with an equal part of the tinc- ture of iodine, it is a valuable application in the incipient stages of periodontitis, as it relieves the inflammation by retard- ing the circulation and stimulating lymphatic action. For such purpose the gum or root of the affected tooth should be painted with this combination until it assumes a dark brown color, taking the precaution to first remove all moisture from the surface to which it is to be applied, and after its application, protecting the adjoming parts, such as the lips or cheeks, until the remedy is ab- sorbed. A drop or two of the tincture, introduced into the cavity of an aching tooth, will relieve odontalgia ; and the same quan- tity will subdue the pain which follows the extraction of a tooth, especially when the cause has been the inflammation of the peridental membrane. Tincture of aconite is also serviceable in the conservative treatment of irritated or inflamed pulps of teeth. Combined with an equal quantity of chloroform, it is applied as a local anaesthetic for the extraction of teeth. For ACOXITE. 207 the same purpose it is combined with chloral, pyrethrum, morphia, etc. (See Dental Formulae.) It is also a useful dressing for the pulp canals of teeth, preventing the forma- tion of inflammatory products. The alkaloid, acoiiitia, is a useful remedy in neuralgia of the fifth pair of nerves. (See Dental Formulae). Care is necessary in the application of the tincture of aconite to large surfaces, or where the skin is abraded, as dangerous constitutional effects may result. Fifteen drops of the tincture, taken internally, have caused death. The symptoms of poisoning by aconite are as fol- lows : Overpowering sense of fatigue in the lower extremities, great muscular weakness, dimness of vision, with diluted pupils ; great dyspnoea, the respirations being short and la- bored ; the pulse at first slow and small, and afterward imper- ceptible ; surface of body ; tongue and breath cold ; a profuse perspiration ; muscles of respiration paralyzed ; ceasing of the heart's action. The antidotes are emetics and stimulants — heat, brandy and ammonia ; keep flat on back. DENTAL FORMULA. For Neuralgia. A Local Anasthetic for the Extraction R. Pulveris radicis aconiti ^x -^ ' Camphone gss R. Tincturse aconiti . . ^iss Spiriti rectificati . . . q.s. Pyrethri :? iij Moisten the aconite with some of the VeratrinEe gr.x alcohol and macerate in a close ves- Morphinge sulphas . gr.iv sel for 3 days, then percolate slowly Spiriti rectificati . . . ,^ iv into a receiver containing the camphor Chloral hydratis . . . gr.iv M. until the product measures half a Let it stand 4 days and then filter. P'"t- SiGNA. — Apply to the gum over root of SiGNA. — Apply with a camel-hair brush. tooth to be removed for sixty seconds, by means of an applicator. For Odontalgia. R . Tinctune aconiti, r^, r ■ r ■■■ For u Local AitcBstlutic for Extraction Chloroformi . . aa . .fsui. ^ ™ ,, . . •' ■' of Teeth. Tmct. capsici . . . . f^j Tinct. pyrethri., R. Tinctura aconiti . . . f.^j- 01. caryophylli . aa . f.f ss Menthol K'-x- Gum camph . . . . ^ss. M- Chloroformi .... f;^]. M. SiGNA. — To be applied on a pallet of Signa. — Apply freely to gum about cotton. tooth for several minutes. 208 DENTAL MEDICINE. For Neuralgia and Rheumatic Pains^ Bruises, Etc, R . Tincturse aconiti, Chloroformi venalis, Spiriti ammonise . aa . f^ij Oleo ricini ^i Linimenti saponis . • f^j- M. SiGNA. — To be rubbed on the affected part. For Neuralgia of Fifth Pair of Nerves. (For internal use.) R. Aconitse gr.J^ Glycerini, Alcohol , . aa . . . ^j Aquse menthse pip . . ^ij. M. Dose. — A teaspoonful. For Neuralgia, R . Linimenti aconiti, Lin. belladonnse . aa . ^vij Chloroformi . . . . ^ij. M. SiGNA. — Apply on lint, to the part affected, and cover with a fine piece of sponge saturated with warm water. For Trigeminal Neuralgia. * R. Aconitinse (Duques- nel's) ... ... gr.3-V Glycerini Alcohol . . aa . . ^j Aquae menthae pip . . ,^ ij M. Dose. — A teaspoonful, slowly and cau- tiously increased to y%. For Periodontitis, R . Tincturse iodi, Tincturae aconiti, . aa ^ss. M. SiGNA. — Apply to gum over root of af- fected tooth with a camel-hair brush. To Abort an Abscess, Dr. Geo. Watt. R . Ext. aconiti, fl. Ext. belladonnse, fl. Ext. opii., fl . aa . equal parts. M. SiG. — Apply with brush as needed to ease pain; also give fluid extract of phytolaccse internally. For Odontalgia, Internal Treatment, Dr. Dunogier. R. Aconitine (crystallized) ^ milligr. Gelsemine I milligr. Valerianate of quinine . 5 centigr. For one pill. M. S. — One to three pills to an adult in the 24 hours. ^THER— ETHER. iETHER SULPHURICUS SULPHURIC ETHER. Formula. — QHjoO. Sp. gr. — Of pure ether, .0713: of stronger ether, 0.728 ; of ordinary officinal ether, 0.750. Derivation, — Sulphuric Ether is obtained by the distillation of alcohol and sulphuric acid, and is rectified byre-distillation with solution of potassa. The form of sulphuric ether em- ployed for inhalation is still further purified by agitation with water, and it is freed from this and from an excess of alcohol and deleterious acid substances by the action of chloride of lime and freshly calcined lime, when it is known as stronger ether — ^ther Fortior. Sp. gr. 0.728. Sulphuric ether is a colorless, limpid, volatile and inflammable fluid, with a sweet ETHER. 209 odor and a hot. pungent taste ; on account of its great vola- tility, it should be kept securely in ground-glass-stoppered bottles. It usually reddens litmus paper slightly; when it does so strongly, the ether is impure. The impurities, besides acids and fixed substances, are heavy oil of wine, an excess of alco- hol and water. Acids being detected by litmus paper, may be removed by agitation with potassa ; fixed substances may be removed by evaporating the ether. Some alcohol is always found in ether, and it is only when it is present in too great a quantity that the density of the ether is rendered too high. The quantity of alcohol any preparation of ether may contain, can be determined by agitating it in a minim measure with half its volume of a concentrated solution of chloride of cal- cium. This will remove the alcohol, and the reduction of the volume of ether when it rises to the surface will indicate the amount of alcohol which has been present. Heavy oil of wine can be detected by the ether becoming milky when mixed with water. Ether boils at 98° F., and a cold of 166° below zero will not freeze it. When kept too long it undergoes decom- position, and is converted in part into acetic acid. It evaporates so readily and completely in the air as to cause a great degree of cold ; hence it has been employed in the form of spray, as a local anaesthetic. It combines with alcohol and chloroform in all proportions, and dissolves in ten times its volume of water. Medical Properties and Action. — Ether is a diffusible stimu- lant, antispasmodic, anodyne and anaesthetic. It is administered internally in the form of ether or of Hoffmann's Anodyne, compound spirit of ether — Spiritus Etheris Compositus (com- posed of ether, Oss, ethereal oil, f5vj, and alcohol, Oj), also, in the form of spirit of nitrous ether, Spiritus Etheris Nitrosi, and known as sweet spirit of nitre (a solution of nitrous ether in alcohol). When ether is taken into the stomach, it causes a cooling sensation, after the subsidence of the burning, which is quickly diffused over the body ; increased action of the heart, flushing of face and warmth of surface follow in a k\v minutes; the »4 210 DENTAL MEDICINE. senses are quickly excited ; the mind becomes more active, and the phenomena of alcohohc intoxication result, which soon pass away, leaving a feeling of calmness and sleep. Therapeutic Uses. — Ether is employed internally as an anti- spasmodic and anodyne, for angina pectoris, hysteria, asthma, flatulence, cramp of stomach and bowels, syncope, epilepsy, hiccough, nervous or hysterical headache. Hoffmann's Aqo- dyne possesses the antispasmonic and stimulating effects of ether, and the anodyne effects of ethereal oil, or oil of wine, and is also carminative. The Spirit of Nitrous Ether is antispasmodic, diaphoretic, and diuretic, and is employed in febrile affections, dropsies, etc., etc. Dose — Of ether, f5ss to foj ; of Hoffmann's Anodyne, foss to f5ij, in sweetened water; of spirit of nitrous ether, fSss to f§ss. Dental Uses. — Ether is employed as a general and local anaesthetic ; as a topical anodyne in neuralgia and odontalgia, for which purpose it is generally combined with other agents ; in aphthse and stomatitis ; as a counter-irritant, evaporation being prevented. Sulphuric Ether as an Anesthetic Agent. — Sulphuric ether is generally considered to be a safer anaesthetic agent than chloroform, as but comparatively few deaths have resulted from its inhalation. The discovery of its anaesthetic properties was first made in 1844, by Dr. Horace Wells, a practicing dentist, of Hartford, Conn. ; and Dr. Morton, of Boston, also a dentist, first demonstrated the application of its anaesthetic properties in dentistry and surgery, in 1846. As the physiological actions of both ether and chloroform are similar, they may be considered as follows : When the vapor of ether or chloroform is inhaled, the first effect is faucial irritation, to a greater or less degree, according to the strength of the agent employed, a feeling of suffocation, with cough, a flow of mucus and the reflex act of swallowing. The desire for air may cause more or less struggling, especially in the case of children. The sensibility of the glottis, however, ETHER— ANESTHESIA. 211 is soon relieved, the cough ceases, and the inhalation of the agent proceeds without further resistance. The primary effect is a general exhilaration ; and, in the case of ether especially, it is often one of excitement, which, in the majority of cases, may continue for a short time only, while in other cases, it may, from its duration and violence, give rise to considerable trouble. But, if the inhalation can be con- tinued and this stage of excitement passed over, insensibility soon occurs. The pulse increases in frequency, the respira- tions become more rapid, and may assume a convulsive char- acter. There is flushing of the face, cerebral intoxication, to a greater or less degree, according to the temperament, such as talking, laughing, singing, crying, etc. In those of a mer- curial or hysterical disposition this stage of excitement is more pronounced and persistent, and during its continuance sensi- bility to pain is considerably diminished, although the sense of touch is still preserved, while those of taste and smell are lost, and complete insensibility soon follows. When the patient is of a full habit, and in robust health, and the inhalation of the anaesthetic agent has been rapid, the stage of complete insensibility is preceded by a convulsive stage, during which there is rigidity of the voluntary muscles, stertorous breathing and lividity of the face. If the inhalation of the agent be still further continued, the tetanic rigidity of the muscles subsides, the lividity of the face disappears, the breathing becomes quiet, complete muscular relaxation ensues, power of movement is lost, as shown by the arm, when raised, dropping without resistance, and the conjunctiva of the eye, under mechanical irritation, being perfectly insensible to pain. During complete anaesthesia the surface of the face is cool and bathed in abundant perspiration ; the countenance is calm, the eyes closed and the pupils somewhat contracted, the respiration easy and the pulse slower. The functions of respiration and circulation continue, all others being suspended. From such a condition the patient will soon emerge, provided the further inhalation of the agent be stopped ; on the other hand, if the inhalation be continued, the functions of respiration and circu- 212 DENTAL MEDICINE. lation will be suspended, and life will end with the cessation of the action of the heart and the respiratory organs. Sudden death from the inhalation of anaesthetic agents is due to paralysis of the cardiac ganglia. When death occurs during the stage of rigidity and stertorous breathing, it is due to tetanic fixation of the respiratory muscles and obstruction of the pulmonary circulation, accumulation of venous blood in the heart and the arrest of the heart's action. Death may also ensue by paralysis of the respiratory mus- cles during the stage of complete muscular relaxation ; also by paralysis of the heart during complete insensibility, the motor ganglia being paralyzed. Death may also occur from depression of the functions and the shock of the accident, or of the surgical operation. Mr. Woodhouse Braine divides anaesthetics into two classes : (i) Those which produce death through the lungs as well as through the heart ; this class includes chloroform, bichloride of methylene, dichloride of ethidene, and many others of the chlorine series ; (2) those which produce death through the lungs alone, the heart's action continuing for some time after respiration has quite ceased : this class includes ether and nitrous oxide ; and he says, that in choosing an anaesthetic three factors are to be considered : (i). The nature of the operation ; (2) the amount of insensibility necessary ; (3) the length of time during which insensibility has to be kept up; and he sums up as follows: (i) It is well to avoid all anaes- thetics which tend to depress the heart's action : (2) for short operations nitrous oxide is the best agent ; (3) for long opera- tions, except where it is desirable to avoid hemorrhage, or where the cautery is used, ether answers perfectly ; (4) the best time for operating is the early morning ; (5) nitrite of amyl is the best cardiac stimulant. The Administration of Anesthetics. — To administer ether or chloroform, take a folded piece of lint, of three or four thicknesses, and of a size that can be held conveniently in the hollow of the fingers and palm of the hand ; and on it pour the anaesthetic agent — half an ounce of ether or a drachm of ETHER— ANESTHESIA. 213 chloroform. Some prefer a large napkin or towel, folded in the form of a cone, with an opening of an inch or an inch and a half at the apex, for the admission of air. The advantage, however, of the lint over the folded napkin is, that by holding the lint in the hand but little evaporation occurs. To give sufficient air to the patient when begining the administration of ether, Dr. D. B. Keefe recommends the use of a large towel, folding it first five times lengthwise, and placing a piece of paper the full length between the outside folds, then roll it up into a cylinder, the size to be governed by the face of the patient : it should be large enough to cover the face, but not too large. This makes a cylinder open at both ends, full size. Then saturate the lower part of the cylinder, that comes against the face with the ether and apply it to the face, and as the other end is open the patient receives considerable air as well as the ether vapor. Before commencing the inhalation, the condition of the pulse should be ascertained by placing the middle finger of the left hand on the left temporal artery, and at the same time en- deavor to reassure the patient and allay fear by cheerful words. The clothes should be loose, and artificial teeth, if any are worn, as well as pins, if the habit of keeping them in the mouth is indulged in, should be removed before the administration of the anaesthetic is commenced. The inhalation should be com- menced by holding the moistened lint or towel three or four inches from the patient's face, directing him to breathe quite naturally, always remembering that a strong atmosphere in the early stages of the inhalation is dangerous, and carefully watching for coughing or acts of swallowing, when, if any such occur, the lint or towel should be moved further away, and approached again more gradually. If the patient shows no signs of the anaesthetic vapor being too strong, the lint or towel may be gradually brought to within an inch and a half of the patient's mouth and nostrils; and to still more concen- trate the atmosphere, if lint is used, the hand holding it may be covered with one fold of an ordinary large napkin, which may hang loose over the mouth and chin, but should be so arranged above that the patient's eyes and forehead may 214 DENTAL MEDICINE. remain uncovered and visible. The inhalation should be com- menced ca^itiously, by instructing the patient to breathe quite naturally, and to obey any direction to raise the hand or open the eyes. When the inhalation has fairly commenced, it should be continued until there is no winking when the margins of the eyelids are touched, or the hand cannot be raised, and the limbs are perfectly relaxed, when the patient is ready for the opera- tion ; what is termed the " surgical period " having arrived. An inhalation with chloroform generally takes about four minutes ; often more ; seldom less. With ether, the time re- quired is longer and the quantity of the agent greater. It should also be remembered that, in summer, chloroform and ether evaporate more readily than in the colder seasons. The operator should devote his undivided attention to the patient, during the inhalation of anaesthetics. One finger should be kept on the pulse, and the respiration should be carefully noted; for the latter is of more importance than the former, although the pulse is by no means to be neglected. When the patient becomes excited, he should be watched very closely, and if the respiration becomes proportionately quick- ened, so must the vapor of the anaesthetic be proportionately weakened, by withdrawing the lint or towel slightly from the face. When the muscles become rigid, and the patient holds his breath and becomes livid, the anaesthetic should be given very weak indeed, as such a state of semi-asphyxiation, due to the suspension of respiration, is often followed by extreme rapidity and depth of respiration, and a dangerous condition is apt to supervene, because anaesthesia is added to asphyxia. The cumulative action of these general anaesthetics should also be remembered, for a state of narcosis frequently intensifies for half a minute or more after the suspension of the administra- tion, which is due to the vapor of the anaesthetic which was in the lungs entering the blood after the administration ceases. Dr. Buxton points out that even admitting greater danger ETHER— AN/ESTHESIA. 215 from chloroform, its use is indicated in the following circum- stances : a. In protracted operations about the mouth, jaws, nose, or pharynx, which necessitates the mouth and nose being un- covered. b. All operations needing the employment of the actual cautery, or lighted candles, lamps, etc., in the vicinity of the mouth; ether being highly inflammable, and when' mixed with air, detonating, so that the incautious bringing of the appara- tus near a light may lead to grave consequences. c. Persons who are suffering from bronchitis, and those liable to that complaint; the emphysematous (if the condition be very pronounced) and, as a rule, asthmatics bear ether badly, since it creates cough, and may clog the bronchial tubes with a quantity of excessive secretion. d. In renal disease, when extensive, ether is said to induce suppression of urine ; so that if given at all in these cases, it should be with the utmost caution. e. The vascular excitement to which ether gives rise, con- tra-indicates its use for persons whose arteries are presumably brittle, etc. f. In infants and very young children. g. As ether always provokes coughing and rapid breath- ing, it should not be used when these are prejudicial to the patient or to the success of the operation. h. The presence of brain tumors, intestinal obstruction, and cancerous tumors is by some considered contra-indicatory of ether. To these the Chronicle adds two other large groups of conditions, viz.: ist, all cases of brain surgery; 2d, where the circumstances of the patient or the requirements of the operation are such as to demand the securing of perfect rest by the free use of opiates, ether must be avoided on account of its action on the kidneys. Prof. J. J. Chisholm, of the University of Maryland, gives the following five simple rules for the administration of chlo- roform, and which will apply to ether also: — "i. I always, without a single exception, give a strong 216 DENTAL MEDICINE. drink of whiskey, from one to two ounces, to every adult to whom I intend to administer chloroform. This is done a few minutes before the operation. "2. Always loose the neck and chest clothing, so as to have no impediment to respiration. "3. Only administer chloroform in the recumbent posture, with body perfectly horizontal and head on a low pillow, this pillow to be removed as the anaesthesia progresses. "4. Give chloroform on a thin towel, folded in conical form, with open apex, so that the vapor, before inhalation, will be freely diluted with atmospheric air. In holding this cone over the face of the patient, at some little distance from the nose, place the fingers under the borders of the cone, for the double purpose of allowing the air to enter freely, and also to prevent the chloroform liquid on the towel from coming in contact with the skin of the patient's face, and thereby avoid its blistering effects. " 5. Should loud snoring occur, force up the chin. This manipulation, by straightening the air passages from the nose to the larynx, makes easy breathing. The forcible elevation of the chin is far better in every respect than pulling out the tongue. It is easier of application, more quickly done, re- quires no instrument, and is much more efficient in removing the impediment to respiration. " While operating, I have constantly in view both the color of the face and the respiration of the patient, which I consider even more important for the surgeon to observe than to feel the pulse." (See " Chloroform " for further directions and pre- cautions to be observed during the administration of this agent.) Dr. H. A. Hare states that if during anaesthesia, respiration stops, he has found that in a large number of instances, both in man and in the lower animals, the free use of ether poured upon the belly causes so great a shock, by the cold produced by its evaporation, as to cause a very deep inspiration, which is often followed by the normal respiratory movements. Dr. H. I. Neilson gives the following conclusions concern- ing the pupil as a guide in the administration of chloroform : ETHER— ANESTHESIA. 217 1. The first effect of chloroform narcosis on the pupils consists in a dilatation which varies in intensity and duration in different individuals. As the anaesthesia becomes more profound the pupils begin to contract and finally become very small and immovable. If now the chloroform is pushed still further, a sudden dilatation occurs, which is the result of asphyxia, from which the patient seldom recovers. 2. As long as the pupil is observed to dilate in response to sensory stimuli, such as pinching the skin, the anaesthesia is not yet sufficient to allow the commencement of the operation. 3. As soon as the pupil becomes strongly contracted and immovable, the administration of the anaesthetic must be sus- pended until a commencing dilatation is observed, and the pa- tient must be held at just this point as long as the operation continues. 4. Vomiting causes a dilatation similar to that occurring as the patient emerges from the narcotic condition, but it is usually more sudden in the former case. The contraction of the pupils does not appear to begin until the blood-pressure is somewhat reduced, and the dilatation proceeds pari passu with the increase in the blood-pressure. He therefore regards the appearance of the pupil as a very reliable guide for the ad- ministration of chloroform, as he is enabled to judge accu- rately concerning the condition of the patient. When ether or chloroform is administered for the extraction of teeth, the operation should be performed in a dental chair so constructed as to admit of the patient being placed in as horizontal a position as is possible to operate successfully, and every instrument it is necessary to use should be within reach of the hand of the operator. As soon as the operation is completed the head of the patient should be gently inclined to the side, so as to permit the blood to run from the mouth and not pass down the throat. Any considerable change in the position of the patient should be avoided until recovery has taken place. Fresh air should be admitted by lowering the window, and the patient freely supplied with it by means of a fan. 218 DENTAL MEDICINE. M. Paul Bert instituted experiments with mixtures of ether, chloroform and air, or nitrous oxide and air, or nitrous oxide and oxygen, under pressure, which he claimed diminished the danger without lessening the advantages of the anaesthetic. A proportion of eight per cent., after six or seven minutes, sufficed to induce and maintain a state of surgical coma for fifteen to thirty minutes, and the symptoms of the stage of exhilaration were much less marked than usual. He also claimed that there is an absence of the feeling of suffocation common to the old method ; that the face retains its natural color ; that respiration is regular, but somewhat quickened and sometimes snoring ; that the pulse shows no marked disturb- ance ; that the buccal secretion is scanty ; that the patient is spared violent coughing, which often seems to initiate the after vomiting; that the return to consciousness from complete anaesthesia takes from eight to ten minutes ; that the quantity of chloroform used is small — in one case, where the anaesthesia lasted half an hour, it was only five grammes ; that by means of the apparatus used the patient escapes any local irritation of the skin, and the operator does not receive the fumes of the drug in his face. The appliance used in Bert's method is the invention of Dr. H. Martin for analyzing the gases of respira- tion, and consists of a pair of reservoirs connected with a caoutchouc mouth-piece, and containing the required mixture of air and chloroform. By a special contrivance a constant supply of the anaesthetic is maintained, to make up for the loss by inhalation, and the pressure within the reservoirs remains, under all circumstances, equal to that of the surrounding air ; and the respiratory movements can be accurately watched by means of a water manometer and scale affixed to the instru- ment. In operations on the mouth, anaesthesia is first produced by the aid of the mouth-piece, and afterward kept up by an occasional jet of the mixed vapor sent into the back of the mouth. Some eminent surgeons, however, among the number Messrs. Gosselin and Richet, consider Bert's method a danger- ous one, and the latter states of the cases at the St. Louis ETHER— ANAESTHESIA. 219 Hospital, Paris, which he witnessed, one in three was accom- panied with vomiting, discomfort, and, on one occasion, with great excitement. What has been styled "vitalized air," is the vapor from a mixture composed of equal parts of chloroform and alcohol combined with the nitrous oxide gas. The vapor from two or three drops of the chloroform and alcohol mixture is used with each gallon of gas, the anaesthetic effect of which, it is claimed, is more lasting, and at the same time less dangerous, than from either of the two agents alone. An apparatus for combining these two agents is in use, which is attached to the gas cylin- der, in place of the ordinary connection. The administration of anaesthetics through the nose has been suggested by Dr. B. C. A. Windle, of England, a pecu- liar instrument being employed for pumping the vapor of the anaesthetic through a tube which passes into one nostril; wings, to close the outer surface of the nostril containing the tube and the opposite surface of the septum nasi, are attached to the tube, so that air may pass through the passage unoccluded by the tube. The inventor of this method claims that by its use perfect anaesthesia can be maintained throughout an opera- tion about the face, of any length, without interfering with the operator's actions ; also, that in operations about the mouth and palate the patient can be maintained at that point of anaes- thesia which may be considered desirable, and that the supply can be regulated. Dr. Axel Yversen, of Copenhagen, suggested etherization by the rectum, the vapor being conducted to the rectum by a rubber tube (attached to a bottle containing the ether, in a water bath of 120°), terminating in a recurrent catheter, the free or recurrent end being closed by pressure of the thumb during the inflation of the bowel ; the expiratory act being performed by removing this pressure and the water bath. The principal advantage this method appears to possess is that it permits operations on the face without the ordinary obstacles of the common method. The Dangers of An/esthesia. — The conditions rendering 220 DENTAL MEDICINE. general anaesthetics dangerous are fatty degeneration of the heart (a prominent contra-indication) ; previous alcoholic habits ; brain tumors and degenerations ; respiratory obstruction from swollen epiglottis, enlarged tonsils, oedema glottidis, laryngeal paralysis, thoracic tumors or aneurism ; emphysema and ob- structed pulse circulation from engorgement of right heart and deficient heart power ; valvular lesions ; incomplete anaes- thesia during painful surgical operations, causmg death from shock, as the result of peripheral irritation. Muscular debility and weakness from exhaustion, if otherwise uncomplicated, are considered to be rather aids to anaesthesia than contra- indications. Preventive Measures Against the Dangers of Anaes- thesia. — A thorough examination for sources of danger should always be made previous to the administration of the anaes- thetic. An anaesthetic should never be administered on a full stomach, as an anaesthesia of the glottis prevents the expulsion of vomited matter from the larynx, in case it enters by regur- gitation. An anaesthetic should never be administered after long fasting, as absence of nutrition may tend toward cardiac paralysis. One or two ounces of whiskey should be adminis- tered immediately before the operation. All excitement should be avoided, to the patient, from fear, sight of instruments, too many spectators, etc., all of which tend to induce shock. All appliances for resuscitation should be at hand, and plenty of fresh air be available during the inhalation. In using chloro- form mix only three and a half per cent, of the vapor with air, to ensure safety. In the administration of ether the respira- tions, according to some authorities, alone need be watched ; in chloroform, however, both the respirations and the pulse should be carefully noted. Treatment of Dangerous Symptoms of Anesthesia. — The suspension of the heart's action necessitates the immediate withdrawal of the vapor and the immediate inversion of the patient, according to Nelaton's method. The failure of respi- ration necessitates the forcing up of the chin, or the forcible drawing out of the tongue to lift the epiglottis ; the practice of ETHER— ANESTHESIA. 221 artificial respiration by the Sylvester method, and by faradiza- tion of the respiratory muscles ; the inhalation of gtt. iij to gtt. iv of nitrite of amyl; ammonia to the nostrils ; galvanism (the positive pole being placed to the nostril, and the negative pole over the diaphragm, to excite a reflex action between the fifth pair and the pneumo-gastric, or the poles may be placed directly over both phrenic nerves, on a line with the fourth cervical vertebra, in order tostimulate 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). Artificial warmth should be applied, but no cold applications. The inversion of the body, according to Nelaton's method, and artificial respiration, according to Sylvester's method or Marshall Hall's ready method, or Howard's method, are safe and are the most promising expedients. A simple method of producing artificial respiration is as follows : — " With outspread palms, press the front of the chest forcibly down, whilst an assistant at the same time presses the abdo- men. Make these movements not oftener than fifteen times in the minute." DR. H. R. Sylvester's method of resuscitation. " To Adjust the Patient's Position. — Place the patient on his back, on a flat surface; raise and support the head and should- ers on a small, firm cushion, or folded article of dress, placed under the shoulder-blades ; remove all tight clothing about the neck and chest. 222 DENTAL MEDICINE. " To Maintain a Free Entrance of Air into the Windpipe. — Cleanse the qiouth and nostrils ; open the mouth ; draw forward the patient's tongue, and keep it forward ; an elastic band over the tongue and under the chin will answer the purpose. " To Imitate the Movements of Breathing : — " First, Induce Inspiration Place yourself at the head of the patient ; grasp his arms ; raise them upward by the sides of his head ; stretch them steadily but gently, upward and back- ward, for two seconds. By this means fresh air is drawn into the lungs, by raising the ribs. " Secondly, Induce Expiration. Immediately turn down the patient's arms, and press them firmly, but gently, downward against the sides of his chest, for two seconds. By this means foul air is expelled from the lungs, by depressing the ribs. " Thirdly, continue these Movements. Repeat these move- ments alternately, deliberately and perseveringly, fifteen times in a minute, until a spontaneous effort to respire be per- ceived. By these means an exchange of air is produced in the lungs, similar to that effected by natural respiration." MARSHALL HALL'S READY METHOD IN ASPHYXIA. " 1st. Treat the patient instantly, on the spot, in the open air, freely exposing the face, neck and chest to the breeze, except in severe weather. " 2d. In order to clear the throat, place the patient gently on the face, with one wrist under the forehead, that all fluid, and the tongue itself, may fall forward, and leave the entrance into the windpipe free. ETHER— ANESTHESIA. 223 *' 3d. To excite respiration, turn the patient slightly on his side, and apply some irritating or stimulating agent to the nostrils, as Vcratrinc, dilute A vmionia, etc. " 4th. Make the face warm by brisk friction ; then dash cold water upon it. " 5th. If not successful, lose no time; but, to imitate respira- tion, place the patient on his face, and turn the body gently, but completely, on the side and a little beyond ; then again on the face, and so on, alternately. Repeat these movements deliberately and perseveringly, fifteeti times only in a minute. (When the patient lies on the thorax, this cavity is compressed by the weight of the body, and ^^piration takes place. When he is turned on the side, this pressure is removed, and zVzspira- tion occurs.) "6th. When the prone position is resumed, make a uniform and efficient pressure along the spine, removing the pressure immediately before rotation on the side. (The pressure aug- ments the ^;rpiration ; the rotation commences /aspiration.) Continue these measures. *' 7th. Rub the limbs upward, with firm pressure and with energy. (The object being to aid the return of venous blood to the heart.) " 8th. Substitute for the patient's wet clothing, if possible, such other covering as can be instantly procured, each by- stander supplying a coat or cloak, etc. Meantime, and from time to time, to excite inspiratio?i, let the surface of the body be slapped briskly with the hand. " 9th. Rub the body briskly till it is dry and warm, then dash cold water upon it, and repeat the rubbing. " Avoid the immediate removal of the patient, as it involves a dangerous loss of time ; also the use of bellows, or any forc- ing instrument ; also the warm bath, and all rough treatment." DR. Howard's method of REsucrrATioN. One of the most efficient, as well as the most recent method, is that of Dr. Howard for performing artificial re- spiration. 224 DENTAL MEDICINE. Position of Patient. — Face upward, a hard roll of clothing beneath the4:horax, with shoulders slightly declining over it. (One twist of handkerchief around the crossed wrists will keep them there.) Rip or strip clothing from waist and neck. Position of Operator. — Kneel astride the patient's hips ; place your hands upon his chest, so that the ball of each thumb and little finger rests upon the inner margin of the free border of the costal cartilages, the tip of each thumb near or upon the xiphoid cartilage, the fingers fitting in the corresponding intercostal spaces. Fix your elbows firmly, making them even with your sides and hips ; then — Action of Operator. — Pressing upward and inward toward the diaphragm, use your knees as a pivot, and throw your weight slowly forward two or three seconds until your face almost touches that of the patient, ending with a sharp push, which helps to jerk you back to your erect kneeling posi- tion. Rest three seconds, then repeat this bellows-blowing movement as before, continuing it at the rate of seven to ten times a minute, taking the utmost care on the occurrence of a natural gasp, gently to aid and deepen it into a longer breath until respiration becomes natural. When practicable, have the tongue held firmly out of one corner of the mouth with thumb and finger armed with a dry cotton rag. Very frequently during the early stages of the administra- tion of an anaesthetic the patient may " forget to breathe," LOCAL ANESTHESIA. 225 even before the ability to perceive peripheral irritation is lost. Even later in the anaesthesia, when the breathing suddenly ceases, instead of using cold water externally and slapping the patient with wet towels. Dr. H. A. Hare recommends pour- ing a quantity of ether upon the belly, the shock caused by the cold produced by its evaporation bringing on a very deep in- spiration, followed often by the normal respiratory movements. Local An.esthesia. — The fatality attending the use of general anaesthetics led to the introduction of what are termed " local anaesthetics," some of which depend upon the therapeutic property of cold, which is properly an anaes- thetic only when it freezes the part to which it is applied. The use of cold for such a purpose must necessarily be lim- ited to small parts of the body, and its utility depends upon the ease and rapidity with which a desired spot of living flesh can be frozen, in other words, temporarily deprived of its vi- tality, without inflicting mechanical injury on the delicate structure of the part. According to Dr. Richardson, the proposer of the method, the principle consists in directing on the part of the body a volatile liquid, having a boiling point at or below blood heat, in a state of fine subdivision or spray, such subdivision being produced by the action of air or other gaseous substance on the volatile liquid to be dispersed. When it falls on a part of the body, it comes with force into the most minute contact with the surface upon which it strikes. As a result, there is rapid evaporation of the volatile fluid^ and so great an evolution of heat force from the surface of the part to which the spray is applied, that the blood cannot supply the equivalent loss. The part consequently dies for the mo- ment, and is insensible ; but as the power of the body is unaffected, the blood, as soon as the external reducing agency is withdrawn, quickly makes its way again through the dead parts, and restoration rapidly occurs. The fluids used are ether, of a specific gravity not exceed- ing 0.723, highly rectified, and as free as is possible from either alcohol or water — what is known as " absolute ether " — and 15 226 DENTAL MEDICINE. rhigolene, a product of petroleum, and the lightest liquid known, and bromide of ethyl. When a current of the volatile liquid, either atomized ether or rhigolene, comes in contact with the skin by the use of the spray apparatus, an intense degree of cold is produced, which deprives the nerves of the part of their power to transmit impressions to the sensorium. For the extraction of teeth, destruction of the pulps of teeth, opening abscesses, and other minor surgical operations, and neuralgia of superficial nerves, success has attended the use of such local anaesthetics. The greatest objections to such a method of inducing local anaes- thesia, are the great pain which attends the first application, and the unpleasant burning sensation of the part when it is recovering from the freezing process. (See Rhigolene.) (See Aconite, for obtunding mixture.) Liquefied chloride of methyl dissolved in ether and carefully applied by means of a hair pencil, is recommended for the painless extraction of teeth, the opening of alveolar ab- cesses, etc., etc. (See Cocaine as a local anaesthetic.) A plan of local anaesthesia, known as Voltaic Narcotism, has been suggested by Dr. Richardson, of London. It consists in passing a galvanic current through a narcotic solution held in contact with the part to be operated upon. This plan ap- pears to be successful only where the cavity of the tooth to be extracted is exposed. Electro-magnetism has also been employed as a local anaes- thetic, and it is a mooted question whether it relieves pain or complicates the sensations. It is well, however, to remember that some persons are so peculiarly constituted as to render them very susceptible to the influence of electricity. Dr. Scott describes his method of applying electricity for the extraction of teeth as follows : "Use a Kidder electro-mag- netic machine, or any other giving very rapid vibrations of ar- mature. Place the positive electrode on the gum of the tooth to be extracted, and the negative in the patient's hand, or at the back of the neck. Start with a light current and gradually increase the strength as much as can be borne without pro- LOCAL ANESTHESIA. 227 ducing pain. The electrode applied to the tooth should em- brace each side, the better to convey the current. For this purpose it should be bifurcated at the end of the handle, the arms of sufficient length for convenience in operating. At the end of these solder small disks about the size of a dime. The handle and arms must be insulated to prevent the current passing off at any other point than the disks. Cover the disks with thin pads of fine sponge. A cylinder electrode, also cov- ered with fine sponge or cloth is the proper one for the hand. Moisten each with saline water. Another method is to attach one pole of the battery to the extracting forceps, the handles of which are well insulated, the other pole being held in the hands of the patient. As soon as the forceps come in contact with the tissues about the tooth the circuit is completed, and the electrical effect produced, which is often painful. A Com- mittee of the College of Dentists, England, in a recent report upon the anaesthetic value of electricity, were unanimous that in no case was local anaesthesia produced by such currents, but that the effects were due to " diversion of sensation, less difficulty of extraction as compared with other extractions, syncope more or less marked, and differences in methods of operating." (See Electricity as a Therapeutic Means, etc.) Obtunding mixtures, consisting of a combination of cocaine, pyrethrum, aconite, chloral, veratria and alcohol, or chloro- form, aconite, belladonna, opium and carbolic acid, etc., have been employed to produce local anaesthesia, and in many cases with satisfactory results. (See recipes for obtunding mixtures and local anaesthetics). For, although entire insensibility to pain cannot in all cases be brought about, yet some dimi- nution of it may be effected by the use of such agents. They have the merit, at least, of being less dangerous than the gen- eral anaesthetics. Such pain obtunding mixtures are best applied to the parts about the neck and over the root of a tooth by means of a simple apparatus, devised by Von Bonhorst. It consists of two small metallic cups, attached to the free ends of a spring some seven inches long, and which contain sponges to hold the liquid. When used, the sponges in the 228 DENTAL MEDICINE. cup are saturated with the obtunding mixture and applied by pressing them on the gum on each side of the tooth to be re- moved, where they are retained from one-half to two minutes. Previous to the application the patient should be cautioned against swallowing any portion of the mixture. (See Cocaine, hyperdermic use of.) Rapid Breathing as a Pain Obtimder. — A method first sug- gested by Dr. W. G. A. Bonwell, and from which he claims a similar effect to tliat of ether, chloroform and nitrous-oxide gas in their primary stages, and to render the patient suffi- ciently unconscious to any acute pain from any operation, where the time consumed is not over from twenty to thirty seconds. " While the special senses are in partial action, the sense of pain is obliterated and, in many cases, completely annulled, consciousness and general sensibility being pre- served." " To accomplish this, each patient must be instructed how to act and what to expect. As simple as it may seem, there is a proper and consistent plan to enable you to reach full success. Before the patient commences to inhale he is informed af the fact that while he will be unconscious of pain, he will know full or partially well any touch upon his person ; that the inhalation must be vigorously kept up during the whole operation, without for an instant stopping ; that the more energetically and steadily he breathes, the more perfect the effect. It is obligatory to do so, on account of its evanes- cent effects, which demand that the patient be pushed by the operator over energetic appeals to ' go on.' It is very difficult for any one to respire over one hundred times to the minute, as he will become by that time so exhausted as not to be able to breathe at all. For the next minute following the comple- tion of the operation, the subject will not breathe more than once or twice. Very few have force enough left to raise hand or foot. The voluntary muscles have nearly all been subju- gated and overcome by the undue effort at forced inhalation of one hundred and seventeen, the normal standard. " The heart's action is not increased more than from seventy (the average) to eighty and sometimes ninety, but is much LOCAL ANESTHESIA. 229 enfeebled, or throwing a lesser quantity of blood. The face becomes suffused, as in blowing a fire or in stooping, which continues until the breathing is suspended, when the face becomes paler. (Have not noticed any purple, as from as- phyxia by a deprivation of oxygen.) The vision becomes darkened, and a giddiness soon appears. The voluntary mus- cles farthest from the heart seem first to be affected, and the feet and hands, particularly the latter, have a numbness at their extremities, which increases until, in many cases, there is par- tial paralysis as far as the elbow, while the limbs become fixed. The hands are so thoroughly affected, that when open the patient is powerless to close them and vice versa. There is a vacant gaze from the eyes, and a looking into space without blinking of the eyelids for a minute or more. The head seems incapable of being held erect, and there is no movement of the arms or legs, as is usual when in great pain. There is no dis- position on the part of the patient to take hold of the operator's hand or interfere with the operation," Dr. Bonwell bases his method on the following theory: — 1. Diversion of the will-force in the act of forced respiration at a moment when the heart and lungs have been in normal reciprocal action (twenty respirations to eighty pulsations); which act could not be made and carried up to one hundred respirations per minute without such concentrated effort that ordinary pain could make no impression upon the brain while this abstraction was kept up. 2. There is a specific effect resulting from enforced respira- tion of one hundred to the minute, due to the excess of carbonic acid gas set free from the tissues, generated by this enforced normal act of throwing into the lungs yf-z/^ times the normal amount of oxygen demanded in one minute, when the heart has not been aroused to exalted action, which comes from violent action in running, or where one is suddenly startled; which excess of carbonic acid cannot escape in the same ratio from the lungs, since the heart does not respond to the pro- portionate overaction of the lungs. 3. "Hyperaemia is the last in the chain of effects; which is 230 DENTAL MEDICINE. due to the excessive amount of air passing into the lungs, pre- venting but little more than the normal quantity of blood from passing from the heart into the arterial circulation, but damming it up in the brain, as well as throughout the capillary and ve- nous systems as well as upon the heart, the same as if it were suspended in that gas outside the body." Dr. A. Hewson agrees with Dr. Bonwell as to the efficacy of rapid breathing as a pain obtunder, yet he differs with him as to the theory or nature of the changes in the different symptoms brought about during its progress. Says Dr. Hew- son : " Every circumstance would therefore seem to indicate that this process of inducing insensibility to pain is one essen- tially of diminished oxidation and decarbonization of the blood, and recognizing such a state as belonging to the initia- tive stage of all anaesthetics, when insensibility to pain is positively marked, we have no necessity for begging any spe- cial theory for this process, as in its action it readily comes under the category of such agents, and is thus not either an absurdity or an impossibility from a scientific point of view." ALCOHOL. Formula. — CgHjHO. Sp. Gr. of officinal alcohol, 0.820; of rectified spirit — Spiritus Rectificatus, 0.838 ; of stronger alcohol, — Alcohol Fortius, 0.817; of diluted alcohol — Alcohol Dilutum (equal parts of alcohol and distilled water), 0.928. Derivation. — Alcohol is obtained from vinous or fermented liquors by repeated distillations, and, in its officinal form, con- tains about fifteen per cent, of water. It is colorless, inflam- mable, wholly vaporizable by heat, and unites in all propor- tions with water and ether. It frequently contains such im- purities as fusel oil or amylic alcohol (obtained from fermented grain or potatoes), the presence of which can be detected by agitating the alcohol with sulphuric acid, when the former becomes colored. Stronger Alcohol. — Alcohol Fortius — Absolute Alcohol — is obtained by agitating the officinal alcohol with heated carbonate of potassium. Sp. Gr. 0.794, when containing no water. ALCOHOL. 231 Medical Properties and Action. — All the different forms of alcohol, including brandy — Spiritns Vini Gallici (the spirit ob- tained from fermented grapes by distillation, and containing 45 to 55 per cent, by volume, of absolute alcohol); whiskey — Spiritns Frumenti (the spirit obtained from fermented grain by distillation, and containing from 50 to 58 per cent, by volume, of absolute alcohol); wine — Vinum (the fermented juice of the grape, and containing alcohol in varying proportions), are powerful diffusible stimulants, increasing the action of the heart and arteries, exciting the nervous and vascular systems, and causing a general exhilaration of spirits. Excessive quan- tities produce the effect of narcotic poisons, ending in coma and death. The habitual use of alcoholic drinks causes most injurious effects upon the system generally, and directly upon the mucous coats of the stomach, deranging and destroying its functions and structure, resulting in dyspepsia, followed by cirrhosis of the liver and kidneys, loss of mental and physical strength, derangement of the nervous system, and, at last, delirium tremens. When properly administered in diseased conditions, however, alcoholic preparations are valuable agents. Therapeutic Uses. — The different forms of alcohol are em- ployed as stimulants in acute inflammations, such as pneumo- nia, pleurisy, bronchitis, pulmonary affections of children, etc., etc., and in rheumatic pericarditis, in the latter stages of typhus and typhoid fevers, diphtheria, acute neuralgia, convulsions of dentition, tetanus, asphyxia from cold, pyaemia, etc., etc. Ex- ternally in superficial inflammation, bruises, sprains, ptyalism, gout, cerebral affections, bed-sores, etc., etc. According to Bartholow, alcohol is an excellent haemostatic for restraining oozing from a large surface, and an efficient antiseptic dressing, as it destroys germs, removes fetor, and stimulates the tissues to more healthy growth. Dental Uses. — Alcohol, as a narcotic, is employed to relieve pain. In combination with tannic acid or chloride of zinc, it obtunds the sensibility of dentine ; as a styptic, it arrests hem- orrhage from relaxed tissues, coagulating the blood by its 232 DENTAL MEDICINE. effect on albumen, and causing contraction of the mouths of the vessels by its astringent property. Equal parts of alcohol and water make an excellent application as an evaporating lotion, for the relief of superficial inflammations, its antiseptic properties rendering it useful as a mouth-wash when the secre- tions are vitiated and the surfaces of the mucous membrane soft and spongy. It is also useful for cleaning pulp-canals as a preparatory treatment to the use of the more active antisep- tic agents, such as the bichloride of mercury. For suppurating wounds, it is a useful antiseptic dressing, as it destroys germs, removes fetor, and stimulates the tissues to a more healthy action. It also favors the cicatrization of open wounds, coag- ulating the albumen, and forming an impermeable covering^ In mercurial salivation (mercurial stomatitis), it forms an ex- cellent gargle. For softened and sensitive dentine, and for drying cavities preparatory to filling them, the stronger or absolute alcohol is employed. A simple method of preparing this form of alcohol is to add one part of carbonate of potassa to four parts of the ordinary or officinal alcohol. Owing to the great affinity car- bonate of potassa has for water, it abstracts the latter from the alcohol to a sufficient degree to answer all practical purposes. The cavity of a tooth is first dried with cotton and bibulous paper, and then bathed with the absolute alcohol, which at once evaporates, and causes the almost perfect absorption of moisture. Brandy and water form, in combination, an excellent lotion for mercurial and other forms of stomatitis. DENTAL FORMULA. For Obtunding Sensitive Dentine. For Obtunding Sensitive Dentine. R. Alcohol (absolute) . ^ss R. Alcohol (absolute) . gss Acidi tannic! . . . . 3 ss Zinci chloridi . . . 3 ss Glycerini ^ss. M. Glycerini ^ss. M. For Superficial Inflammations. For Mercurial Stomatitis. R . Alcohol, U . Spts. vini gallici . . i part Aquae . . . aa . . ^ ss. M. Aqn9e .... 4 to 6 parts. M. SiGNA. — To be applied as a lotion. SiGNA. — To be used as a gargle. ALOES. 233 Antiseptic Mouth Wash. Gum camphor . . . §ss Gallipe and Malassez. Tinct. opium . . . . ^j R. Alcohol 370 parts; Oil cloves ^ss. Carbolic acid . . 10 parts; Apply in the cavity on a pledget of cotton. ThjTnol 5 parts ; For Odontalgia. Oil of peppermint . 15 parts; Dr. J. N. Harris. Tincture of arnica. 100 parts. M. ^ Alcoholis (best) . . gj This may be colored with tmcture of Chloroformi . . . . .^ij ^°^^i°^^l- Etheris Sulph. . . . ^ ^ SlGNA.-Use twice a day and at same Camphone (gum) . . ^ss time rinse out the mouth with a weak Tinct ooii 5 '/ solution of boric acid. qj^^^ caryophilli ". ". 3 ss M. For Pain After Extraction of Teeth. SiGNA.— Apply to cavity, and soon as pain ceases, fill the cavity with cotton Dr. T. B. Welch. *^ . ^ , .^, u r -^ ^ 1 moistened with carbolic acid and oil R. Alcohol (best) . . . ^j of cloves; drop on this cotton sand- Chloroform . . . . ^ ij arach varnish, and allow it to remain Sulphuric ether • • • "a^i 20 or 30 minutes. ALOE— ALOES. Source. — Aloes is the inspissated juice of the leaves of the Aloe Socotrina, and contains a bitter precipitate known as aloin, and also a volatile oil, to which its odor is due. Its prepara- tions are purified aloes — aloe ptirificata ; watery Extract of Aloes — Extractmn Aloes Aqiiosttm ; Tincture of Aloes — Tinc- tura Aloes ; also a number of pilular forms, and a tincture combined with myrrh — Tinctura Aloes et Myrrhae, and wine of aloes — Vinum Aloes. Purified Aloes is in the form of pieces of a dull or reddish-brown color, very brittle and soluble in alcohol, and a very bitter and disagreeable taste. Medical Properties a?id Action. — Aloes is a stomachic tonic and purgative, being principally employed for the latter effect. In large doses its action is that of a powerful purgative, and hence it is contraindicated in irritable or inflammatory condi- tions of the stomach. It stimulates the functions of the liver, and increases the flow of bile as well as the intestinal secre- tions generally. Its chief effects are on the large intestine, increasing its peristaltic movement, and causing tormina and tenesmus with heat and irritation of the rectum. It also in- creases the menstrual flow and the blood supply of the pelvic 234 DENTAL MEDICINE. organs. It requires some ten or twelve hours to produce its cathartic effects. A purgative action may be induced by ap- plying it to an exposed surface. In moderate laxative doses the stools are not liquid and but slightly altered in character. It is commonly administered in small doses in combination with nux vomica. Therapeutic Uses. — Aloes is very efficient in constipation dependent on weakness of the muscular layer of the large intestine. It is also employed in jaundice, atonic dyspepsia, hemorrhoids without active pelvic congestion, amenorrhoea dependent upon anaemia, menorrhagia in debilitated conditions, gonorrhoea, catarrh of uterus, etc. Dose. — Of Aloe purificata, grj to v ; extractum aloes aqiiosum, gr. ss to iij ; Tinctura Aloes, f5ss to ij ; Tinctura Aloes Myrrhae, 5ss to 5ij ; Vinum Aloes, 5j to oss. ALUMEN— ALUM. Formula.— Mi^YL^^l^O^ 1 2H2O. Source. — It is found native in Italy, in the neighborhood of volcanoes, and is the mineral from which the metal aluminium is obtained. Derivation. — Alum is also obtained from aluminous slate, shale or schist, from which it is obtained by the process of roasting and exposure to the air. Alum is a white, slightly efflorescent salt, which crystallizes in regular octahedrons. It possesses an astringent, acid, and sweetish taste. It is insoluble in alcohol, but dissolves in from fourteen to fifteen times its weight in cold, and three-fourths of its weight of boiling water. Medical Properties and Action. — Alum is astringent and styptic, and is employed both externally and internally. When taken internally, it is absorbed into the system, and has been detected in the liver, spleen and urine. Excessive doses cause vomiting, griping, purging, and inflammation of the gastro- enteric mucous membrane. Powdered alum, in doses of a teaspoonful, is an efficient emetic. It coagulates albumen, and causes an abundant flow of saliva, coagulating the albumen ALUM. 235 of the saliva and buccal mucus in whitish, membranous flakes. Its astringent influence is chiefly upon mucous surfaces. Applied locally to relaxed or bleeding parts, it corrugates the surrounding tissues and causes contraction of the capillaries, and, in this manner, acts as an astringent. Therapeutic Uses. — Alum is internally administered in diar- rhoea, chronic dysentery, colica pictonum, catarrh of the stom- ach, etc. Externally it is applied in ulcerated and relaxed throat affections, ptyalism, gonorrhoea and gleet, uterine hem- orrhage, morbid growths, haematuria, ophthalmia, chronic whooping cough, chronic skin diseases, chilblains, ulcers, hospital gangrene, etc., etc. Dose. — Of alum, gr. x to 3j or 3ij, in powder, or solution in water, or in some simple infusion. Ammonia Alum — Sulphate of alumina and ammonia — Alimiince et AmmonicB Sulphas — is prepared by adding sulphate of ammonia to a solution of sulphate of alumina. Dried Alum — Aliimen Exsiccatum (alum deprived of its water of crystallization by heat) — is employed externally as a mild escharotic, to destroy exuberant granulations, etc. Dental Uses. — Alum is employed in dental practice as a styptic in alveolar hemorrhage ; as a gargle in stomatitis, ulceration, and sponginess of the gums, morbid or fungous growth of gums, dental pulp, etc., superficial hemorrhage from the mucous membrane of the mouth, ulcers of the mouth, cancrum oris, odontalgia, etc., etc. In congested conditions of the mucous membrane of the mouth and throat, alum gargles afford great relief Powdered alum added to liquor sodae chlorinatai (Labarraque's Solution), is an excellent bleaching application for discolored necrosed teeth. The habitual use of alum as an ingredient of a dentifrice is injurious to the teeth, on account of the sulphuric acid it contains. Potassi alum — Aliiminii et Potassii Sulphas — the alum of commerce (which has been superseded by ammonia alum, 236 DENTAL MEDICINE. will render plaster casts hard, when they are boiled in a strong solution for jjalf an hour. DENTAL FORMULA. For Odontalgia. ' For Inflamed and Ulcerated Mucous R. Pulveris aluminis . . ^ij Membrane and Gums. Athens nitrici . . . gvij. M. R- Pulveris aluminis . . gr. Ixxx SiGNA.— To be applied on a pellet of Aquae destillatse . . f|x. M. cotton. SiGNA. — To be applied as a mild, astrin- gent gargle. For Ulceration of the Gums and Mucous pgy Ulcerated and Spongy Gums. Membrane of the Mouth. j> _ Aluminis Z i Oj 3y ^ij. M. R. Aluminis ^j Vini Zinci sulphatis . . . ^ss Tinct. cinchonse Sodii borat gr-iv. Tinct. myrrhse . Aquse rosffi ^viij. M. Mel. rosse . . . SiGNA. — To be applied as a lotion. SiGNA. — To be used as a gargle. For Inflammation and Ulceration of the Mouth and Throat. R ■ Infus. lini § ^"^ Tinct. kino ^j Aluminis ^^^ij. M. SiGNA. — To be applied as a gargle. ALUMINA ACETAS— ACETATE OF ALUMINA. Formula. — AI2O32C4H3O34-4HO. Derivation. — The salt, Acetate of Alumina, is obtained by the direct combination of hydrated alumina with acetic acid, or by reaction between sulphate of alumina and acetate of lead. The solution, when properly prepared, is a clear fluid, of a sharp, sweetish, astringent taste, and a distinct odor of acetic acid. When it is evaporated, there is deposited light, fragile, glossy scales, which are perfectly soluble in water, and not readily affected by the atmosphere. Medical Properties and Action. — It is disinfectant and anti- septic. In maximum doses it produces an unpleasant sensation of warmth and fulness in the stomach, and, at the same time, vertigo and confusion of the senses, which may continue for several hours. Therapeutic Uses. — Acetate of alumina is rarely employed internally, and only for zymotic and contagious diseases. It is generally used externally, and is a very effectual remedy in ALUMINII SULPHIS. 237 the treatment of wounds, preventing pyaemia in suppurating wounds and ulcers. It is also applied in parasitic skin affec- tions, as an injection in gonorrhoea, and for the destruction of animalculje in putrescent fluids. As a surgical dressing, it is used by keeping the wound saturated with a solution of moderate strength, or by irrigation. A concentrated solution will preserve anatomical subjects for a considerable time. Dose. — Of acetate of alumina, gtt. xx to gtt. 60 of the SDlution. Detttal Uses. — Acetate of alumina is useful in dental practice, as an antiseptic and disinfectant in cancrum oris, ulcers of the mouth, suppurating wounds of mucous membrane, pyorrhoea alveolaris, alveolar abscess, etc. A very weak solution has been employed as a mouth wash for offensive breath depending on scrofulous ulcerations, aphthae, caries of the teeth, or the wearing of artificial teeth. SULPHITE OF ALUMINIUM— ALUMINII SULPHIS. The sulphite of aluminium is a new antiseptic, being a sul- phurous salt of aluminium ; that metal uniting with acids to form salts in the proportion of two molecular equivalents of the base and three of the acid. The persulphite may be made by adding sulphurous acid to the undried sesquisulphite to solution and crystallizing without heat ; or by precipitating the persulphite from solution with alcohol, filtering or decanting, washing the precipitate with alcohol and drying on bibulous paper. The sulphurous salts of aluminium are the best repre- sentatives of its antiseptic, therapeutic properties, two being pro- duced — the sesquisulphite and the persulphite; the former being insoluble in water, while the sulphite is soluble. Three hundred times as much of the sesquisulphite of aluminium can be admin- istered with safety as of the bichloride of mercury, and while the latter is two and a half times as active as the aluminium salt in equal quantity, the difference in dose permissible favors the relative efficiency of the latter ; and the same relations exist in the topical use of these two agents. The insoluble sesquisul- phite may be made by taking the theoretical quantities of 238 DENTAL MEDICINE. potassic alum and sulphite of sodium and mixing their solu- tions in water; the precipitate to be washed and carefully dried. The proportion is ten parts of alum and eight of sodium sul- phite. These aluminium salts are applicable to almost every conceivable condition where an antiferment is indicated. AMMONIUM— AMMONIA. Formula. — N H3. Ammonia, often called ammoniacal, or ammonia gas, is colorless and readily soluble in water, and forms a number of volatile stimulants, such as Aqua ainmonicE — ammonia water, which is the stronger water of ammonia diluted with two parts of water; Aqua ammonicB fortior — stronger water of ammonia, is made by passing ammonia gas into water to make its specific gravity, O.900 at 59° F, ; Spiritus ainmonicz — which is a ten per cent, solution of ammonia gas in alcohol ; Spiritus aniinoni(2 aromaticus, which is an alcoholic solution of carbon- ate of ammonium, to which are added oils of lemon, nutmeg and lavender. (See also muriate of ammonia, sal ammoniac, carbonate of ammonium, solution of acetate of ammonia, spirit of mindererus, chloride of ammonium, and valerianate of ammonium.) Medical Properties and Action. — Ammonia gas is very al- kaline, and an irritant to mucous surfaces. Inhaled, it causes an overpowering sense of suffocation and spasm of the glottis, and when prolonged, violent inflammation of the air-passages. Solution of ammonia when swallowed causes destructive in- flammation of the mucous membrane, extending to the stomach. The long-continued use of ammonia interferes with digestion by neutralizing the gastric juice, and by in- creased waste of tissue causes pallor, emaciation and feeble- ness. In the blood it injures the red blood globules, and thus affects the nutrition of the body, being largely converted into urea. The preparations of ammonia are stimulant expectorants. Therapeutic Uses. — Aqua ammonia is administered by in- halation in syncope and shock, and as a counter-irritant ; for which purpose ammonia liniment is also employed. The in- SOLUTION OF ACETATE OF AMMONIA. 239 cautious inhalation of ammonia may cause inflammation of the fauces and glottis, but when cautiously employed some- times gives relief to acute catarrh and hay asthma. The di- luted aqua ammonia will relieve the pain of stings of insects, and the strong aqua ammonia is an antidote, when at once applied, to the bite of venomous snakes, and of rabid animals. The aromatic spirits of ammonia is useful in acidity of stomach, gaseous eructations and abdominal distension ; also in sick headache, and migraine; but the bromides are more effective in the latter affection. Ammonia salts stimulate the liver and increase the secretions of the kidneys and intestinal mucous glands and the action of the heart, hence are frequently used in adynamic states, constipation, coated tongue and scanty urine. The preparations of ammonia for internal use correct obsti- nate vomiting when the irritating substances are removed, and the raatters vomited are acid. Dose. — Of Aqua Ammonise, Ttlv to 5ss, much diluted; of Spiritus Ammonise, TTtx to f5j, greatly diluted; of Spiritus Ammonise Aromaticus, f5ss to foij. Dental Uses. — Ammonia is used as a stimulant in danger- ous narcosis ; to prevent syncope or severe shock ; in facial neuralgia, especially the chloride, and in periodontitis when it is combined with aconite and opium. Aqua ammonia is locally applied as a counter-irritant to the gums in acute in- flammation of the peridental membrane. (See Acetate, Car- bonate, Valerianate and Chloride of Ammonium). LIQUOR AMMONII ACETATIS— SOLUTION OF ACETATE OF AMMONIA. SPIRIT OF MINDERERUS. Formula. — NH^C2H302. Derivation. — Spirit of Mindererus is obtained by saturating diluted acetic acid with carbonate of ammonia, being a solu- tion of the acetate of ammonia. It is a colorless liquid, with a saline taste, and requires to be freshly made when about to be used. Medical Properties and Action. — It is refrigerant, diaphoretic, 240 DENTAL MEDICINE. and diuretic, and its action can be greatly increased by com- bination with other remedies. Few medicines are in more general use. Therapeutic Uses. — Spirit of mindererus is employed in the treatment of febrile and inflammatory affections, and exanthe- mata, sick headache, catarrh and influenza, etc., etc. Externally it is used as a lotion to sprains, bruises, glandular enlarge- ments, etc. Dose. — Of spirit of mindererus, f5j to fSj. Dental Uses. — A lotion composed of one part to ten of water is a serviceable application in inflamed conditions of mucous membrane. Internally administered as a refrigerant, it is useful in acute periosteal inflammation, inflammation of the dental pulp — pulpitis, and is a diaphoretic and refrigerant in periodontitis, when it may be combined with either aconite or opium, or both. AMMONII CARBONAS— CARBONATE OF AMMONIUM. Formula. — N^H^gCgOg. Derivation. — Carbonate of Ammonium is a sesquicarbonate, and is obtained by subliming a mixture of chloride of ammo- nium and chalk. It is in the form of white, translucent masses, with a pungent, ammoniacal odor, and an acrid, alkaline taste. It is soluble in water, and on exposure to the air it becomes opaque and falls into powder, losing its ammonia. Medical Properties and Action. — It is antacid, stimulant, dia- phoretic and expectorant, and it is considered to be especially useful in cases where the vital powers are greatly depressed. In large doses it causes colic, convulsions and great dis- turbance of the nervous system, and when long continued, an annoying itching of the scalp, and skin over the surface of the body. It has a tendency to fluidify the blood. Inter- nally, as a diffusible stimulant, it is preferred' to solution of ammonia. Therapeutic Uses. — It is internally administered in diabetes, scrofula with languid circulation, asthma, pneumonia, croup, CHLORIDE OF AMMONIUM. 241 chorea, diseases of the skin, puerperal insanity, mercurial erethism, drunkenness, etc., etc. Externally it is employed as a volatile or smelling salts, in syncope, hysteria, and asphyxia. Dose. — Of carbonate of ammonium, gr. v. to gr. x, in pill or in solution with gum and sugar. Dental Uses. — It is a useful internal remedy in cancrum oris, in doses of gr. v, gradually increased to gr. x, every two or three hours, using strong nitric acid as a local application. It is also a very useful remedy in mercurial erethism, in conjunc- tion with camphor and other stimulants ; also as a stimulant in dangerous narcosis from anaesthetic agents. AMMONII VALERIANAS— VALERIANATE OF AMMONIUM. Formula. — NH^CsHjOg. Derivation. — Valerianate of ammonium is obtained by com- bining valerianic acid with a strong solution of ammonia and evaporating to a syrupy consistence ; it is also obtained by sub- jecting the monohydrated acid to the action of dry, gaseous ammonia. It is in the form of a white salt, in quadrangular plates, with the odor of valerianic acid, and a sharp, sweetish taste. It is soluble in water and alcohol. Medical Properties and Action. — It is stimulant, nervine, and antispasmodic. Therapeutic Uses. — It is employed in neuralgia, nervous head- ache, hysteria, epilepsy, chorea, etc., etc., especially for females. Dose. — Of valerianate of ammonium, gr. ij. to gr. viij,in pill or elixir, with aromatics (valerianate of ammonium 5j, fluid extract of vanilla f^ss, tincture of cardamom fSvj, curacoa f5ij, water f^iv — Misce. Dose, a teaspoonful three times a day). Dental Uses. — It is internally administered for neuralgia. AMMONII CHLORIDUM— CHLORIDE OF AMMONIUM. MURIATE OF AMMONIA — HYDROCHLORATE OF AMMONIA — SAL AMMONIAC. Formula. — NH^Cl. Derivation. — Chloride of Ammonium is obtained by neu- i6 242 DENTAL MEDICINE. tralizing hydrochloric acid with ammonia, and evaporating to dryness. It is in the form of a snow-white, crystaUine powder, soluble in two and a half parts of cold water, and sparingly soluble in alcohol. It has a pungent, saline taste. Medical Properties and Action. — In large doses it is an irritant poison, with a purging action ; but in small doses it is a power- ful resolvent alterative ; it is also refrigerant and anodyne. Its action upon the system closely resembles that of mercury as an alterative. Externally it is used as a discutient application, and as a cold lotion in fevers, hernia, etc. Therapeutic Uses. — It is employed internally in amenorrhoea, rheumatic affections, chronic bronchitis, pneumonia, dropsical affections, hemorrhages, whooping cough and myalgia. Ex- ternally in abscesses of the mamma, skin diseases, ecchy- mosis of the eye, hydrocele, senile gangrene, gonorrhoea, leucorrhoea, etc. Dose. — Of chloride of ammonium, gr. v-xxx, every two or three hours, in powder or mucilage. Dental Uses. — It is employed in facial neuralgia, in doses of 5ss, repeated four times daily. Externally it is used as an application to indolent ulcers, for its stimulating effect. As a gargle, it is employed in the strength of 5ss to §xij of water. It is also applied to cancerous tumors, and has been used to restore zinc which has become deteriorated from long use in laboratory work. Chloride of ammonium (sal ammoniac) is also used as a flux, in refining gold for laboratory use. AMYLENE. Formula CgH^,,. Derivation. — Amylene is obtained by distilling amylic alcohol with chloride of zinc. It is a colorless, very mobile liquid, with a boiling point of 102°, and the density of its vapor 2.45. It has a very peculiar and disagreeable smell. Medical Properties and Action. — Amylene was introduced as an anaesthetic in 1856, by the late Dr. Snow, who regarded it as possessing the following advantages : the safety of ether, AMYLENE. 243 absence of pungency and irritating property, readiness with which the absence of pain is obtained, with less coma than with chloroform or ether, the speedy recovery from its effects, less nauseating, and less headache and rigidity and struggling than in the case of ether or chloroform. Others, however, have not been so much impressed with this anjesthetic agent as was Dr. Snow ; hence, it has not been regarded with the same favor as other agents of this class. An extreme quantity being required to produce complete insensibility to pain, its operation is considered to be dangerous. Therapeutic Use. — As an anaesthetic. Hydrate of Aniylene is a tertiary alcohol first prepared by Wurtz. It is a colorless, watery-looking fluid, with a sharp taste and smell, and is soluble in eight times its volume of al- cohol. It is generally regarded as a safe and reliable narcotic and hypnotic, sleep being produced in from fifteen to forty- five minutes, and sometimes almost instantly. Where large doses are given, sleep may be induced in five or eight minutes, and as a rule its actions are prompt and safe. Contra-indi- cations of the drug have not yet been observed, but in cases of severe gastric troubles and ulcerations of the pharynx, it should be given per anus. Its action may be briefly summed up as follows : 1. Hydrate of amylene is a hypnotic whose action can be confidently relied upon when sufficiently large doses are given. Experiments have shown that it is not so strong as chloral, yet stronger than paraldehyde. 2. Hydrate of amylene also acts upon persons who are ac- customed to the use of hypnotics, although the dose employed in such cases must be comparatively large. 3. Sleep occurs soon after the administration of the drug, and is not preceded by any period of excitement. The sleep produced is light or heavy, according to the dose given ; yet it is always easy to awaken the patient. Upon waking, the patient is perfectly sensible and bright, but if not disturbed further will at once fall asleep again. 4. Sleep lasts from two to three hours if small doses have 244 DENTAL MEDICINE. been given, or from six to eight hours under the influence of larger doses. 5. The awaking is similar to that from natural sleep. The patient feels rested and strengthened. No headache or weak- ness was ever observed. 6. The respiration remains unchanged. 7. The change in the pulse's frequency and in the pressure of blood is no more than that which accompanies natural sleep. 8. The patients were never observed to wake up with a bad taste in their mouths and complaining of a disagreeable smell, symptoms which nearly always follow the use of paraldehyde. 9. Whether or not a habit and tolerance for the drug may be formed remains yet to be seen. As yet, even when the dose has been used continually, an increase of dose was never found necessary. Dose. — Of hydrate of amylene grs. xii to grs. xxxvii. It m.ay be administered in gelatin capsules containing 15^ grains each, or in the fluid form mixed with claret and water, or raspberry syrup. AMYL NITRIS— NITRITE OF AMYL. Formula. — CgHi^NOg. Sp. gr. 0.877. Derivation. — Nitrite of Amyl is obtained by heating one part of strong nitric acid with two parts of rectified fusel oil, until reaction commences, when the heat is withdrawn, and afterward re-applied. The distilled portion obtained below 212° F. is rectified by means of carbonate of potassium, and that portion only distilling between 200° and 206° F. is re- served, being a nitrate of the oxide of amyl. It is a yellowish or amber-colored liquid, somewhat oily, very volatile and in- flammable, and boils at 182° F. It has an odor like that of ripe pears, and belongs to the class of compound ethers. Medical Properties and Action. — It is used by inhalation, causing an accelerated action of the heart, sudden flushing of the face, dilatation of the arteries, paralysis of the action of the smaller arteries, a sense of great fullness of the brain, a lowering of the blood pressure and temperature, and com- NITRITE OF AMYL. 245 plete resolution of the muscular system. The vapor of nitrite of amyl, when applied directly to the muscular or nervous tissues, arrests their functional activity, and, circulating in the blood, appears to act most on the vaso-motor system and unstriped muscular fibre. It affects respiration and the com- position of the blood, producing headache, which is often pro- longed. Therapeutic Uses. — Being a powerful stimulant to the heart, it is an antidote to chloroform and cocaine. A case is men- tioned in the Bntish Medical Journal, w\verQ,d\\rmgc\\\ovo{orvs\ narcosis, respiration ceased, and artificial respiration failed to restore the patient. Some nitrite of amyl was then poured on lint, and held to the patient's nostrils. In ten seconds there was a flushing of the face, the pulse was again felt, and respi- ration was restored. When from two to five minims are poured on lint and applied to the nostrils, the heart's action will be accelerated, a sudden flushing of the face takes place, dilatation of the arteries results, also a fall in the blood pressure and a lowering of the temper- ature, and complete muscular relaxation. As a remedy for chloroform narcosis, it is supposed to antagonize cerebral anaemia by causing capillary dilatation and thus promoting the inflow of blood to the brain. By inhalation, for relieving the pain of angina pectoris, and preventing epileptic seizures; also used in asthma, strychnia poisoning, hydrophobia, tetanus, epileptic attacks, and in many other convulsive or spasmodic diseases. Dose. — Of nitrite of amyl, TTLij to TTLv, by inhalation ; not more than TTL. iij should be administered, unless the patient has been accustomed to its use. Dental Uses. — As an antidote for chloroform narcosis, for the relief of epileptic attacks during the extraction of teeth, for relieving the pain of neuralgia of the fifth pair of nerves, and for restoration from syncope. As nitrite of amyl is a powerful and dangerous agent, care must be observed in its use, and but small doses applied at first, as some patients, especially the weak and nervous, are very susceptible to its influence. 246 DENTAL MEDICINE. ANTHEMIS— CHAMOMILE. Source. — The flowers of the Anthemis Nobilis. A German variety is known as Matricaria, which is similar to Anthemis in its effects. The herb chamomile has a fragrant odor and a bitter aromatic taste. A volatile acid is obtained from the flowers, which is similar, if not identical, with valerianic acid. Medical Properties and Therapeutic Uses. — Chamomile is a mild tonic in small doses, but in large doses may act as an emetic. It is used in the form of a cold infusion in enfeebled digestion, flatulent colic and infantile disorders connected with digestive derangement. It is also employed in the form of infusions prepared with hot water and vinegar, for the re- lief of pain of boils, abscesses, etc. When employed for the relief of odontalgia in the form of fomentations to the face, there is danger of the abscess pointing externally; it is also applied to flabby, ill-conditioned ulcers as a gentle incitant. The tepid infusion will promote the operation of emetics. Dose. — Of the powder as a tonic, 5ss to 5j. It is generally employed in the form of infusion. ANILINE. Formula. — CgHyN. Derivation. — Aniline is an alkaloid obtained by the destruc- tive distillation of various organic substances. It is a volatile, colorless, pungent liquid generally derived from coal tar. Medical Properties and Therapeutic Uses — Professor Stilling claims that wounds and suppurating ulcers, especially those in and about the eye, treated with aniline may be entirely sterilized by the solution penetrating everywhere, and the suppuration be entirely arrested. When the pus is deep in the tissue, injections of aniline solution should be employed, or the introduction of aniline crayons, or bathing with con- centrated solutions. In many cases application of a powdered aniline is very efficacious. These aniline colors are destitute of all toxic action ; they are very diffusible, and they do not coagulate albumen. These colors are, however, soon decom- ANTIFEBRIN— ACETANILIDE. 247 posed by exposure to light, and they should therefore be protected. Dental Uses. — But two of the basic aniline coloring-matters, methyl-violet {'py6kt^mn) and niethyleneblue , have been tested as antiseptics, and although highly recommended by Prof Stilling, they have not, in the experiments of Prof W. D. Miller, when employed as antiseptics in the treatment of the dental pulp, given satisfactory results, as they did not appear to penetrate the pulps to a depth of more than a quarter of an inch, and showed no preservative action. (See Pyoktanin.) ANTIFEBRIN— ACETANILIDE. Formula. — C2H3NO. Antifebrin, as Acetanilide is commonly called, is a white crystalline powder composed of colorless scales or plates sim- ilar to boric acid. It is slightly soluble in water, but readily soluble in alcohol, and has a burning but not disagreeable taste. Chemically it is aniline. Medical Properties and Therapeutic Uses. — In regard to its properties as an antipyretic opinions differ, but it is generally regarded as being more powerful than antipyrine. It in- creases the intra-vascular blood pressure, and the action of the central nervous apparatus, but a quantitative decline en- sues in the functions of motility and sensibility until they are altogether suspended. The quantity required to produce antipyretic effects varies from four to eight grains, the latter dose lessening fever heat effectively, as it reduces the tempera- ture and pulse-rate. It is employed in fevers, neuritis, neural- gia, myalgia, locomotor ataxis, herpes zoster, migraine, sciatica, epilepsy, etc. Three to five grain doses ter die will relieve the pains of inflammations, such as neuralgia, myalgia, migraine, etc. Dental Uses. — Antefebrin has been employed successfully in acute periodontitis, five to eight grains causing a quiet sleep with no return of the pain. It is also administered for pulpi- tis, etc. 248 DENTAL MEDICINE. Dose of Antefibrin. — Grs. v to grs. viij. A Convenient Prescription of Antifebrin. Dr. E. L. Clifford, R. Antefibrin (Acetanilide) 3J Sp. vini gallici . . . 5 iv. ss Syr. Simp Aquse aa ^vj. M. S. A tablespoonfiil contains five grains, an adult dose. ANTIKAMNIA. Formula. — CnH2n-6. Antikamnia is a combination of coal tar derivatives into which the amnines have entered, forming various amido com- pounds. It has as its base the derivatives of the amido-benzoles so combined, it is claimed, as to obviate the bad effects caused by many of this series of organic bodies when administered alone. It is in the form of a white powder with a pungent taste. Medical Properties and Therapeutic Uses. — Antikamnia is an antipyretic, analgesic and anodyne, and causes a quieting influence upon the nervous system, inducing and promoting sleep. It is employed in neuralgia, myalgia, sciatica, acute rheumatism, hemicrania, typhoid fever; also headache and other neuroses due to irregularities of menstruation ; also in asthma, hay fever, influenza, la grippe and allied affections. Dose. — grs. iij to grs. x, every three or four hours. To Prevent the Disturbance of the Ner- Syr. Aurantii Flor. aa . ^ iv. M. vous System which accompanies the gj^^ Tablespoonful every 3 or 4 administration of quinine : , R . Antikamnia 5 ss Anodyne and Analgesic. Sulphate of quinine . . 9ij. M. ^ Antikamnia .... Make xii capsules, one every 2 q^j^j^ ^^^^-^ ^^ ^ ^^^ or 4 hours as may be indicated. p^j^ j^^^^^ .... grs viii Analgesic and Anodyne. Soda bicarb grs. xij R . Antikamnia 3 ij Ft. viij capsules. Spts. Vin. Gall .... Dose. One capsule every 4 hours. ANTIPYRINE. 249 ANTIPYRINE— DIMETHYLOXYQUINIZINE. Formula. — CaoHigN^Oj. Antipyrine is in the form of whitish or grayish-white crys- talline powder, slightly bitter sweetish taste, and soluble in water. It combines with acids to form salts. Medical Properties and Therapeutic Uses, — Antipyrine is a powerful antipyretic, local anaesthetic, disinfectant, hemostatic and stomachic tonic, and acts as an antiseptic in preventing fer- mentative changes in the intestines. It is also slightly hyp- notic. It stimulates the secretions and readily diffuses into the blood. It first stimulates and then paralyzes the nerve- centres, dilates the cutaneous vessels, and increases the loss of heat by radiation, reducing the temperature rapidly. Some- times it may cause dangerous symptoms, such as a feeble pulse, profuse diaphoresis and collapse. It is employed in typhoid and malarial fevers, pneumonia, phthisis, neuritis, sciatica, locomotor ataxis, neuralgia of the fifth pair of nerves associated with neuritis and sciatica, migrain, acute rheuma- tism, epilepsy, chorea, etc., and as a substitute for morphine, and in the morphine habit. Its administration is soon followed by profuse perspiration, coldness of the surface, slowed pulse, depression, and if fever is present by lowered temperature within a half hour after taking the drug. In health its use may cause slight nausea, singing in the ears, and a slight decrease in the temperature of the body. It has no effect upon respiration, but acts as a seda- tive upon the brain. It is eliminated by the kidneys, appear- ing in the urine about three hours after ingestion. Dose, — Grs. v to grs. Ix, being determined by its uses. Sub- cutaneously injected, it is very effective in painful affections originating in the nerves. The hypodermic use of antipyrine has given very satisfac- tory results in the treatment of nervous articular and muscular pains, gastric affections, bronchial asthma, articular rheuma- tism, chronic lumbago. A painless injection may be made by half-filling a hypodermic syringe with a fifty per cent, solution 250 DENTAL MEDICINE. of antipyrine, which will amount to about five and a half grains ; the|i immerse the syringe into a ten per cent, solu- tion of cocaine, drawing up enough of the cocaine into the syringe to make it about three-fourths full ; this will amount to one-third grain of cocaine. The two solutions readily mix and do not decompose, and may be used as a local anaesthetic. Dental Uses. — Antipyrine is used hypodermically with great success in cases of severe neuralgia of the fifth pair of nerves. Also, in cases of acute pericemental irritation, and in reflex neuroses of dental origin it has given great relief. Fif- teen grains in half an ounce of water have given relief in a case of pericementitis, ceasing in twenty minutes with no re- turn of the pain : but many prefer antifebrin (acetanilide) as being safer than antipyrine. It also has a marked effect in controlling hemorrhage from the gums and alveolar cavities when used as a haemostatic after the extraction of teeth. Prof G. Cesari claims that antipyrine more or less speedily arrests hemorrhage from both large and small blood-vessels when applied in solutions of not less than forty, or, better, fifty per cent. The solution as well as the powder should be applied on pledgets of cotton wool. Antipyrine has also been admin- istered internally with satisfactory results in the treatment of periodontitis ; and in cases where, owing to the severity of the symptoms in the same affection, the internal administration has proven unsuccessful, the hypodermic injection of fifteen grains has afforded relief; or the hypodermic injection followed in one half hour by the internal administration of fifteen grains of the drug will afford relief in cases of acute periodontitis. For Nervous Cases. R . Antipyrine gr. xviij Aq. destillat q.s. ad ft, sol. Ft. sol et adde Acidi valerianici . . . gtt. xv. Shake well and stand aside to allow salt to crystallize. ANTISEPTIC AND STYPTIC COTTON-WOOL. Antiseptic Cotton. — ^First free the ordinary cotton-wool from grease, by macerating it in benzine for ten minutes, press and dry in the air. Then steep the purified cotton, for ten NITRATE OF SILVER. 251 minutes, in a solution of tannin 5, carbolic acid 4, alcohol 50, and castor oil 8 parts. Styptic-Cotton-Wool. — Purify, as before, with benzine, dry in air, and then steep it in a solution of alum 2, water 12, chlor- ide of iron solution 2 parts ; dry at 60° C. AQUA DESTILLATA— DISTILLED WATER. Derivation, — " Take of water 80 pints. Distill two pints, using a tin or glass condenser, and throw them away ; then distill 64 pints, and keep them in glass bottles." — U.S.D. Properties. — Distilled water has a vapid, and by no means pleasant taste, and is only perfectly pure when the vessel used in the distillation is of silver. It should evaporate without residue. Therapeutic Uses. — It is very essential in the preparation of some formulae, and of no use whatever in others, as the com- mon pure water will answer. Such agents as tartar emetic, nitrate of silver, corrosive sublimate, chlorides of calcium, barium, acetate and subacetate of lead, permanganate of potassa, the sulphates of iron and zinc, sulphate of quinia, the salts of morphia, and all the alkaloids and their salts, require, when given in solution, distilled water. Dental Uses. — Distilled water is required in the preparation of many formulae for use in dental practice. ARGENTI NITRAS— NITRATE OF SILVER. LUNAR CAUSTIC. Formula. — AgN03. Derivation. — Nitrate of Silver is obtained by dissolving silver in nitric acid and distilled water, and evaporating the solution. It is in the form of a heavy, colorless, anhydrous salt, and crystallizes in shining, rhombic plates. The action of light and organic matters causes it to turn black. It is wholly soluble in distilled water, the only preparation of water that should be employed in forming solutions of this salt. It has a strong, metallic, styptic taste. In the preparation of the solid form of sticks, it is first melted and poured into moulds, ex- posure to the light causing the sticks to become gray, and 252 DENTAL MEDICINE. more or less dark, owing to the reduction of the silver by the sulphuretted hydrogen contained in the atmosphere ; hence, on account of the decomposition of this salt, it should be care- fully excluded from the light. Medical Properties and Action. — Nitrate of silver is tonic, antispasmodic, sedative and astringent. When applied to the skin, mucous membrane, or ulcers, it produces, at first, a white appearance, owing to its union with the coagulated albumen of the cuticle, but this gradually changes to a bluish-gray, purple, and finally, black color, on account of the partial reduction of the silver by the sulphuretted hydrogen. Small doses, ad- ministered for a long time, give a peculiar blue appearance to the skin. When internally administered, it has an astringent action on the mucous coats of the intestines. It is a power- ful tonic to the nervous system, and has been chiefly em- ployed as an antispasmodic tonic. It is chiefly used ex- ternally, as a stimulant, vesicant, and escharotic. If applied, even lightly, three or four times, to the moistened skin, it will cause vesication in a few hours. The blue appearance on the skin, when small doses are long continued, is said to be pre- ceded by a peculiar blue line on the gums, like that from lead poisoning. A very minute quantity of this salt, when inter- nally administered, is eliminated by the kidneys, as most of it escapes by the liver and the intestinal glands, a portion re- maining permanently deposited in the tissues, when its use has been long continued. Six weeks is the length of time it is safe to continue its internal use, and during that time occa- sional purgatives should be given, to promote its elimination. The persistent use of iodide of potassium and the hyposul- phite of soda will cause the absorption and excretion of the silver deposits, in cases of skin discoloration from its long continued use, aided by baths of the hyposulphites, and the very careful use of lotions containing cyanide of potassium, which possesses a solvent power over silver deposits. As long as inflammation is present, it should not be internally admin- istered, and during a course, it should be occasionally inter- mitted for a few days, and a purgative used. The gums and NITRATE OF SILVER. 253 fauces should be frequently examined, and if the slightest blue discoloration is observed, the remedy should be discontinued. Exposure to the sun should be avoided. Therapeutic Uses. — Nitrate of silver is internally employed in dyspepsia, chronic gastritis, chronic diarrhoea and dysentery, cholera, diseases of the eye, chorea, epilepsy, asthma and whooping cough. Externally in ophthalmia and other diseases of the eyes, cutaneous diseases, diphtheria, erysipelas, hydrophobia, en- largement of glands, diseases of the genito-urinary organs, diseases of the ear, burns, ulcers, hemorrhage, etc., etc. Dose. — Of nitrate of silver, gr. J, gradually increased to gr. ^2 three times a day, in pill made of some vegetable pow- der, or in solution. The fused nitrate of silver — Argenti Nitras Fusa — or solid form, is used externally. Dental Uses. — For inflamed and ulcerated conditions of the mucous membrane of the mouth, nitrate of silver is a valuable application, in the form of injections or solutions of various strengths, from gr. ij to 5ss of distilled water ; also in diseases of the antrum and fistula, as an injection. It is also used as a styptic, for the arrest of alveolar hemorrhage, but is not so re- liable as tannic acid, gallic acid, etc., on account of the coagulum or clot formed by it, being soluble in an excess of albumen. It is also employed to obtund the sensitiveness of dentine, especially where the cause is mechanical abrasion ; also in aphthae, mercurial stomatitis, ulceration of the gums, salivary fistula, alveolar abscess. For obtunding sensitive dentine, the stick form (one end of a stick inserted into a quill, or fused on the end of a platinum wire) is employed ; or the end of a silver wire may be immersed in nitric acid, and applied to the sensitive surface, taking care to limit its action to the part on which it is to act. When applied to sensitive dentine, it acts on the gelatinous portion of the tooth, destroy- ing its vitality to the extent of the combination which takes place. The objection to its use in such cases is the discolora- tion it causes. As salt decomposes the nitrate of silver, a solution of the 254 DENTAL MEDICINE. chloride of sodium will relieve the excessive pain following its applicatioq to sensitive dentine, or to ulcers of the mouth ; such a solution will also remove recent stains, if followed by the application of a solution of ammonia. Old stains may be removed with tincture of iodine, followed by cyanide of potassium. The antidote in cases of poisoning by nitrate of silver is chloride of sodium (common salt), which converts it into chloride of silver, to be followed by emetics, and the proper antiphlogistic treatment. DENTAL FORMULA. For Inflamed and Ulcerated Mucous For Ulcers and Aphthce. Membrane. jg^. Argenti nitratis . . . . ^ss R. Argenti nitratis . gr. ij to ^ss Aquae destillat^ . . . . ^j. M. Aquae destillatee . . . . f^j. M. Signa. — To be applied with a camel- SlGNA. — To be used as a lotion. hair brush. For Diseases of the Antrum. For Mercurial Stomatitis. R . Argenti nitratis . gr.j to gr.v R . Argenti nitratis .... gr.ss Aquae destillatse . . . fgj. M. Aquae destillatae . . . f^j. M. Signa. — To be used as an injection. SiGNA. — To be used as a mouth wash. ARISTOL— DITHYMOL-DIODIDE— DITHYMOL-BINIODIDE. Derivation. — Aristol is obtained by adding a solution of iodine in iodide of potassium, to an equal solution of hydrate of sodium, containing thymol. It is in the form of a red brown precipitated amorphous non-crystallizable powder. The pro- portion of iodine in aristol has been estimated by Carius at 45.80 per cent. Aristol is insoluble in water and glycerine, slightly soluble in alcohol, but readily soluble in chloroform, ether, and in the essential oils ; but the solution must be made by friction without heat, as the aristol is decomposed by heat and also by light. It possesses but a slight odor, like that of thymol, and is not unpleasant. Medical Properties and Therapeutic Uses. — Aristol possesses no irritant action upon the unbroken skin, and when applied to mucous membrane it promotes absorption. Not being absorbed, it has no toxic effect, and for such reason, together with its free- dom from disagreeable odor, it possesses a great advantage over ARISTOL. 255 iodoform. It produces rapid healing, and has been employed with benefit in varicose ulcers as a dusting powder ; also in cutaneous diseases, gonorrhoea, gleet, in operations of anal fistula, abscess, lymphadenitis, periostitis, psoriasis, ulcers, etc., etc. It is chiefly employed as a dusting powder, or in ethereal solutions or ointments, epithelioma, burns and scalds. Aristol is considered to be an excellent and prompt antiseptic, but the name is merely an assumed one for dithymoldic iodine. Impurities in aristol would be all the by-products derived from unskilful treatment; it might contain potassium or sodium iodide, or free iodine ; it might be adulterated even, for, as a patented article, it is above control, as patents have been granted by the U. S. Patent Office for its control, manufacture and sale under the name of " aristol," being a compound of thymol with iodine. The virtues of aristol over iodoform, etc., have as yet not been so pronounced as to exclude it from the general class of patented medicines. Dental Use. — Aristol has been used as a substitute for iodo- form, iodol, carbolic acid, etc., etc., in all cases when the ordi- nary antiseptics are indicated, as in gangrenous pulps, anti- septicizing of root-canals, disinfection of cavities before the introduction of fillings, in the form of a lo per cent, solution in sulphuric ether for disinfecting purposes ; for gangrenous pulps, the aristol in solid form may be applied with a small brush. Sticks made of cacao butter lo parts, and aristol i part, may be used to promote granulation and healing. Aris- tol has the advantage of being effective in small quantities, and may be diluted with sugar of milk. Dr. E. C. Kirk highly recommends aristol for alveolar pyorrhoea, a ten per cent, solution being rubbed upon a glass plate with oil of cinnamon and introduced into each suppu- rating pocket, and around the root at the base of each pocket, on threads of absorbent cotton saturated with the solution ; the oil of gaultheria may be substituted for the oil of cinna- mon if desired. Dr. Kirk and others also recommend aristol in the essential oils as a medicament for canal-dressings, and as a topical dressing in acute pulpitis. Dr. Kirk recommends 256 DENTAL MEDICINE. that as a root-canal dressing, its use should be strictly confined to those case? where pericemental inflammation is not a present factor, as it does not possess antiseptic qualities sufficiently- powerful to overcome quickly septic conditions due to the putrefactive changes common in root-canals. He also finds it extremely valuable in connection with gutta pereha, as an antiseptic in conjunction with permanent root fillings — aristol with chloroform being used to dissolve the gutta pereha. It is also recommended as an ingredient of nerve paste, being equal to iodoform for such a purpose, but free from the dis- agreeable odor of the latter substance ; it is also used in chloroform solution, instead of sandarach varnish, for saturat- ing cotton used for wedges or temporary fillings in retaining medicaments in cavities in the teeth ; such a dressing or wedge may be retained for days or a week, and being antiseptic, it is free from disagreeable odor during that time. Aristol is also recommended as a dressing where approximal caries has ex- tended beyond the gum margin, and where hypertrophy of the gum festoon occurs to the degree of forming a polypoid growth which invades the cavity; also in the form of a varnish it is combined with collodion as a pulp-capping material. To increase the adhesiveness of the aristol solution, a small quan- tity of Canada balsam may be added to it. ARNICA. leopard's bane. Source, — Arnica Montana is a perennial, herbaceous plant of which the dried flowers and root — Amices Flores and ArniccE Radix — are the medicinal portions, and is found in the moun- tains of Northern Europe and the Northwestern portions of America, Medical Properties and Action. — Arnica is nervine, stimulant, and diaphoretic. In over- doses, it is an acro-narcotic poison, causing vomiting, purging, vertigo, tetanic twitching of the muscles, and convulsions. Moderate doses, when long con- tinued, are liable to cause a very troublesome eruption. Its ARNICA. 257 activity depends upon an alkaloid — Arnici?ia, which is a bitter and acrid extractive. Therapeutic Uses. — Arnica is administered internally in typhus and typhoid fevers, chronic dysentery, rheumatic gout, etc., etc. Externally to bruises, sprains, lacerations, chilblains, etc., in the form of tincture — Tinctura Arnica. The antidote for poison by arnica is common vinegar. Dose. — Of the extract of arnica, gr. v to gr. x. Of the tincture of arnica (arnica root Sj, rectified spirit Oj), the dose is Tttx to f5ss. Dental Uses. — In dental practice, the tincture of arnica is applied to irritable pulps of teeth, in periodontitis to prevent suppuration, to wounds of the mucous membrane of the mouth, combined with glycerine, to abraded surfaces caused by artificial teeth, and with tannic acid or glycerine of tannin for ulcers of the mouth. The tincture of arnica, when largely diluted with water, forms an efficient mouth wash during operations upon the teeth. Equal parts of tincture of arnica and glycerine diluted with water form an effective mouth wash in inflammations of the mucous membrane of the mouth. For Abraded Surfaces of the Mucous Membrane of the Mouth. R . Tinctune amicae, Glycerini . . aa . . . ^j. M. SiGNA. — To be used as a lotion. DENTAL FORMULA. For Ecchymosis. U. Tincturae Amicae . . . ^ss Liquor ammonii muriat. ^ ss Aquae ^^v. SiGNA. — To be used as a lotion. M. Astringent Mouth Wash in Alveolar Pyorr/uBa, etc. DR. J. R. BELL, R. Tincturae Amicae . . . ^j Acidi carbolici .... tT^xx Tincturae myrrhae . . J ss Olei gaultheriae . . . . ^jss For Inflamed and Ulcerated Mucous Membrane. R . Tincturae amicae . . . ,^ ij Glycerini ^ij Aquae rosee ^ ij Aquae destillatae . . . ^x. M. Alcoholis 3 ijss M. Signa, — To be used as a gargle. »7 258 DENTAL MEDICINE. ATROPINE SULPHAS— SULPHATE OF ATROPINE. ATROPINE. Formula. — CiyHggNOg. Derivation. — Sulphate of Atropine is obtained by adding a mixture of sulphuric acid to an ethereal solution of atropine. It is in the form of a white, slightly crystalline powder, very soluble in water and alcohol, but insoluble in ether. It is in- odorous, and of a bitter taste. Medical Properties and Action. — Sulphate of atropine has the same medical properties and action as belladonna, of which it is the alkaloid, but is far more energetic in its action. It is an active poison, and should only be administered internally with the greatest care. Hypodermically employed, it is a useful anodyne and antispasmodic, and the quantity should be cautiously increased from a very small dose in the beginning. Such symptoms as dryness of the throat, vertigo, and diplopia, are indications that its use should be discontinued. Without being a direct hypnotic, it induces sleep by relieving pain. Although it is not so well tolerated, as a general rule, as is morphine, yet patients who cannot bear morphine will bear atropine. Therapeutic Uses. — See Belladonna. Dose. — Of sulphate of atropine, gr. yi^ to gr. Jg-. For an anodyne and antispasmodic, hypodermically injected, the dose is ifllij=gr. xg-Q^, as a commencement. An ointment is made of atropine gr. viij, rectified spirit f5ss, lard oj. The antidote in cases of poisoning by Belladonna and its alkaloid is an infusion of galls and lime water, first evacuating the stomach as speedily as possible. Dental Uses. — In dental practice, sulphate of atropine is applied externally to obtund the sensitiveness of inflamed pulps of teeth, preparatory to their treatment, and to their devitalization ; it is also applied to acute inflammation, depend- ing upon alveolar periostitis and abscess. It forms one of the ingredients of a nerve paste, for devitalizing pulps of teeth, being substituted for the acetate of morphine, but there is SULPHATE OF ATROPINE. 259 doubt as to its being so efifective as the morphine salts ; in facial neuralgia, in the form of an ointment ; in neuralgia and in profuse salivation. As an anodyne for internal use, it proves efficacious in relieving intense pain, such as may result from an inflamed pulp or periosteum ; also internally, or in the form of hypodermic injections, for the relief of facial neuralgia; for such a purpose yt^ of a grain of the atropine sulphate is often combined with morphine sulphate. DENTAL FORMULA. Far Facia/ Neuralgia. R . Atropinse sulphat . . . gr.j Adipis ^]. M. SiGNA. — To be applied in the form of an ointment, over seat of pain. R. For Neuralgia, J. L. Ludlow. Atropinae sulphatis . . gr.ss Aconitinae . . . Olei tiglii . . . Ung. petrolei . . SiGNA. — Apply externally, . gr.iss • gttij M. For Facial Neuralgia. R . Pulveris belladonnse . . ^ x Camphorse ^ ss Spiritus rectificati . . . q.s. M. SiGNA. — To be applied with a camel- hair bnish. For Neuralgia of Superficial Nerves, AlTKEN. R. Atropinae sulphat . . . gr.v Aquse destillat .... f5iii. M. SiGNA. — Use on a compress and renew several times in 24 hours, and con- tinue for at least one hour at a time, covering with oilskin, to prevent evaporation. For Facial Neuralgia. R. Ext. belladonnae . . . gr.ss Quininae sulphat . . . gr.ij. Ft. pil. No. I. SiGNA. — Use three times daily. M. For Facial Neuralgia. R . Linimenti belladonnse, Linimenti aconiti . aa . 7^ vij Chloroformi f,5ij- M. SiGNA. — To be applied as a lotion, on lint saturated with it, and covered with oiled silk. For Neuralgia in Superficial Nerves. R . Chloroformi, Spts. vini rect. . aa . . ^ ss Atropinae sulphat . . . gr.v. M. SiGNA. — To be applied on lint to pain- ful part, and covered with oiled silk. For Neuralgia, R. Ext. belladonnae gr.iv Ext. stramonii gr.v Ext, hyoscyami gr.v Quininae sulphat ^ij. M. Ft, pil. No. XX. SiG.NA. — One pill two or three times a day. 260 DENTAL MEDICINE. AURUM TERCHLORIDUM— TERCHLORIDE OF GOLD. Formula. — Au CI 3 . Derivation. — The Terchloride of Gold is obtained by dis- solving gold in aqua regia (three parts, by measure, of hydro- chloric acid, and one of nitric acid) using gentle heat to has- ten the solution, the acids employed being chemically pure. The solution is then evaporated to dryness, when ruby-red, prismatic crystals of the terchloride of gold result. Properties a7id Action. — Terchloride of gold is very deli- quescent, and is soluble in water, alcohol and ether. It pos- sesses a disagreeable, styptic taste, reddens blue litmus paper and will impart a purple stain to the skin, which may be re- moved by a solution of cyanide of potassium. It is readily decomposed by many metallic and non-metallic elements, and also by saline and organic compounds, on account of its ele- ments being held together by a feeble affinity. It is escharotic and disinfectant, and its physiological effects are similar to those of corrosive sublimate. It is not used internally. Dental Uses. — In dental practice, the terchloride of gold, in the form of an aqueous, alcoholic, or ethereal solution, is em- ployed for the purpose of obtunding the sensitiveness of dentine, for which it is a valuable application : and the ethereal solu- tion possesses some advantages over the aqueous or alcoholic solutions for such a purpose. To prepare an obtunding solu- tion : "Dissolve the crystals of the gold in pure water; fill a test tube half full of the solution ; then add an equal quantity of sulphuric ether, and agitate the mixture. Let it then rest for a few minutes, when the ethereal solution will rise to the surface, and may be poured off into another tube or phial, and securely stopped. It should be kept, as much as practicable, from the action of light and air. Applied to dentine, on pledgets of cotton, it acts like chloride of zinc, but more promptly and with less pain. Chlorine is more abundantly liberated during its action than from chloride of zinc ; hence it is a better disinfectant than the latter. It has a fine yellow tint, and it is not absorbed by the dentine, but forms an in- BELLADONNA. 261 soluble compound with the gelatinous elements. As it is an irritant poison, care should be observed in its use. If not protected in a glass-stoppered bottle, the gold is precipitated in a metallic form. BELLADONN.^ FOLIA— BELLADONNA LEAVES. BELLADONNA RADIX— BELLADONNA ROOT. DEADLY NIGHTSHADE. Source. — Belladonna is a perennial, herbaceous plant, found in Europe, the leaves and root being the medicinal portions. Medical Properties and Action. — Belladonna is anodyne and antispasmodic, its activity depending upon an alkaloid, Atro- pine. Belladonna, in small doses, is a valuable narcotic and anodyne stimulant. It causes a peculiar dryness of the mouth, fauces, stomach and intestines, but increased secretion follows, especially in the case of the latter organs, when atropine is administered or subcutaneously injected. In larger doses, it causes dilatation of the pupils, giddiness, loss of vision, difficult deglutition, constriction of the throat, difficult articulation, increased action of the heart, quickened respiration, nausea, vomiting, diuresis, purging, and sometimes a red eruption. It is eliminated chiefly by the urine. Opium is the antidote, or hypodermic injections of mor- phine. When applied to the eyebrows, belladonna causes dilatation of the pupils. Therapeutic Uses. — Belladonna is extensively employed, either alone or in combination with sulphate of quinia, in the treatment of neuralgia ; also in mania, Bright's disease, epi- lepsy, lead colic, spasmodic affections, diseases of the cerebro- spinal system, as a preventive of scarlatina, night sweats of phthisis, etc. Dose. — Of powdered belladonna, gr. ss to gr. j. daily ; of the extract, gr. ]^ to gr. j ; of the tincture, gtt. v to gtt. xx. (See Atropine.) BENZOIC SULPHIDE OF SODIUM. Benzoic Sulphide of Sodium is obtained by dissolving a large quantity of benzoic acid in a concentrated solution of 262 DENTAL MEDICINE. sulphide of sodium. It is a valuable antiseptic for dressing wounds, arid may be used as a wash, lotion or injection, its antiseptic properties being very active and healing. Thirty to forty-five grains are used to the quart of water. Heckel con- siders it to be equal to carbolic acid, and superior both to sublimate and iodoform, as it is not poisonous like corrosive sublimate, and is free from the disagreeable effects of iodo- form. It is very soluble in water and contains the antiseptic properties of its two principal ingredients — benzoic acid and sul- phite of sodium. It is harmless, even when given in large doses. BISMUTHI SUBNITRAS— SUBNITRATE OF BISMUTH. Formula.— BiONOgU^O. Derivation. — The metal Bismuth — Bismuthum, Formula Bi, from which the subnitrate is obtained, is found native in Europe and America, and generally in combination with sul- phur and oxygen. It fuses at 476° F., and is brittle and pulverizable. It is employed in the dental laboratory for making fusible metal alloys for dies and counter-dies. The Subnitrate of Bismuth is obtained by dissolving the metal bismuth in dilute nitric acid, and converting the nitrate thus formed into carbonate, by adding a solution of carbonate of sodium, which is then dissolved in nitric acid and the nitrate of bismuth again formed, which is washed in water and the nitric acid removed by ammonia. Such a process frees it from the arsenious acid which metallic bismuth gen- erally contains. Subnitrate of bismuth is in the form of a heavy, white powder, with a faint acid odor and slightly metallic taste, and is insoluble in water. Large quantities are poisonous, with symptoms of arsenical poisoning. Medical Properties and Action. — Subnitrate of bismuth is sedative, astringent and alterative. Owing to the formation of a sulphide, it coats the tongue black, and its continued use may give rise to the formation of a bluish-red line on the gums, similar to that resulting from the use of lead, except that the line is wider and deeper in color. In proper doses, it promotes the appetite and increases the digestive power. Being SUBNITRATE OF BISMUTH. 263 somewhat astringent, it affects the intestinal movements, and can be detected in the blood, urine, and other secretions. Therapeutic Uses. — Subnitrate of bismuth is employed in atonic dyspepsia, gastric irritations (milder forms), pyrosis, gastrodynia, ulcer of the stomach, diarrhoea from debility, etc., chronic laryngitis, epilepsy, ringworm (in form of an oint- ment 5j to lard 5j), chronic skin diseases, chlorosis, when iron is not tolerated, etc., etc. If not well borne by the stomach, it may be combined with aromatic powder, or if alkalies are indicated, with chalk and magnesia. Bismuthi subnitras is also employed as an antiseptic dress- ing for wounds, to promote primary union. The subnitrate is held in suspension in water, in the proportion of lo per cent., and during the operation the wound is, from time to time, sprinkled with the solution, and afterward sealed with a bis- muth paste, and the subsequent dressings made in the same manner. Dose. — Of subnitrate of bismuth, grs. v-x to 5j, in powder or emulsion. Dental Uses. — Subnitrate of bismuth is a valuable internal remedy in aphthae, mercurial salivation, painful ulcers of the mucous membrane of the mouth, vomiting, cholera infantum, and diarrhoea of children during painful dentition. It is best given in milk, and before meals. For cancrum oris, after using a disinfecting solution to cleanse the gangrenous part, the topical application of sub- nitrate of bismuth, every three hours, corrects the fetor, arrests the progress of the gangrene, and hastens cicatrization. DENTAL FORMULAE. For Vomiting and Painful Digestion of SiGNA. — A tablespoonful for adults, Teething Children, Acidity and Pyro- and proportionate quantity for chil- sis. dren three or four times a day. BarthoI-OW. R . Bismuthi subnitrat . 3 iij ^'"' Gangrene of Mouth ( Cancrum Oris). Acidcarhol gr. ij-gr. iv B- Bismuthi subnitras (powd.). Mucil. acacix- . . . . .^j SiGNA. — Applied to ulcerated surface, Aquai menthec pip . . .^iij. M, and covered with absorbent cotton. 264 DENTAL MEDICINE. For Diarrhcea of Dentition. water, milk and lime water. Starchy R . Bismuthi^ subnitrat . . gr.lx ^od prohibited Extract rhei fluid . . gtt. viij Syrup rubus . . . . f ^ ss Elixir aurantii . . . . f ^ ss. M. For Internal Administration to Support the Strength. R . Quininae sulphat . , . gr. iij to v SlGNA. — A teaspoonful four or six Tinct. ferri chloridi . . gtt. v. M. times a day. Proper feeding — ^barley Signa. — Three time daily. BROMIDES. Bromides are diffusible agents which rapidly pass into the blood, and in large doses can be detected in the faeces and intestinal mucus, owing to a portion of the agent not being absorbed. They depress the heart's action, and also respiration and animal temperature ; in some cases large doses may cause transient excitement, giddiness and intoxication. Moderate doses have a tranquillizing effect and refreshing sleep, and lower the sensibility to pain and irritation. Their immoderate use will cause paralysis of the muscles, and a condition known as bromism, the symptoms of which may be extreme pallor and anaemia, dilated pupils, slow and feeble action of the heart, breathlessness and quickened pulse on slight exertion, acne, skin eruption, cool extremities, tremulous and uncertain movements, want of tactile feeling, relaxation of the genitals, dry fauces, difficult deglutition, and weak mind. Ammonii Bromidum — Bromide pf Ammonium, Formula. — NH4Br. In the form of colorless, transparent crystals, or a white granular salt, with a pungent, saline taste, neutral re- action, and no odor. Ammonii Bromidum is soluble in 1.5 parts of water, in 150 parts of alcohol at 60° F., and in 0.7 part of boiling water. Dose. — Gr. x to 5ss, considerably diluted. Calcii Bromidum — Bromide of Calcium. Formula. — CaBrg. In the form of a white granular, deliquescent salt, with a pungent, saline, bitter taste, and no odor. It has a neutral reaction, and is soluble in 0.7 part of water, and in i part of alcohol. Dose. — 9j to 5ij. BROMIDES. 265 LiTHii Bromidum — Bromide of Lithium, Formula. — LBr. In the form of white, granular, deliquescent salt, with a pungent, bitter taste, and a neutral reaction. Quite soluble in water and alcohol. Dose. — Gr. v to 3ij. SoDii Bromidum — Bromide of Sodium. Formula. — NaBr. In the form of small, colorless crystals, or a white crystalline powder, with a saline taste, neutral reaction, and no odor. It is soluble in 1.6 parts of water, and in 200 parts of water at 60° F. Dose. — 9j to 5ii. (See Bromides of Potassium, Camphor ■ and Ethyl.) Aledical Properties and Therapeutic Uses. — The bromides have the same general action and are employed for the same purposes. The bromide of lithium is considered to have a more hypnotic influence than the others ; and the bromide of sodium is generally given in full doses ; the others in rather smaller doses. Prof Bartholow considers the bromide of potassium to possess more toxic power, and the bromide of sodium the least. As regards their influence on the pulse, body-head, and respiration, the same author places the bro- mides in the following order: bromide of sodium, bromide of lithium, bromide of potassium, bromide of ammonium. The bromides are eliminated through the kidneys chiefly ; also through the mucous membrane of fauces, bronchi, intestinal canal and the skin ; several days being required for their dif- fusion outwardly from the blood. The bromides are admin- istered in delirium tremens, insanity, increased action of the heart, tetanus, neuralgia, epilepsy, vaso-motor disturbances, spasmodic asthma, abnormal sexual excitement, nocturnal sem- inal emissions, vomiting of cerebral congestion, pregnancy and sea-sickness, cholera infantum, migraine, strychnine-pois- oning, etc., etc. Locally in pruritus, prurigo, eczema, epithe- lioma, old ulcers, etc. (For Dental Uses, see Bromide of Po- tassium.) 266 DENTAL MEDICINE. BROMOL— TRI-BROM-PHENOL, BROMO-PHENOL. Formula. — CgHgBr.gHO. Derivation. — Bromol is a compound of bromine and carbolic acid. It is in the form of soft, white needles, and is prepared by treating phenol or carbolic acid with an excess of bromine in aqueous solution. Medical Properties and Therapeutic Uses. — Bromol possesses strong antiseptic properties, and at the same time is non-toxic. Rademaker recommends it for external use, either dissolved in olive oil (i in 30) or mixed with vaseline (4 in 40). It may also be employed in the form of powder like iodoform, for sprinkling in wounds. It is also used internally in cholera infantum, typhoid fever, etc., etc. Dose. — For internal administration, the dose of bromol is from -Y^to \ grain. Dental Uses. — The uses of bromol in dental practice are the same as iodol, iodoform and other antiseptics. Good results have been obtained by its application to teeth affected with alveolar abscess and gangrenous pulps, CADMII SULPHAS— SULPHATE OF CADMIUM. Formula.— I (CdCSOg) + SHO. Derivation. — Sulphate of Cadmium is obtained by the action of nitric acid, diluted with distilled water, on the metal cad- mium, the solution filtered and mixed with carbonate of soda, and again dissolved in sulphuric acid diluted with distilled water. It is in the form of transparent, colorless crystals, like those of sulphate of zinc. Medical Properties and Action. — Sulphate of cadmium is emetic and astringent, and closely resembles sulphate of zinc in its action, but is stronger, with a caustic astringent taste. It is very nauseant and depresses greatly. Locally it is an irritant poison, and produces the cerebro-spinal symptoms of coma and convulsions ; it is not administered internally, as the preparations of zinc are preferable for such use. HYPOPHOSPHITE OF LIME. 267 Therapeutic Uses. — Sulphate of cadmium is employed locally in affections of the eye, being valuable as a collyrium; it has the power of causing absorption of opacities of the cornea to a remarkable degree. It is also used as an injection in gon- orrhoea, in the strength of one grain to four ounces of water. It is also used in the form of ointment, two grains with four scruples of lard. Dejital Uses. — Sulphate of cadmium has been employed in ulcerations of mucous membrane, gangrene of the mouth, or cancrum oris, indolent ulcers, purulent diseases of the antrum, in the form of injections and lotions, of a strength about one grain of the sulphate to four ounces of water. CALCII HYPOPHOSPHIS— HYPOPHOSPHITE OF LIME. Formula. — CajPHjOg. Derivation. — The salt, Hypophosphite of Lime, is obtained by boiling phosphorus in a mixture of hydrate of lime in boil- ing water, until phosphoretted hydrogen escapes, and phos- phate and hypophosphite of lime are formed in the solution, which is then filtered and evaporated over sulphuric acid, when the salt is crystallized out in the form of white, pearly crystals, with a nauseous, bitter taste. It is soluble in six parts of water, but is insoluble in alcohol. Medical Properties and Action. — The hypophosphite of lime, with those of soda and potassa, are all included under the term "alkaline sulphites." Taken internally, they are readily absorbed, and are partially changed in the system into sul- phates. They combine with acids to form salts, and they dis- solve albumen, and increase the formation of saliva. Being regarded as tonic, alterative, stimulant and nervine, they are employed in cases of debility, more especially where the phos- phates are deficient, as they possess the therapeutic properties of phosphorus. Therapeutic Uses. — The different sulphites of lime, soda, and potassa, are employed in intermittent and malarious fevers, typhus fever, smallpox, and other exanthematous diseases, pyaemia, dyspepsia, neuralgia with nervous depression, anaemia, 268 DENTAL MEDICINE. for which affections they are combined with iron and quinine; diphtheria, -cystitis, phthisis, etc., etc. Externally, the sul- phites are efficient as local applications (especially the sul- phites of soda), in gangrenous and other ulcerations, diseases of the skin, etc. One or two ounces to the pint of water form a stimulant and deodorizing lotion, which is promotive of healthy action. Dose. — Of the hypophosphites, gr. iij to gr. xv, three times a day in syrup. Dental Uses. — The hypophosphite of lime is the most eli- gible salt, but the different sulphites are often administered together, in the form of a syrup. Where there is nervous depression, as a result of trigeminal neuralgia, the hypo- phosphites prove serviceable. In the case of delicate chil- dren, where there is reason for believing the phosphate of lime, or the lime salts generally of the teeth, are deficient in quantity. CALENDULA. MARIGOLD. Source. — Calendula is a well-known garden plant, some- times growing wild, with a peculiar and rather disagreeable odor, and a bitter, rough, saline taste. Both the leaves and the flowers are employed. Medical Properties and Action. — It is slightly stimulant, diaphoretic, antispasmodic, sudorific, and emmenagogue, but is seldom used internally. It contains a bitter principle known as calendidin. Therapeutic Uses. — Calendula has been employed in low forms of fevers, scrofula, jaundice, amenorrhoea, etc. Ex- ternally it is used in the form of tincture — Tinctnra Calendula — in its full strength or diluted, and is very serviceable in exercising a curative influence in the treatment of incised wounds and contusions, preventing inflammation and suppura- tion. Some writers consider it to be unequaled as a local application after surgical operations, as it promotes union by first intention. It is applied as a lotion on lint. It is also thought to be a preventive against gangrene and tetanus. CALCIUM. 269 Dose. — Of the tincture of calendula, f3j to f5ij. Dental Uses. — Calendula, in the form of tincture, is em- ployed in dental practice as an application to wounded or irritated pulps of teeth, when partially exposed ; also after the extraction of teeth ; wounds about the mouth ; and in such cases it proves a very useful remedy. A few drops added to a wine-glass of water form a soothing and efficient mouth-wash for the soreness resulting from the removal of salivary cal- culus ; also useful in superficial inflammations of the mucous membrane of the mouth, etc. CALX— CALCIUM. LIME. Formula. — CaO. Derivation. — Lime is obtained by calcining limestone or chalk, until the carbonic acid is driven off Lime is more soluble in cold than in hot water, and a compound of lime and sugar is more soluble in water than pure lime alone. Calcium is the metallic base of lime. Medical Properties and Action. — Quicklime is a powerful escharotic and irritant. Liquor Calcis — Lime Water. — It is prepared by adding cold water to freshly slacked lime, and the clear fluid poured off The officinal preparation consists of four troy ounces of saturated solution of lime in eight pints of distilled water. It is a colorless, inodorous liquid, possessing a disagreeable alkaline taste. Exposure to the air causes it to gradually absorb carbonic acid, with the formation of insoluble carbonate of lime, and it should therefore be preserved in glass-stoppered bottles. The addition of liquorice or coriander seed will disguise its taste. Medical Properties and Action. — Lime water is antacid, astringent, antiseptic and detergent. It is applicable to all cases where antacids are indicated, and where an astringent effect is not objectionable. Therapeutic Uses. — Lime water is an excellent remedy in gastric irritation, accompanied with nausea and vomiting; 270 DENTAL MEDICINE. also in dyspepsia, attended with vomiting of food ; also in diarrhoea, "after the inflammatory action has been relieved; also in glandular affections, as an alterative resolvent. Ex- ternally, as a wash for foul ulcers, diseases of the skin, and as an injection in gleet and leucorrhoea. Atomized inhalations have been found useful in diphtheria and membranous croup. Dose. — Of lime water, f^ss to fgiij or iv, several times a day. It may be mixed with an equal quantity of milk for internal use. Lime liniment — Linimentum Calcis (lime water foviij, flax- seed oil Svij) — is a valuable application to burns, scalds and in small-pox. Dental Uses. — In dental practice lime water is a useful agent in the form of a gargle, where the secretions of the mouth are viscid and fetid, and especially where the teeth are soft in structure and exceedingly sensitive, owing to the condition of the oral fluids, and especially in mucous secretions, which act readily on teeth deficient in earthy constituents. For young patients, the use of lime water is very beneficial to the teeth, owing to an acid condition of the oral fluids, common to an early period of life. It is also useful where the teeth are very sensitive, on account of the recession of the gum and absorp- tion of the process. When lime water is applied to inflamed mucous membrane, or to suppurating surfaces, it arrests secretion. It is also useful in sickness and irritability of the stomach during dentition ; also to relieve the superficial ulceration of the mucous mem- brane of the mouth, caused by the acid eructations attending dyspepsia, in the proportion of one part of lime water to two or three of milk. Syrup of the Lacto-phosphate of Lime. — Syrupus Calcii Lacto-phosphatis — is composed of precipitated phosphate of calcium 22 parts; lactic acid 33 parts; orange flower water 80 parts ; sugar 600 parts ; hydrochloric acid, water of ammonia and water, each, a sufficient quantity. Dose. — fSj to fSj. This syrup is especially useful in rickets, moUities ossium, CHLORINATED LIME. 271 delayed union of fractures, caries and necrosis in bone, anaemia of nursing mothers, mammary abscesses or boils, carbuncles, chronic bronchitis, leucorrhoea, early decay of the teeth in children, etc. CALX CHLORATA— CHLORINATED LIME. CHLORIDE OF LIME. Formula. — CaCl202CaCl2. Derivation. — Chloride of Lime is obtained by passing chlor- ine over hydrate of lime till saturation is effected. It is in the form of a grayish-white substance, either in powder or friable masses, dry or but slightly moist. It is readily soluble in water, and will absorb moisture when exposed to the air. It has a bitter, caustic taste, and a slight odor of chlorine. Medical Properties and Action. — Chloride of lime is a stimu- lant, deodorizer, disinfectant, antiseptic and bleaching agent. In small doses it increases the action of the secreting organs, and if long continued it acts specifically upon the lymphatic glandular system, causing the reduction or absorption of glan- dular and other tumors. In large doses it acts as an acro- narcotic poison, and its use should always be commenced in small doses, carefully increased, and discontinued when such symptoms as nausea, vomiting or giddiness appear. It is chiefly used as a disinfectant. Therapeutic Uses. — Solutions of chlorinated lime are em- ' ployed locally in scarlet fever, diphtheria, aphthae, gangrene ; and it has been administered internally in scrofula, typhus, malignant scarlet fever, syphilis, etc. Dose. — Of chloride of lime, gr. j to gr, v, in solution, sev- eral times a day. As a wash, i part dissolved in loo parts of water. Dental Uses. — Chloride of lime is employed in dental prac- tice in the treatment of cancrum oris ; one method of applica- tion being the introduction of the dry powder, with the pomt of the finger, to the ulcerated surface, and the mouth well washed out immediately afterward ; also, in the form of a gargle composed of l part of powdered chloride of lime to 30 272 DENTAL MEDICINE. parts of mucilage and 15 parts of syrup. Solutions of chloride of lime arealso efficient in scorbuticand other ulcerations of the mouth. It is also employed to correct the fetor of the breath, in the form of a mouth wash, prepared as a weak solution. One of the most important uses in dental practice is as a bleaching agent, either alone or in combination with other substances, to restore the color of devitalized teeth. When chlorinated lime is employed for bleaching discolored teeth, a good quality should be obtained, and no steel instrument used for its introduction ; wood or gold instruments are to be pre- ferred, and the chloride should be perfectly dry, and have been kept so from the time it was made. An efficient bleaching preparation is composed of equal parts of dry chlorinated lime and tartaric acid, mixing them together dry, and adding a little of the acid at a time. When prepared, the mixture should be kept in a glass-stoppered bottle. For bleaching purposes, chlorinated lime is also combined with chloroform, in the form of a thin paste. When chlorinated lime, or its combinations, is introduced into the cavity of a tooth, it should be secured by a temporary filling of gutta percha, Hill's Stopping, or one of the zinc preparations, and be secured from passing beyond the foramen of the root, by a filling introduced near the apex of the root. More than one application may be required, after which the cavity should be thoroughly cleansed, and a tem- porary fiiUing of the whitest shade of the oxychloride of zinc filling material be introduced and worn for some time, after which a more durable gold filling can be inserted. DENTAL FORMUL. pend the functions of the cerebrum. Great care is necessary in its use where symptoms of pulmonary disease, fatty heart or degenerated blood-vessels are apparent. When a proper dose is administered the pupil contracts slightly, but the pulse may remain unaltered or become slower, and the respiration unaffected. When an improper or dangerous dose is taken, profound narcotism ensues, the respiration becomes slower, the pulse weak, rapid and irregu- lar, sensibility is lost, all reflex movements are impossible, and complete muscular relaxation follows. It destroys life by the suspension of the functions of the cerebrum, and by paralysis of the respiratory centre, and of the cardiac ganglia ; also death may suddenly follow by paralysis of the heart, in cases of fatty degeneration, and the lower lobes of the brain remain unaffected. The paralytic phenomena caused by chloral are due to its direct action on the nervous centres. The con- gestion of the meninges of the brain and cord, and distention of the right cavities of the heart, have been observed after poisoning by chloral. The antidote in cases of poisoning is strychnia, and the same treatment as in opium poisoning. Therapeutic Uses. — The most important uses of chloral are in diseases of the nervous system, such as delirium tremens, insanity, tetanus, acute mania, neuralgia, chorea, whooping cough, and in rheumatism, cholera morbus, sea-sickness, etc., etc. Having no direct pain-relieving power, except by sus- pending the functions of the cerebrum and in dangerous doses, sleep can be procured and pain relieved by combining the chloral with morphine, when it is very effective. Dose. — Of hydrate of chloral, gr. v to 3j ; but it must be remembered that one half drachm has produced poisonous symptoms. Thirty grains of hydrate of chloral are equal in effect to gr. j of opium. For adults, if short intervals of sleep are required, from gr. xx to xxx will answer; for young CHLORAL. 287 children, gr. vij is the dose recommended. Moderate and frequently repeated doses are better than a single large one. Dental Uses. — In dental practice, the hydrate of chloral, in the form of from gr. ss to gr. j, is applied to inflamed pulps for the relief of odontalgia, and is an efficient remedy ; it is also employed for the relief of neuralgia of the fifth pair of nerves ; as a stimulant and deodorizing application to foul and fetid indolent ulcers ; also as a local anaesthetic, for this purpose being combined with camphor and other agents (see Aconite), (see Camphor) ; also as an anodyne, for the relief of the pain of periodontitis ; and as an injection, for alveolar abscesses. It is also used as a lotion (when diluted with water) for in- flammations of the oral mucous membrane, and as an anti- septic (chloral, 5j ; aqua, f5ij) for injecting putrid pulp-canals and chronic alveolar abscesses. Although it is employed hypodermically, yet painful phlegmons have resulted from its repeated application. Oiloral Phenol. — When chloral is combined with carbolic acid it liquefies, and a preparation composed of equal parts of phenol and chloral is used for odontalgia as well as for its antiseptic qualities. Chloral Phenol is a colorless, clear liquid, soluble in alcohol, acetic acid, amyl-alcohol, chloroform, carbon, glycerin and ether. It possesses the odor and taste of its constituents. Chloral has the property, when rubbed with certain bodies, such as camphor, of forming therewith syrup liquids. With phenol (absolute carbolic acid) it also liquefies, and a prepara- tion composed of equal parts of phenol and chloral is used in medicine for allaying toothache, as well as for its antiseptic properties. A recent study by Fabini, says the Chemist and Druggist, shows that chloral-phenol possesses the odor and taste of its constituents, and when applied to the skin produces inflammation and an eruption of small blisters. It is a colorless and clear liquid, having a sp. gr. at 20° C. of 1.289, ^^ that it sinks in anhydrous glycerin. It is soluble in alcohol, acetic acid, amyl-alcohol, chloroform, carbon bisulphide, and glycerin, as well as in ether when slightly warmed. It is only partially 288 DENTAL MEDICINE. soluble in petroleum ether, and benzine only dissolves a little of the fluid, and what is dissolved is chloral phenol. Fabini tested the fluid thoroughly, with a view to determining whether it is a mechanical mixture, and it behaved in every way towards re-agents as carbolic acid does, while with sulphuric acid some of the chloral-phenol yielded, after twenty-four hours, a velvet- colored plaster-like mass, which consisted of meta-chloral and phenol-sulphonic acid. There seems to be no doubt, therefore, that chloral-phenol is a mixture. This preparation should not be confounded with the phenol camphor devised by Cockrane (not campho-phenique)> and made by mixing together i part of carbolic acid and 3 parts of camphor. After twenty-four hours this becomes a liquid, having a sp, gr. of .990. It is used with oil as an anti- septic. As a spray it may be applied to the skin to produce local anaesthesia. It may be employed for disinfecting surgical instruments, and upon wool and gauze for wound dressing. It is soluble in alcohol, ether and oils, but not in water or glycerin. Menthol, cocaine, salicylic acid, iodoform, chloral hydrate, and mercuric chloride are soluble in phenol camphor. DENTAL FORMULAE. For Foul and Fetid Indolent Ulcers. For Foul and Fetid Indolent Ulcers. R . Chloral hydratis . . . gr.x R . Chloral hydratis . . . 5 ss Aquae destillatae . . . f ^j. M. Adipis §j. M, SiGNA. — To be applied as a lotion. SiGNA. — To be used as aa ointment. For a Local Ancssthetic. Local AncBsthetic. Dr. Storie. R. Chloral hydratis . . . gij r^.^ ^^.A ,■ ■n 1 • T, T" HT Ix- Chloral hydratis. rulvens camphorse , . 3 ij. M. ^ •' c, . ^- I, T J -u. J Camphors (gum) . equal parts. SiGNA, — io be applied as an obtund- ^ v& / 1 r . ^ , r 1- Rub well in a mortar to liquefaction mg mixture, by means 01 an appuca- . ^ and add gtt.v of carbolic acid, tor. ^ For a Hypnotic. R , Chloral hydratis . . . 3 ij Syrupi aurantii flores . 3 iv R . Chloral hydratis . . . 3 iij Syrupi tolutani . , . 3 iv Aquse destill . . . . f gj. M. Aquae destillatae . . . ^vj. M. SiGNA. — Apply on cotton. Signa. — Dose ]/(, part, largely diluted. For Odontalgia — Pulpitis. Flagg. CHLORALAMID— CHLORALAMIDE. 289 For Neuralgia. SiGNA. — Apply with camel's-hair brush ; R . Chloral hydratis, . partes 3 dry rapidly, and reapply. Camphor;^ . . . partem I. M. SiGNA.— To be applied over seat of For Neuralgia and Exposed Pulps. pain. R . Chloral hydratis . . 2 parts For a Local Ancssiketic. Camphorse .... 5 parts B. Chloral hydratis, Cocaini hydrochloratis I part. M. Pulveris camphors .aa . gij ^eat to about boiling point of water Morphine sulph . . , ^ss till liquefied. Chloroformi ^]. M. SiGNA. — Apply locally. CHLORALAMIDE. CHLORALAMID. OH Formula. — CCUCH NH.CHO Derivation. — Formed by the combination of two parts of chloral hydrate and one part of formamide. Medical Properties arid Action. — Chloralamide has been used with good results in hysteria, chorea, acute mania, monomania, typhoid fever, senility, neurasthenia, insomnia, phthisis, and diseases not attended by much pain. Mupfenbach, from a number of trials, regards it a useful hypnotic, but with the disadvantage that its certainty of action can never be relied upon. No bad effects upon the circulation or in the feelings of the patients have been observed by Reichmann, although vomiting may occur. According to Langaard, this drug pro- duced a decided reduction of blood-pressure, which is devel- oped more gradually and is later in making its appearance than that caused by chloral. Compared with chloral, chloral- amid is more agreeable to the taste, and more easily admin- istered, rarely causes digestive disorders, does not depress the heart or the circulation, seldom produces cerebral disturbances. Compared with sulfonal, it is more prompt in its action, more soluble, more easily administered, the sleep it produces always passes away by morning, and it is less expensive. The action of chloralamide upon digestion is as follows: 1. Large quantities retarded the digestion of fibrin in the ratio of the quantity employed. 2. Small quantities, for example, up to 0.02 gramme, did 19 290 DENTAL MEDICINE. not have any marked influence either in accelerating or in de- laying the digestion of fibrin. 3. Putrefaction was not retarded by either large or small quantities. Therapeutic Uses. — The most important uses of chloralamid are in diseases of the nervous system not attended by much pain, such as have before been enumerated. Dose. — Of chloralamid, gr. 30 to 45. In doses of twenty to thirty grains, it produces better effects than sulphonal, but caution in the use of this drug is necessary in diseases of the heart, on account of its causing decided reduction of blood- pressure. For Use as a Hypnotic. ^. Chloralamid ^iv Spts. vini gallici ^ ij Curacao 5ij. M. S. — A tablespoonful (30 grains chloralamid) in water and repeated in foiir hours if necessary. CHLORINIUM— CHLORINE. Derivation. — Chlorine is a greenish-colored gas, of a pene- trating and suffocating odor, very persistent and characteristic. It is soluble in water, in the proportion of two volumes of the gas to one of water, and is a supporter of combustion. It is generated from black oxide of manganese, hydrochloric acid and water, is an active irritant, and, when breathed, excites cough, a sense of suffocation and irritation of the mucous membrane of the nostrils and bronchial tubes, and, when con- siderable quantities are inhaled, it induces spitting of blood, violent pains, and sometimes death. It is a deodorizer and disinfectant, and has been used to destroy disease germs and offensive effluvia. Chlorine Water. — Aqua Chlori — is an aqueous solution of chlorine, formed by passing the gas through water. It is a greenish-yellow liquid, with an astringent taste and the suffocating odor of chlorine gas. It should be kept in glass- stoppered bottles, in a cool place, and protected from the light. Therapeutic Uses. — Chlorine water is used internally in CHLOROFORM. 291 malignant fevers, such as scarlet fever, typhus, and in diph- theria, aphthse, gangrene, syphilis, diseases of the liver, skin diseases, etc. ; and as an antidote for hydrocyanic acid. The poisonous effects of chlorine gas may be prevented by am- moniacal gas. Albumen is the antidote for chlorine water, given freely, in the form of milk, flour, eggs, etc. Dose. — Of chlorine water, f5j to f5iv, diluted. Dental Uses, — Chlorine water is employed in dental prac- tice as a local application in gangrene of the mouth and fauces, aphthae, cancrum oris, and fetor of the breath. Chlorine gas has been employed to bleach discolored teeth, care being taken that it reaches no other part than the cavity of the tooth undergoing such treatment, which may be accomplished by the application of a large rubber dam, such as is used in the operation of filling teeth. DENTAL FORMULA. For Aphtha and Gangrene of the Mouth. For Aphthes, Stomatitis, and Cancrum B . Aquae chlori ^ ss Oris. Aquae destillatie . • - 5 iiiss R . Liquoris chlori Syrupi simp ^ss. M. Mellis . . . aa . . . | ij. M. SiGNA.— To be used as a gargle or lo- SiGNA. — To be applied as a lotion. For Mercurial Stomatitis. tion. .For Fetor of the Breath and an Anti- septic. R . Liquoris chlori . . . part j R. Liquoris chlori . . . . ^iv Aquae destillatse . . parts viij. M, Mellis 3 iv Signa. — To be used as a gargle for cor- Aquae destillatae . . . ^ x. M. recting the fetor, and diminishing SiGNA. — To be applied as a gargle. slightly the discharge. CHLOROFORMUM— CHLOROFORM. Formula. — CHCI3. Sp.gr. 1.480. Derivation. — Chloroform is obtained by the distillation of alcohol with chlorinated lime. The form for medicinal use {Chloroformiim Piirificatiini) is purified by agitation with sul- phuric acid, which frees the crude chloroform from such dele- terious agents as chlorinated pyrogenous oil; the lighter liquid is then separated, and carbonate of sodium, previously dis- solved in water, is added to it. The mixture is then agitated, the chloroform separated from the supernatant layer, alcohol 292 DENTAL MEDICINE. mixed with it, and lime in coarse powder added. It is a color- less, volatile liquid, of an agreeable ethereal odor, and a hot, aromatic, sweet taste. It is slightly soluble in water, and dis- solves very readily in alcohol and ether in all proportions. The boiling point is 142° F. The purest form of chloroform has a specific gravity of 1.5022, while the officinal contains a little alcohol ; it is a terchloride of formyl. The purest chloroform for internal use is obtained from the hydrate of chloral. The purity of chloroform may be ascertained by agitating it with the binitro-sulphuret of iron, which shows the presence of alcohol by the production of a brown tint ; chlorinated pyro- genous oil may be detected and removed by strong sulphuric acid, which gives the solution a yellowish or reddish-brown color, if such an impurity is present. Medical Properties and Action. — Chloroform, when inhaled, is an anaesthetic ; and when administered internally, is ano- dyne and antispasmodic. Its effects on the system are similar to those of ether, but more powerful and more rapidly pro- duced, and it requires more care in its administration, both in- ternally and by inhalation of the vapor. Undiluted, it excites great irritation and inflammation of the mucous membrane, and the vapor, passing through the fauces in quantity, may enter the larynx and cause great heat, inflammation and even oedema. When taken internally it causes a feeling of warmth in the stomach, followed by coldness, similar to ether, and if taken in large quantity, undiluted, it acts as an irritant poison, inducing violent gastritis. It is diffused into the blood, and affects remote parts. It increases the action of the circula- tory system, producing excitement of the brain, followed by a deep, heavy sleep ; and in poisonous doses, stupor and insen- sibility. The first effect of the inhalation of the vapor of chloroform is a feeling of warmth and excitement extending to the extremities, which is succeeded by noises in the ears and a vibratory thrilling and benumbing sensation throughout the body, followed by a loss of feeling, motion and conscious- ness, with general paralysis of the respiratory muscles, ster- torous breathing, quick pulse, which may become irregular CHLOROFORM. 293 and weak, owing to the sedative action on the heart. The pupils, at first contracted, become dilated, and there is com- plete relaxation of the muscular system. The following are the practical conclusions of the second Hyderabad Commission : " The recumbent position on the back and absolute freedom of respiration are essential. If during an operation this position cannot be from any cause maintained during the administration of chloroform, the ut- most attention to the respiration is necessary to prevent as- phyxia or an overdose. If there is any doubt about the state of respiration, the patient should be at once restored to the recumbent position on the back. To insure absolute freedom of respiration, tight clothing of every kind, either on the neck, chest, or abdomen, is to be strictly avoided ; and no assistants or bystanders should be allowed to exert pressure on any part of the patient's thorax or abdomen, even though the pa- tient be struggling violently. If struggling does occur, it is always possible to hold the patient down by the shoulders, pelvis, or legs, without doing anything that can possibly inter- fere with the free movements of respiration. An apparatus is not essential, and should not be used, as, being made to fit the face, it must tend to produce a certain amount of asphyxia, and take up part of the attention required elsewhere. How- ever it is made, it introduces an element of danger into the administration. A convenient form of inhaler is an open cone or cap with a little absorbent cotton inside at the apex. At the commencement of inhalation care should be taken by not holding the cap very close over the mouth and nose, to avoid exciting, struggling or holding the breath. If struggling or holding the breath does occur, great care is necessary to avoid an over-dose during the deep inspirations which follow. When quiet breathing ensues, as the patient begins to go over, there is no reason why the inhaler should not be applied close to the face ; and all that is then necessary is to watch the cornea and see that the respiration is not interfered with. In children, crying ensures free admission of chloroform into the lungs; but as the struggling and holding the breath 294 DENTAL MEDICINE. can hardly be avoided, and one or two whiffs of chloroform may be sufficient to produce complete insensibility. They should always be allowed to inhale a little fresh air during the first deep inspirations which follow. In struggling persons, but especially in children, it is es- sential to remove the inhaler after the first or second deep inspiration, as enough chloroform may have been inhaled to produce deep anaesthesia; and this may only appear, or may deepen, after the chloroform is stopped. Struggling is best avoided in adults by making them blow out hard after each inspiration during the inhalation. The patient is, as a rule, anaesthetized and ready for the operation to be com- menced when unconscious winking is no longer produced by touching the surface of the eye with the tip of the finger. The anaesthesia should never, under any circumstances, be pushed until respiration stops ; but when once the cornea is insensitive, the patient should be kept gently under by occa- sional inhalations, and not be allowed to come out and renew the stage of struggling and resistance. As a rule no operation should be commenced till the patient is fully under the influence of the anaesthetic, so as to avoid all chances of death from surgical shock or fright. The admin- istrator should be guided as to the effect entirely by the res- piration ; and his only object, while producing anaesthesia, is to see that the respiration is not interfered with. If possible the patient's chest and abdomen should be exposed during chloroform inhalation, so that the respiratory movements can be seen by the administrator. If any thing interferes with the respiration in any way, however slightly, even if this occurs at the commencement of the administration, if breath is held, or if there is stertor, the inhalation should be stopped till the breathing is natural again. This may sometimes create de- lay and inconvenience, but experience will make any admin- istrator so familiar with the respiratory functions under chlo- roform, that he will in a short time know almost by intuition whether anything is going wrong, and be able to put it right without delay, before any danger arises. If the breathing be- CHLOROFORM. 295 comes embarrassed, the lower jaw should be pulled or pushed from behind the angles, forward, so that the lower teeth pro- trude in front of the upper. This raises the epiglottis and frees the larynx. At the same time it is well to assist the respiration artificially till the embarrassment passes off. If by any accident the respiration stops, artificial respiration should be commenced at once, while an assistant lowers the head and draws forward the tongue with catch forceps, by Howard's method, assisted by compression and relaxation of the thoracic walls. Artificial respiration should be continued till there is no doubt whatever that natural respiration is com- pletely re-established. A small dose of morphia may be in- jected subcutaneously before chloroform inhalation, as it helps to keep the patient in a state of anaesthesia in prolonged operation. There is nothing to show that atropine does any good in connection with the administration of chlo- roform, and it may do much harm. Alcohol may be given with much advantage before operations under chloroform, provided it does not cause excitement, and merely has the effect of giving a patient confidence and steadying the circu- lation. And it is the opinion of the Commission that "if the above rules be followed, chloroform may be given in any case requiring an operation, with perfect ease and absolute safety, so as to do good without the risk of evil." [As the physiological actions and mode of administration of chloroform and ether are similar, the reader is referred to the article on Sulphuric Ether.] Therapeutic Uses. — Besides its use as a general anaesthetic agent, chloroform is internally administered in substance, as an anodyne and antispasmodic, for non-inflammatory affec- tions, such as nausea and vomiting, sea-sickness, sick head- ache, flatulent colic, intermittent fevers, and in cholera, for which it is very efficient. The vapor is employed for the re- lief of hay asthma, whooping cough, spasmodic asthma, and as a hypnotic in delirium tremens, and as an injection and lotion in neuralgia, and as a counter-irritant or vesicant, for which purposes it is applied to the skin, and evaporation pre- 296 DENTAL MEDICINE. vented. Great care is necessary in the administration of chloroform in substance, as fatal effects have followed such use; 15 drops have destroyed life. Externally, chloroform is employed as a stimulating application to foul and indolent ulcers. Dr. Spark recommends highly, as a haemostatic agent, a solution composed of chloroform 2 parts, water 100 parts. He claims that it acts with a rapidity that is truly marvelous, and it has not the slightest disagreeable taste. It is useful in all operations upon the mouth and throat. Dose. — Of chloroform, Tltj to v, in sweetened water or mu- cilage. Dose of chloroform for inhalation, 5j to 5ij. Spirit of Chloroform — Spiritus Chloroforrni — is composed of chloroform ^j ; diluted alcohol 5ij. Dose of spirit of chlo- roform, 5ss to 5j. Mixed Chloroform-Morphia Narcosis. — A method prac- ticed by Prof. Thiersch, of Leipsic, succeeds often in inducing a perfect analgesia without unconsciousness. Morphine is first hypodermically injected, and in from five to seven min- utes afterwards the patient is very lightly chloroformed till near the stage of excitement ; the operation is performed ; as soon as pain is felt, if the operation is a prolonged one, a little chloroform is added. In this manner not the tenth part of chloroform is needed, and it is claimed that the operation is as painless as under full chloroform narcosis, and there is no risk of danger incurred. Men receive one-half a grain of morphine, women one-quarter of a grain, children one-twelfth to one-eighth of a grain. Cocaine-Chloroform Narcosis. — This consists essentially in the combined use of cocaine and chloroform, and is strongly favored by Prof. Obolinski, of Cracow, who injects either be- fore or after the anaesthesia is obtained, from one to three cen- tigrammes of cocaine ; or he injects in the neighborhood o the seat of the operation, and during its progress, from three to seven centigrammes. Cocaine is used on the ground that it is a complete antagonist of chloroform and chloral ; but it is not so regarded by others, who represent it to be a general ex- CHLOROFORM. 297 citor of the central nervous gray matter, rather than a direct and powerful stimulator of the heart, while its stimulant effect upon respiration is not to.be depended upon. Prof Obolin- ski claims that this mixed narcosis secures anaesthesia with the use of less chloroform, and that vomiting is prevented, and there are fewer disagreeable after-effects. Dental Uses. — Chloroform is employed in dental practice as a general anaesthetic, also as a local anaesthetic, for which pur- pose it is generally combined with other agents ; as an ano- dyne and antispasmodic, either locally applied or the vapor inhaled, as in the treatment of convulsions of dentition, for which it is a very efficient remedy. DENTAL For Neuralgic Affections. R . Chloroformi, Spinti ammonise, Tincturae aconiti aa f ^ j Olei ricini . . . . ^ij Linimenti saponis . fjj. M. SiGNA. — To be applied as a liniment over seat of pain. For a Local Ancesthetic. R . Chloroformi purificati, Tincturse aconiti, Alcoholis . . aa . . f ^ j Morphinse sulphat . gr.vj. M. SiGNA. — To be applied to gum over root of tooth to be extracted. For a Local Anaesthetic. Von Bonhorst. R. Chloroformi, .i^itheris sulph., Spiriti lavandulae, Pyrethri (fluid ext.) . aa f ^ j. M. SlGNA. — Apply for one or two minutes to gum over root of tooth to be ex- tracted. For Odontalgia — Pulpitis. R. Chloroformi . . . . .^ ij Alcoholis Jj FORMULAE. /Ether §ss Camphorae (pulv) . .|ss Tinct. opii . . . . |ss Oleum caryophylli . 3J. M. SiGNA. — Apply on cotton wool, to ex- posed pulp. For Neuralgic Affections of the Teeth. R . Chloroformi . . . . f ^ j or ij Aquae Oj. M. SiGNA. — To be used as a wash or a gargle. Camphora; . . . . 5 iss M. SiGNA. — To be applied as a liniment over seat of pain. For Neuralgic Affections. Chloroformi . . • • .5iJ Camphora; . . . . 5 iss Olei olivEe . . • • 3'J- R. For ( Odontalgia — Pulpitis. Chloroformi, Tinct. aconiti . aa . f.^i'j Tinct. capsici . . . f5J Tinct. pyrethri Oleum I caryoph . aa . f 5 ss Camphorae (puh '■) • 5SS. M. SioNA. — Apply on cotton wool. 298 DENTAL MEDICINE. R. Chloroformi ... 12 parts, Tinct. aconiti . .12 Tinct. capsici . . 4 Tinct. pyrethri . , 2 Olei caryophilli . 2 Camphorae ... 2 Dissolve the camphor in the chloro- form, then add the oil of cloves, then the tinctures. For an Anodyne Application in Neu- For excessive vomiting and irritability ~yalgia. du7ing Infantile Diarrhoea. R . Chloroformi . . . . f 5 j ^^- >'• ^\ "^«^^^- T • • i- 1, r 2 •• -KK R. Spt. chloroformi . . . ? i Lmimenti camphorae f^ij.M,^^ ^ t)J Creasote W ij SiGNA. — To be applied over seat of ,j. . ^^ ^^ . . Vm. ipecac tllv pain, and covered with oiled silk, to . . . i rr •• ,, ^ Aqu3e anisi . . q. s ad 5 ij, M. prevent evaporation. SiGNA.-A teaspoonfiil in a little water „ _ , J. r^ ,.,. for a child one year old. For Earache of Dentition. •' Local Ancesthetic. R. Chloroformi. . . . ^j Dr. Parson. Olei olivse ^ j M. SiGNA. — Pour from gtt. x to xx in ear, and close orifice with cotton. For a Local AticBsthetic. R. Chloroformi .... part, xx Acidi acetici (cryst.) part. j. M. SiGNA. — Apply with camel's-hair brush, or by applicator. CREOLIN— CREOLINE Creolin is a product of the decomposition of coal tar. Derivation. — It is obtained from English pit-coal by distilla- tion, and is in the form of a brownish, syrupy liquid, complex and very impure, with an odor like tar ; and in its impure state is slightly irritating, slightly caustic and strongly acid, and resembles in its properties the phenols. A purified preparation of creolin is, however, as neutral as vaseline, and quite as in- offensive to man and animals. It is insoluble in water, but soluble in ether, chloroform, and absolute alcohol. Therapeutic Uses and Medical Properties. — Creolin is both antiseptic, germicide and haemostatic, being employed for the latter purpose in obstetrical practice ; it is also employed in tonsillitis. It is employed with great benefit in ulers of the cornea. Its germicidal powers are said to be ten times superior to those of carbolic acid, and its action on the spores is even more pronounced than corrosive sublimate. The addi- tion of from eight to ten drops of a three per cent, aqueous solution is sufficient to completely sterilize and prevent the development of the comma-bacillus, and from one to three CREOLINE. 299 drops of a one per cent, solution will retard the development of the micro-organisms, and four drops will prevent it com- pletely. Its antiseptic properties are said to be superior to all other drugs at our command. It is soluble in water, alcohol and glycerine, and it does not affect the skin nor corrode in- struments, and the odor of the purified preparation is not dis- agreeable. It appears to have an anodyne effect, and is cura- tive when applied to open wounds. Creolin has also been em- ployed in antral disease. An aqueous solution of creolin is made of: 3^. Creolin, gr. iss ; aquae destil., TTLcl, which may be applied with a brush or in the form of spray. For dental use it may be injected, or applied on floss-silk or cotton wool. Creolin is considered to be a good deodorizer of iodoform. One or two drops of creolin may be added to half a glass of water for a mouth-wash, to correct disagreeable odors from the teeth and mouth. It will also hold in check acid-produc- ing germs ; it is also recommended for its action on mucous surfaces in soft and congested mouths, and to correct acid conditions, and the treatment of fistulous tracts of suppurat- ing surfaces ; also in root canals to deodorize dead tissue. It will also remove the rust on instruments when applied by means of a felt wheel of a lathe. To sterilize instruments a two per cent, solution may be used; also on the hands, and a one per cent, solution for irrigation of wounds and treatment of mucous surfaces. DENTAL FORMULAE. For Alveolar Pyorrhoea. Dr. a. W. Harlan. B . Creolin 3 j Sodium fluo. silicate gr. xx Olei Cassiae TTl xx Glycerinse S'v. M, Dilute with water to suit. SiGNA. — Use as a mouth-wash on a soft brush, during the intervals between sit- tings when escharotic and antiseptic agents have been applied. 300 DENTAL MEDICINE. CINCHONA FLAVA— YELLOW CINCHONA. CALISAYA BARK, PERUVIAN BARK. Source. — Cinchona is the bark of the tree cinchona calisaya, which grows on the western coast of South America, espe- cially of Bolivia and Southern Peru. Different varieties are named, according to their color, as Cinchona Flava, yellow cinchona ; Cinchona Pallida, pale cinchona ; Cincliona Rubra, red cinchona. The medical properties of these barks depend upon the alkaloids they contain in varying proportions, Quin- ifia being the most important. Medical Properties and Action. — The yellow bark has a much more bitter taste than the others, but is comparatively free from acidity. It is brownish yellow, the powder being of an orange color, and it contains more of the alkaloid quinine than the other barks. Cinchona is tonic, astringent and antiperiodic, and the different varieties owe their tonic and antiperiodic properties to the alkaloids quinina, cinchonina and cinchonidina. On account of the large quantity of the powdered barks it is necessary to take in order to obtain the full effects, and which cause, in some cases, derangement of the stomach, vomiting, headache and constipation, the alkaloid quinine, in the form of sulphate of quinina, is preferable. Sulphate of Quinina — Quini?icB Sidphas, is prepared by boiling the yellow bark in water acidulated with hydrochloric acid, by which the alkaloid is separated from its combination with kinic and other acids, to form a soluble hydrochlorate. This salt is decomposed, and the quinine is precipitated by the addition of lime, and afterwards washed in boiling alcohol. Sulphate of quinine is in the form of colorless, very light and silky crystals, and is readily soluble in alcohol, and in water acidulated with sulphuric acid. It is insoluble in ether, and requires 740 parts of cold, or 30 parts of boiling water to entirely dissolve it. Cinchona is also antiseptic, as the powder dusted over unhealthy wounds will arrest putrefaction, and promote healthy YELLOW CINCHONA. 30I cicatrization. Quinina will destroy minute organisms, and preserve substances from decomposition. The cinchona alka- loids are readily diffused into the blood, and when hypodermi- cally injected, are absorbed by the blood. Cinchona and its alkaloids increase the action of the heart slightly, but in large doses quinine depresses the heart's action and enfeebles the pulse. As quinine accumulates in the brain, a sense of fullness in the head, a tightness and constriction about the forehead, a ringing in the ears {tinnitus auriuin), giddiness and vertigo are experienced. Deafness also occurs, as the effect of consider- able doses, and, if continued, permanent injury may result. Poisonous doses cause intense headache, dilated pupils, de- lirium, coma and convulsions. Peruvian bark and its alkaloids are the most reliable tonics and antiperiodics. Tlierapentic Uses. — Cinchona, and its alkaloid, quinine, are internally employed in the treatment of intermittent fevers, and also other fevers, such as remittent, typhus, puerperal and scarlet; also in influenza, neuralgias of a malarial origin, acute rheumatism, phthisis, advanced stages of pneumonia and pleu- risy, erysipelas, urticaria, diseases of the eye, epilepsy, gangrene and mortification, scurvy, pyaemia, malarial dysentery, passive hemorrhages, and as an anthelmintic, etc., etc. Dose. — Of powdered cinchona, 3j to 5iij, given in infusion of liquorice; of the extract of cinchona, gr. j to gr. x, in pill; of sulphate of quinine, gr. j to 3j. Dental Uses. — Cinchona and its alkaloid, quinine, are em- ployed in dental practice, in the treatment of neuralgia of the fifth pair of nerves, when due to malaria, in from five to ten grain doses of quinine; in aphthous ulcerations, in one or two grain doses every two or three hours, especially when there is great debility ; and in cancrum oris ; also in the form of gargles and lotions, in gangrenous ulcerations of the mouth. Cinchona is also employed in the form of powder, as an ingredient of certain dentifrices, for its tonic and antiseptic properties. 302 DENTAL MEDICINE. DENTAL FORMULA. B. B. B Dentifrice, Pulv. cinchonas flav . . ^iv Pulv. saponis cas. albi . ^ iv CretK prep ^ ij Magnesia calc ^iij Otto rosse ,,..,. gtt. viij Olei caryophylli . . . gtt. vj. M. Dentifrice. Pulv. cinchonee flav. . Cretse prep Sacchari albi .... Pulv, cinnamom , . . Pulv. saponis cas, albi. Pulv. myrrliae . . . , 3J- M. For Mercurial Stomatitis. Garrettson. Tinct. cinchonse Potassce chloratis Sodae bibor . . Aluminis pulv. . Potassse permanganatis Aquse coloniae . , Tinct. myrrhae . . Tinct. capsici . . Tinct. kramerise . Aquse SiGNA. — Use as a gargle Jss gr.xxv I) Si §i ^viij. Dentifrice. R . Pulv. cinchonse flav . , Ib.ss Cretse prep Ib.ss Pulv, myrrhse . . . . §iv Pulv. radicis iridis . . ^ iv. M. For Ulceration of Gums. R, Pulv. cinchonse . . . . jij Cupri sulph gr.x Acacise (pulv.) . . . . ^j Mellis ^ij Aquse purse giij. M. SiG. — Apply with a camel's-hair brush to ulcerated surface of mucous mem- brane. For a Wash after the Extraction of Teeth. R, Cinchonse (decoct.) , . f^ij Aluminse jij Infus, rosse f^ij. M. SiGNA, — Use as a gargle. For Digestive Stimulation in Pyorrhcea Alveolaris. Dr. Chas. B. Atkinson. R. Cinchonidinse sulph. . ^ss; Acid, sulph. arom . . § ij ; Alcohol, 95 per cent. ^ iij ; M. Aquse dest. q. s. ad. . ^ xv. M. S. — One teaspoonful ter die. CINNAMOMUM— CINNAMON, CASSIA BARK, Source. — The best variety of cinnamon is obtained from Ceylon, and is the prepared bark of a tree of the natural order Laurace(E. It is in the form of long, cylindrical pieces, thin, smooth, and of a yellow-brown color, with a fragrant odor, and a warm, sweetish, aromatic and slightly astringent taste. It contains a volatile oil, a slight amount of tannic acid, an acid peculiar to itself, cinnamic acid, mucilage, lignin, etc. CINNAMON. 303 Medical Properties and Action. Cinnamon is an aromatic stimulant and astringent, being more powerful as a local than as a general stimulant. Its medicinal virtues principally reside in a volatile oil, oleum cinnamomi. TJierapeiitic Uses. — Cinnamon is chiefly used as an adjunct to other medicines, being seldom prescribed alone, though it is capable of allaying nausea and vomiting, and also relieving flatulence. Combined with chalk and with other astringents, it is well adapted for the treatment of diarrhoea. Dose. — Of cinnamon, gr. x to 5ss of the powder ; of the tincture, the dose is f5j to foiij. Oil of Cinnamon — Olctun Cinnamomi — is obtained by dis- tillation, and when fresh, is of a light yellow color, which becomes deeper by age, and ultimately red. It has an exces- sively hot, pungent taste. It is often employed to conceal the taste of other medicines, and is a powerful local stimulant. Large doses of the oil of cinnamon are poisonous, producing an inflamed and corroded condition of the gastric and intesti- nal mucous membrane. Dose. — Of the oil of cinnamon, gtt. j or gtt. ij, administered in the form of an emulsion. Oil of Cassia. — The oil of cassia is prepared from the bud, and the oil of cinnamon from the bark of the same order of tree LaiiracecB. The oil of cassia is preferred by many to the oil of cinnamon. (See Essential Oils, also Antiseptics in Dental Practice). Cinnamon water — Aqua Ci7i7iamomi — (cinnamon, carbonate of magnesia and distilled water), is used as a vehicle for other medicines. Spirit of cinnamon — Spiritus Cinnamojni — (oil of cinnamon, I part, stronger alcohol 15 parts). Dose, gtt. x to gtt. xx. Dental Uses. — Cinnamon, in the form of powder, is cm- ployed as an ingredient of dentifrices, for its stimulant, astringent and aromatic properties. Oil of cinnamon is em- ployed as an ingredient of dentifrices, for its stimulant, astrin- gent and aromatic properties. Oil of cinnamon is employed in dental practice for the relief of odontalgia. One drop 304 DENTAL MEDICINE. applied to an inflamed dental pulp will afford temporary relief; it is,- also, combined with iodoform, in the treatment of alveolar pyorrhoea. COCAINE. Source. — Cocaine is the alkaloid obtained from the leaves of the Erythroxylon Coca, a shrub indigenous to certain parts of South America, as Peru and Chili. The leaves resemble those of Chinese tea, and in the preparation of the alkaloid it is necessary that they should be of the best quality, which depends upon their being gathered at a proper time, carefully dried and not injured by age or by exposure to the air, as moisture deprives them of all value. Cocaine being extremely susceptible to the influence of acids, A. Castaing, Ph.G., de- vised a method by which one grain of cocaine can be extracted from four hundred and eighty grains of the leaves without using acidulated fluids, which is as follows : " On one part by weight of coca leaves pour eight parts of boiling water, and let them steep for half an hour in a closed vessel, in a water bath ; pour the whole into a percolator, and when all the liquid part is strained off, continue the exhaustion of the leaves by pouring on them eight parts of alcohol, at 85° ; mix the two liquids and precipitate them by means of acetate of lead; draw off with a siphon, and then add sulphate of sodium to remove the salts of lead ; filter and evaporate, at a gentle heat, until the liquid has attained the consistence of syrup ; treat the whole with water, to separate the resinous part, and then precipitate with carbonate of sodium ; the precipitate is then to be exhausted by sulphuric ether, and the ethereal solution, after the ether is distilled, is exposed to the air until every trace of ether has completely disappeared ; by this means is obtained a crystallized residue, of a brownish-yellow color, and of a disagreeable smell. This is impure cocaine. The coloring matter is removed by washing once or twice with cold alcohol. The cocaine thus purified, appears in the form of transparent prisms, without smell, bitter to the taste, soluble in seven hundred parts of cold water, more soluble in alcohol, and entirely soluble in ether. The solution has an COCAINE. 305 alkaline reaction, and, when applied to the tongue, it imparts a bitter taste, and a certain insensibility, followed by a slight sensation of cold, recalling the effect of ether spray upon the epidermis. Heated to 208° F., the cocaine becomes liquid, and under the influence of cold, it becomes a transparent mass, which gradually assumes a crystalline form. If it be exposed to a higher heat than 208° F., cocaine changes its color and decomposes. It is inflammable, and burns with a brilliant flame, leaving an ash. It forms soluble salts with acids (its hydrochlorate is one of the best), and all these salts are more bitter than the alkaloid. It is a compound of carbon, hydrogen, nitrogen and oxygen. Pure cocaine is in the form of colorless, transparent prisms, without odor, but with a slight bitter taste. The chemical composition of the alkaloid is Ci7H2jN04 ; its reaction is strongly alkaline. The two forms in which cocaine is most generally used are the hydrochlorate or muriate and the oleate. The hydrochlor- ate of cocaine is generally employed in surgery, and is in the form of a white crystalline powder, which is sparingly soluble in water, but readily soluble in alcohol, ether, oil and vaseline. At first a 2 per cent, solution was used, but subsequently it was increased to four, five, ten, and twenty per cent. Merck has, however, introduced a new preparation known as the Citrate of Cocaine, in the form of pills, made by incorporating it with gum tragacanth dissolved in glycerine, each pill con- taining ]/i grain of the citrate, in which form it retains its strength. The citrate of cocaine, however, in solution, will decompose in three or four days. Dr. John S. Marshall, from experiments made with the citrate of cocaine, is of the opinion that it is more reliable when applied to hypersensitive dentine or to the dental pulp, than the first two forms, but appears to possess no special ad- vantages over them for operations on submucous tissues or in the extraction of teeth. Another new salt of cocaine, the hydrobromate, has been produced by Dr. Lyons by a combination of hydrobromic acid, with cocaine, in the form of slender, translucent prisms, of 306 DENTAL MEDICINE. snowy whiteness. It is claimed that the local anaesthetic effect of this preparation is greater, for the same amount of solution, than that of any of the other salts employed. Medical Properties and Action. — Dr. Niemann, of Goslar, as early as i860, noted the fact that cocaine, when applied to the tongue, produced local anaesthesia but his investigations, as well as those of others at a later period, appear to have been forgotten, until 1884, when Dr. KoUer, of Vienna, demonstrated the action of cocaine, in solution, on the eye. Apparently very little is known concerning the physiological action of cocaine, but that it is a valuable local anaesthetic and local anodyne is beyond question. It appears to paralyze the nerves of the vessels, causing, at the same time, a constriction, as is evident from the blanching of the part acted on. Many are of the opinion that its effects are mainly due to its influence upon the sympathetic. When one drop of a 2 or 4 per cent, solution of cocaine is applied to the eye, a slight burning sensation is felt, and a minute or two later the cornea and con- junctiva become anaesthetized, and lose all reflex excitability* The finger can be passed over the cornea and conjunctiva, and the latter can be taken up with the forceps, without pain. At the same time there is a feeling of tension in the lids, and the eyes seem protruding. These effects last about ten minutes and gradually disappear. Dr. Konigstein reports having re- moved the eyeball of a dog cocainized, without the animal feeling any pain. A ten or twenty per cent, solution is used, according to the sensitiveness of the parts and the nature of the operation, when less sensitive organs than the eye have to be obtunded. For the larynx, it should be applied three or four times, at intervals of ninety seconds ; for the eye, a drop of the two per cent, solution, at intervals of two minutes, the maximum effect being reached in fifteen minutes. Dr. Jelinek recommends a dilute alcoholic solution of ten or twenty per cent. For the former strength the proportion of alcohol to water should be one to four ; for the latter, two to three. Therapeutic Uses. — Cocaine is employed in some forms of insanity, melancholia, neurasthenia, gastralgia and in wasting COCAINE. 307 diseases, pruritic skin affections and hoarseness. The leaves in cigarettes have relieved hay fever and throat affections. Co- caine is employed as a local anaesthetic and local anodyne in all painful affections of the eye, the operation for cataract, al- though the evidence as to its reliability in such deep opera- tions as iridectomy, cataract, squint, etc., is conflicting. (There are, however, cases reported by Dr. Konigstein of even the surfaces of the eyelids entirely losing their sensitiveness when hydrochlorate of cocaine was applied in solid form.) It is also employed in painful affections of the pharynx and larynx, or of any other excitable mucous membrane or of nerve tissue. Prof Engle reports a case of trigeminal neuralgia successfully treated by hypodermic injections of the hydrochlorate of co- caine. Dr. Wagner of Vienna, basing a theory upon the es- tablished principle that fluids move from the positive to the negative pole in a galvanic current, saturated the positive elec- trode with a strong cocaine solution, applied it to the skin, and applied the negative pole a short distance from the positive, and found that incisions could be made without producing any pain. Dr. Lewis H. Adler, Jr.. writing on the status of hydrochlor- ate of cocaine in minor surgery says : " In minor surgery, cocaine, when used hypodermically, is of value in all operations in which the circulation can be tem- porarily arrested, in order to prevent undue absorption of the drug, and in which free bleeding can be encouraged at the completion of the operation previous to the tying of the sutures, to allow as much of the unabsorbed cocaine to be washed out as is possible. Attention paid to these two essential points will, as a rule, obviate any untoward results from the use of cocaine employed hypodermically for anaesthetic purposes. It is likewise important to make use of freshly prepared solutions, as otherwise the formation of fungi is liable to occur and the preparation to be spoiled. To prevent this alteration, antisep- tic agents are added, the best one being boracic acid, as it is the least irritating. Such a solution usually consists of about twenty grains of cocaine and ten grains of boracic acid, dis- solved in an ounce of distilled water. A preparation of this 308 DENTAL MEDICINE. character has been used by the writer with perfectly satisfactory results, even when it has been over two months old. Another point of considerable importance in using cocaine hypodermically is to make use of a perfectly aseptic syringe ; frequently in cases where the drug is so used and suppuration follows, it is the fault of want of cleanliness in this particular, and not to the employment of the drug, A four per cent, solution is as strong as need be used for hypodermic injections. The principal advantages in using a solution of no greater strength are, that the anaesthetic prop- erty of cocaine can be made to reach to a larger area with a less amount of the drug than is the case when a more concen- trated one is employed ; and, furthermore, the dilution of the drug renders it less liable to produce toxic symptoms. When the circulation cannot be controlled, extreme caution must be observed in the use of the drug, especially is this the case when any considerable quantity is required. The quantity of cocaine required to produce anaesthesia varies with the operation and its extent ; as a rule for ordinary minor operations from 25 to 40 minims of a four per cent, solution are needed. The length of time necessary for the production of local anaesthesia or insensibility under cocaine varies from three to ten minutes, Individual susceptibility to the toxic influence of cocaine is a complication of sufficiently frequent occurrence to surround the use of the drug with due care and caution, but it is not a contraindication to the employment of the agent as an anaes- thetic. Untoward effects may arise from the use of any one of the anaesthetic substances. Another objection urged by some surgeons to the employ- ment of cocaine for anaesthetic purposes is based on its asserted power of inducing the so-called " cocaine habit." As yet, this influence of the drug is extremely rare. It is most liable to occur among the patients who are informed of the nature of the remedy used, and especially is this the case when it is em- ployed internally for medicinal purposes. I hardly believe that this action of cocaine can be produced when it is employed COCAINE. 309 for its local anaesthetic effect and in the small quantity needed to induce local insensibility." Dr. Edward T. Reichert, from a careful study of the actions of cocaine on the circulation in animals, deduced the following conclusions : i. The discrep- ancies in the testimony offered by different experimenters, in their investigations of the action of cocaine on the circulation, are almost wholly due to variations in the absolute doses em- ployed, and to the individual susceptibility of the animals- 2. The minimal fatal dose, when injected intravenously in divided doses in the form of a one per cent, solution, varies from 0.004 to 0.03 gramme to the kilo of the body weight. Owing to the great differences in the sensitiveness of different dogs to the poison, a moderate dose in one animal might prove a small or a large one in another of similar weight. 3, When the full train of effects on the heart-beat is slowly de- veloped by the repeated injection of very small doses (0.00 1 gramme to the kilo of body Vk^eight), the pulse rate is at first decreased, then increased, and finally decreased. A single very small dose causes a decrease, a small to a moderate dose an increase ; large doses a transient decrease followed by an in- crease ; very large doses a more or less permanent decrease. The primary decrease, which only can be developed by very small doses, is due to a stimulation of the cardio-inhibitory centres ; the secondary increase to a depression of the same centres, and which may be assisted by a similar action on the cardio-inhibitory peripheries ; and the final decrease to a de- pression either of the accelerator or automatic motor-ganglion in the heart. The height of the pulse curves during these changes is always in adverse relation to the frequency of the beat. 4. The cardio-inhibitory centres are invariably affected, being primarly stimulated, and secondarily depressed; but the action on the peripheries is of a very inconsistent character, although a primary stimulant action is never manifest the depressant action is sometimes present to a profound degree very early in the poisoning, and, at others, absolutely absent up to the time of death. 5. The arterial pressure is always increased, unless it be after large doses, when it may temper- 310 DENTAL MEDICINE. arily be diminished, followed by a rise above the normal ; or after very large doses, be permanently lowered. The increase may be decided long after the development of the third stage of the actions of the heart, and, therefore, may outlast the period of the acceleration of the heart's beat. The increase is chiefly due to a stimulation of the vaso-motor centres in the medulla oblongata: to a slight stimulation direct of the vessel- walls ; and to the acceleration of the pulse. The final fall of pressure is chiefly dependent upon a depression of the heart, and partly to vaso-motor depression. 6. The effects of cocaine in normal and curarized animals are identical, unless, in the latter, the curare has been used to excess. 7. Cocaine is a decided circulatory stimulant. Dental Uses. — In operations in the mouth, affecting the mucous membrane and the immediately subjacent tissues, the salts of cocaine have proven efficient for their local anaes- thetic and anodyne effects. But for operations on deep-seated tissues, such as are involved in the extraction of teeth, the action of cocaine has been, as Dr. W, W. Allport remarks, "so uncertain as to render its practicable benefits questionable." Cocaine has, however, proven very efficient in relieving the pain of the surgical treatment of alveolar pyorrhoea, the extir- pation of the pulps of teeth, and, in some cases, that of hyper- sensitive dentine. Exposed pulps are rendered less painful after being treated with a five per cent, solution of cocaine, to which, in some cases, morphine has been added. In some cases also, it is claimed, highly inflamed pulps have been successfully cap- ped, as an experiment, with a paste of cocaine and glycerine, although, as was foreseen, the anaesthetic did not arrest the course of the pulpitis. In treating hypersensitive dentine, the more sensitive the structure the stronger the solution of cocaine to be employed. The pure cocaine in the form of crystals, of the hydrochlorate or other salts, in the form of powder, have proven efficient when applied to hypersensitive dentine ; while the twenty per cent, solution of the salts have relieved the acute pain which is common to such a condition. It is also claimed that the crystals of cocaine, applied to the gum, close COCAINE. 311 to a tooth to be extracted, three times, at intervals of two minutes each, has secured a painless operation. It has been suggested that immediately after the application of the cocaine crystals to the gum, three or four minims of a four per cent, solution be injected with a hypodermic syringe, between the gum and the neck of the tooth to be extracted. For the extir- pation of pulps of teeth, it is recommended first to anaesthetize the pulps superficially, with a paste of cocaine and glycerine, and then to introduce, by means of a syringe, a twenty per cent, solution of cocaine directly on the exposed portion of the pulp, when it can be removed with a nerve extractor without causing any pain. Dr. John S. Marshall, from his experiments with the pills of citrate of cocaine, found that under favorable circumstances, the citrate, in such a form, produces anesthesia, when applied to sensitive dentine, in from five to ten minutes, and that the obtunding effect is of a duration sufficient for the preparation of the cavity. He was also able to extirpate the pulp of a tooth, after the citrate had been applied, in from three to twelve minutes. In using the citrate in the form of pills, one pill is introduced into the sensitive cavity, and, after being secured with a pledget of cotton, moistened in tepid water, is permitted to remain from five to twelve minutes. Dr. Mar- shall suggests the use of granules, containing one-sixteenth of a grain of pure citrate of cocaine, instead of pills containing glycerine and saccharine matters. A solution of the salts of cocaine has also been subcutaneously injected, with favorable results, for the relief of the pain resulting from periodontitis and dental exostosis ; and Dr. Hillischer recommends the rub- bing in of concaine, either in substance or in concentrated solution, after the epithelium has been macerated with tincture of iodine, to promote absorption, to relieve the pain of chronic periodontitis; also the repeated application of the concentrated solution to relieve the ulcers of thrush, aphthai, etc. In the surgical treatment of alveolar pyorrhcea, the pain may be re- lieved by first applying dilute alcohol to the gums, by means of a camel's hair brush, and then in the same manner, a ten per cent, solution of cocaine, repeating the application of the 312 DENTAL MEDICINE. cocaine once or twice during the space of five minutes. The slowness of the action of cocaine is a great objection to its use as an anaesthetic. The four per cent, or five per cent, solution applied to a tooth unprotected by a rubber dam (as the rubber prevents the anaesthetic action of the agent), for the space of twenty minutes, repeating the application if necessary, is recom- mended by Dr. Thompson. Dr. A. W. Harlan recommends a solution composed of cocaine hydrochlorate, ten grains, in sulphuric ether, ninety minims, which is to be applied for four or five minutes, for the painless extirpation of an exposed pulp. Dr. Harper recommends the following method for removing pulps of teeth by the use of crystals of cocaine : * ' Take a drop of the oil of cloves and add enough cocaine to make a thick paste and introduce it into the pulp, after having first put the rubber dam on the tooth ; then with a broach slowly work it down ; with a bur open up the opening slowly, and in ten or fifteen minutes the pulp may be removed from any of the anterior teeth." Where arsenic has been applied to the pulp and the patient returns with pain, he finds that he can get better satisfaction from the application of cocaine. Herbsfs Obtundent consists of a saturated solution of cocaine hydrochlorate in chemically pure sulphuric acid, to which sul- phuric ether is added to the point of saturation, the excess of the ether floating upon the surface and evaporating. Several applications are necessary to produce anaesthetic effects, and seventy grains of cocaine hydrochlorate are required to satu- rate two drachms of the sulphuric acid. Cocaine, owing to the unsatisfactory results which have attended its use as a local application, is now generally applied by hypodermic injection, for the extraction of teeth. Owing to the necessity for introducing the agent deeply into the tis- sues. Dr. Walb's method is to inject a two per cent, solution of the hydrochlorate of cocaine hypodermically over the root of the tooth to be extracted, the injections being usually made on each side of the gum, above the root of the tooth, and as COCAINE. 313 many as the number of teeth to be extracted may indicate ; the same method is employed for obtunding hypersensitive den- tine, and in removing pulps. The full anaesthetic effect is de- veloped in from five to ten minutes, and continues ten cr fifteen minutes. It has also been suggested to hypodermically inject the solutions of cocaine upon both the lingual branch and the inferior dental branch of the inferior maxillary nerve, the former being preferred by some, on account of its supplying the alveoli and gums ; but greater success appears to result from injecting the gum on each side of the tooth. Dr. Ray- mond recommends charging the syringe with thirteen minims of a four per cent, solution of cocaine, and to direct the needle- point on a line extending about midway between the angle and the coronoid process of the inferior maxillary, passing through the internal pterygoid muscle, and, using the finger on the internal oblique line as a guide, to carry the needle- point along inner surface of ramus until the nerve is reached, where it enters the inferior dental foramen, for operations on the inferior molar teeth. Dr. Raymond also suggests the following method of pre- paring and applying cocaine : Obtain a quantity of the soluble alkaloid, and mix it at the time of using it (as it de- teriorates when long kept). The requisites are a minim glass, pair of scales, some filtering paper, and a little water that has been boiled. It is necessary to have an easy-working syringe, with a perfectly smooth, sharp needle. Care must be taken to exhaust the air from the syringe when charged ready for use. This can be done by drawing in more of the solution than is needed, and pressing it out to the required number of minims. Hold the needle-point up, so as to allow the air to get above the solution, then press the piston. The needle of the hypodermic syringe should be fine, sharp, and clean, and rendered thoroughly aseptic previous to its employment, which may be accomplished by drawing up through it a few drops of any good antiseptic solution, such as strong carbolic acid, and the solution should be freshly prepared for each operation as the salts of cocaine rapidly de- 314 DENTAL MEDICINE. compose. The salt should be dissolved in slightly warm water, and the strength of the solution vary from 5 to 20 per cent. A five per cent, solution is made by dissolving yi grain in 10 minims of water. Previous to the injection, the gum should be dried about the tooth, and a folded napkin so placed as to exclude the saliva. All air must be expelled from the syringe, and the gum at the point the needle of syringe is to enter, should be obtunded by applying a few drops of the solution to the mucous membrane, so as to render the punc- ture painless. It is recommended to inject the solution at three points, two punctures on the labial or buccal surface, and one on the palatine or lingual surface. The point of the needle should be inserted about one-sixth of an inch below the free margin of the gum, and pressed in obliquely, upwards or downwards, as the case may be, in a direction towards the apex of the tooth, until the point of the needle rests against the bone ; all of the soft tissues must be penetrated. With the needle in position, and a finger placed on either side and pressed with some force against the gum to keep the tissues in place, the solution should be slowly injected, when the gum should appear completely blanched in the neighborhood of the puncture. After injecting the solution, the needle should not be withdrawn for several seconds, and then a finger should be placed over the puncture to prevent any escape of the solu- tion. Some six or seven minutes elapse before the full anaes- thetic effects of the cocaine are obtained. Dr. Gask recom- mends placing a few crystals of the salt just around the neck of the tooth to render painless the application of the forceps, and he prefers for injection hydrochlorate of cocaine in the form of half-grain tabloids. The combined use of cocaine and chloroform is advocated by Obolinski, who injects, either before or after the anaesthesia is obtained, from one to three centigrammes of cocaine ; or he injects in the neighborhood of the seat of operation, and dur- ing its progress, from three to seven centigrammes. Cocaine is thus used on the ground that it is a complete antagonist to chloroform, of which, however, there is some doubt, as cocaine COCAINE. 315 is rather a general excitant of the central nervous gray matter than a direct and powerful stimulator of the heart, while its stimulant effect upon respiration is not to be depended upon. Obolinski claims that this mixed narcosis requires the use of less chloroform, that vomiting is prevented, and that there are few disagreeable after-effects. Dr. Gordon White recommends a saturated solution of cocaine hydrochlorate in ether as an excellent preparation for sensitive dentine and pulp-extirpation. Dr. A. C. Gask recommends painting the palate with a five per cent, solution of cocaine for obtaining impressions of mouths which exhibit great intolerance to the introduction of all impression materials ; also a 20 per cent, solution applied to the mucous membrane on cotton, for service in wedging and separating teeth, in forcing silk, etc., up in high conical edges, in removing portions of overhanging gum, in lancing abscesses, in treating alveolar pyorrhoea, in extirpation of pulps, and in the treatment of teeth very sensitive from perio- dontitis ; also in the form of a ^ grain compressed tabloid placed in the cavity, to relieve the pain following extraction. The dangers from the use of cocaine are enumerated as follows : Certain persons possess an idiosyncrasy to cocaine, which cannot be foreseen or entirely guarded against; it exerts its toxic effects upon the nervous centres and, secondarily, the heart; its evil effects are most liable in neurotic subjects ; the danger in cocaine poisoning is mainly from paralysis of the heart, syncope; special care is necessary in "weak heart" and organic heart disease; many regard its subcutaneous adminis- tration as dangerous, and that it should be avoided ; the use of the strongest solutions is dangerous and unnecessary; that it may be well to precede its use by the administration of alcohol or other cardiac stimulant, as is done with chloroform. Patients of a sanguine temperament and in good health are the most favorable subjects in the use of cocaine ; while the nervous, hysterical, and those exhibiting great dread of the impending operation, as well as pregnant women, may be re- garded as unfavorable subjects. Great care should also be taken to prevent even the weakest solution of eocaine from 316 DENTAL MEDICINE. running down into the fauces, and restorative agents should always be at hand. Cocaine appears to be absorbed with extraordinary rapidity, and the stronger the solution which is locally applied, the greater the danger of toxic symptoms. The rapidity of the absorption varies in the different tissues, absorption occurring most rapidly through the conjunctiva, then through the nose, larynx, mouth, and ear. A ten per cent, solution is sufficiently strong for most purposes, and is less dangerous than one of greater strength. The treatment of cocaine poisoning consists of measures to rouse the heart, especially inhalations of the nitrite of amyl, and such restoratives as brandy, whiskey, aromatic spirits of ammonia, strychnine, atropine, digitalis, ether and chloroform (when convulsions are present), or five minims of carbonate of ammonia by injection, also nitrite of amyl by inhalation. The hot-baths, hot drinks, and hot sinapisms over the heart, and friction are often serviceable ; also artificial respiration. Cocaine is also employed in combination with arsenious acid for a devitalizing mixture. (See Arsenious Acid). Cocaine Incompatible s. — When combined with nitrate of sil- ver, decomposition of the hydrochloride occurs with the for- mation of an insoluble chloride of silver, and a corresponding change in the cocaine. If calomel and hydrochlorate of co- caine are rubbed together, chemical reaction begins. Added to mercuric oxide, an irritating instead of an anaesthetic ac- tion is produced, due to the formation of oxychloride of mer- cury. DENTAL FORMULA. To Make a Solution of Hydrochlorate Spiritus menthas pip . . f^j. M. of Cocaine (four per cent.). SiGNA.— Apply on a pledget of cotton. For Local Ancesthesia. R . Cocaini hydrocMoratis (cryst.) gr. 2X Aquse destillatae . . . . f^j. M. H. J. McKellops. For Exposed Pulps. g . Mur. cocaini gr.iss R. Cocaini hydrochloratis Spts. alcoholis ^] (cryst.) gr.vj Chloroformi ^j. M, COCAINE. 317 For Neuralgia and Odontalgia. fi . Cocaini hydrochloratis (crj-st.) gr.vj Menthol gr.xxx Alcoholis . qs. . ad . . f^j. M. SlGNA. — Apply as a lotion, or on a pledget of cotton. Chloroform or bromide of ethyl may be substituted for the alcohol. To Make Oleaie of Cocaine. (Five per cent.) R. Cocaine (alkaloid) . . . gT.2^ Acidi oleic (pure) . . . ITtxx Olei amygdalffi .... TTLxl. Dissolve the alkaloid in the oleic acid and add the almond oil. For Pain of Difficult Dentition. M. VlQUIER. R. Cocaini hydrochloratis . gr.ij Syrup simp 3 ijss Tinct. saffron gtt.x. M. SiGNA. — Rub the painful gums fre- quently during the day. For Local Ancesthesia. J. M. Lewis. R . Cocaini hydrochloratis. grs.viii Chloralis hydrat . . . gr.v Acidi carbolici .... gtt.iij Aquae destil f^i'j- ^^• SiGNA. — Inject two or three drops into the gum. For Hypersensitive Dentine. R . Cocaini hydrochloratis (cr>-st.) gr.x Tragacanth. glyceritum q.s. Form a mass. SiG.VA. — Insert a minute portion in cavity half an hour before operating. For Neuralgia and Odontalgia, R . Cocaini hydrochloratis (cryst.) gr.xv Olei caryophylli . . . . f3J. M. Sic.VA. — Apply as a lotion, or on a pledget of cotton. Local AncEsthetic. R. Cocaine hydrate (4 per cent, solution) . . . . 5iij Carbolic acid gtt.v Chloral hydrate . . . gr.v. M. S. — Use hj-podermically around tooth with care. Local Ancestketic for Extraction of Teeth. Dr. J. W. Hope. R. Cocaini hydrochloratis . 5 parts Acidi carbolici 6 " Camphorse (Pine gum) . 6 " Alcoholis (95 pr. ct.) q.s. to make I20 parts. M. S. — Inject with a hj-podermic sjTinge one to three minims deeply into inner and outer surfaces of gum. Apply over the gum absorbent cotton satu- rated with the solution. Wait 4 or 5 minutes. Local AncEsthetic for Gums and Sensi- tive Dentine. Dr. Martin. R. Cocaine gc.% Antipyrine gr.vj Aq. destil TTLxvj.M. Prof. J. E. Michael suggests 2 grains of acetanilid as a substitute for the antipy- rine. For Stomatitis and Difficult Teething of Children. INTERNAT. KLIN. RUNDSCHAU. 1. Paint the gums with the following mixture : R. Cocainaemur gr. iss. Sodii chlor gr. xv. Glycerini, Aquae dest aa 3 iiss. 2. Spray a boracic acid solution on the inflamed parts. 3. To prevent spasms give internally : R. Potassiibrom gr. xv. Syr. alth .5 v, Salep. gummos SJ'S'J- M.— S. Teaspoonful every hour. 318 DENTAL MEDICINE. For Irritation of the Gums. M. F. Besnier. R. Hydrochlorate of Cocaine . . • . . . gr.| Bromide of Potassium gr.vii ss. Distilled water Glycerine • . . . . aa TTtcl. M. COLCHICUM— MEADOW SAFFRON. Source. — Colchicum root — Colchici radix ; Colchicum seed — Colchici semen, the bulb and seed of the Colchicum Autum- nali. Colchicum contains tannic and gallic acids and an alkaloid known as colchicine, which is the active principle; colchicum also contains starch, sugar and gum. It has a bitter taste, and imparts its medicinal virtues to water, alcohol and ether ; wine and vinegar extracting all its properties. Medical Properties and Therapeutic Uses. — Colchicum, in the forms of fluid extract, wine and tincture, increases the mucous and glandular secretions of the stomach, intestines, liver, kidneys and skin, and causes an increased flow of saliva, and also of urine. A large dose may produce heat in the epigastrium, nausea, vomiting, depression of the circulation, muscular feebleness and pain in the head, large, watery stools and an increased secretion of biliary matters. In poisonous doses it produces all the symptoms of an irritant poison, such as acute pain in abdomen, profuse watery and mucous dis- charges, suppression of urine, cold extremities and feeble pulse ; also muscular cramps, in some cases. Colchicum is principally employed in gout, when a quantity sufficient to shorten the duration of an acute attack and reduce the swell- ing by an increased secretion from the skin, intestines and kidneys, is only required. It is often combined with an alkali, such as aromatic spirits of ammonia, bicarbonate of potassium, or carbonate of magnesia, to increase its effect. The active principle, colchicine, is generally more efficacious than the crude colchicum. It is very serviceable in rheumatic gout when combined with alkalies, and also in all affections depen- dent upon a gouty diathesis, such as constipation, congestion of the liver, and headache from torpor of the portal circula- COLLODION. 319 tion. It is now rarely used in acute rheumatism, but in chronic rheumatism it often proves serviceable. Its use is indicated in plethora, constipation and deficient action of the liver, kidneys and skin. Dose. — Of the fluid of colchicum root — Extractiim Colchici Radicis Fluidiim, TTLij to ITLv. Of wine of colchicum root — Vi?i7iin Colchici Radicis, TTLv to TTlxxx. Of acetous extract of colchicum root — Extractian Colchici Radicis, gr. ss to gr. ij. Of tincture of colchicum (seed) — Tinctura Colchici, ITLx to 5j- COLLODIUM— COLLODION. Derivation. — Collodion is a solution of 4 parts of pyroxylin in 70 parts of stronger ether, and 26 parts of alcohol. Pyroxy- lin or gun cotton, is prepared by adding a mixture of nitric and sulphuric acids to cotton freed from impurities. Collodion is a colorless, syrupy, and very inflammable liquid, with a strong ethereal odor. By long standing and exposure, or when applied to a surface, it deposits a thin, transparent and strongly contractile film, which is insoluble in water or alcohol. It should be kept in glass-stoppered bottles. It is applied by means of a camel-hair brush. When it becomes too thick, it may be diluted by a solution consisting of ether, 3 parts, alcohol, i part. Medical Properties and Action. — It is serviceable as an emol- lient, and its action is mechanical, as it draws together and holds in apposition divided parts, and protects such, as well as abraded or denuded surfaces, from contact with the air. As the ether it contains evaporates, the surface of the part to which it is applied is constringed, and a degree of pressure is thus established, which is very useful in moderating vascular action, promoting absorption, and changing the course of pus which may already be formed into a direction more desirable. On account of the liability of collodion to crack and peel off, these objections have been obviated by the use of what is known as Flexible Collodion — Collodium Flexile — (collodion, 92 parts, Canada turpentine, 5 parts, castor oil 3 parts), which is softer and more pliable and elastic. 320 DENTAL MEDICINE. Therapeutic Uses. — Collodion is very useful in ulcers, fissures, incised wounds, abraded surfaces, erysipelas, skin, diseases, etc. Dental Uses. — Collodion is a very useful application in dental practice, to prevent alveolar abscesses from discharging exter- nally on the face ; for such a purpose, it is applied in successive layers, so as to act as a compress, and, by moderating the vascular action, cause absorption, or such a change in the direction of the discharge as will induce it to open in the mouth. It is also employed in combination with carbolic acid, as an application for odontalgia ; when introduced on cotton, it acts as a temporary filling; it has also been employed for arresting the mucous secretion during the operation of filling cavities near to or under the margin of the gum, but the rubber dam has superseded it in this respect. Combined with iron and other agents, it forms a styptic preparation. In the dental laboratory, collodion, in the form of a colored preparation, is employed to coat the surfaces of the plaster models of plastic work, and when not applied too thick, it protects the plaster surface, and also prevents an unsightly rubber surface on that part of the plate which is adapted to the mucous surface of the mouth. When this preparation becomes too thick for use, it may be diluted with a solution of 3 parts of ether to i part of alcohol. Collodion is precipitated by carbolic acid. Cantharidal Collodion — Collodium cum Cantharide — is composed of cantharides (Spanish flies), in powder 60 parts, flexible collodion, 85 parts, commercial chloroform, q. s. The addition of one per cent, of Venice turpentine to cantharidal collodion will prevent the disagreeable, and, at times, painful contraction of the preparation on drying. Like cantharides, cantharidal collodion, when locally applied, excites inflammation of the skin and mucous membrane, which terminates in a copious secretion of serum under the cuticle. It produces a blister in the same time as the ordinary blister- ing plaster, and is applied with greater facility, and is better adapted to cover uneven surfaces, and retains its place more CONIUM. 321 certainly. It acts much more readily if the evaporation of the ether is prevented by a piece of oiled silk placed over the surface immediately after the application of the collodion. Dental Uses. — Cantharidal collodion is a valuable application io periodontitis, applied to the gum over the root of the affected tooth, by means of a camel-hair brush, previously removing all moisture from the surface, and protecting the lips and cheeks, until the ether it contains has evaporated, and an artificial cuticle is formed. The blister which rises on the gum should be punctured with a needle. The counter-irritation thus produced relieves the periosteal inflammation. Iodized Collodion — Collodium lodiduni — (collodion, Sj, iodine, gr. xx), forms a good solution of iodine for external use. DENTAL FORMUL/E. For Odontalgia. For a Styptic. R. Acidi carbolic! cryst., R- Collodii ^^iij Collodii . , aa . . . ^j. M. Tinct. ferri perchloridi. ^j SiGNA. — To be applied on cotton. Olei ricini gtt.'j. M. SiGNA. — To be applied to the bleeding For a Styptic. surface, or, on cotton, to the alveolar R. Collodii partes lOO cavity. Acidi carbolici . . partes lo Acidi tannici . . . partes 5 Por a Styptic. Acidi benzoici . .partes 5. M, R. Acidi tannici, SiGNA. — To be applied to the bleeding Alcoholis, surface by means of a camel-hair ^theris . . aa . . partes aeq. M. brush. Then add as much pyroxylin as the solution will dissolve. CONIUM— HEMLOCK. Derivation. — Hemlock is the fruit of the Conium maculatum, or spotted (not the common) hemlock, which is an umbellif- erous plant. The principal one of its three alkaloids is Conine, CgHuN, which is very powerful. Medical Properties and Action. — Conium is a depressing agent producing motor paralysis, first causing, as the effects of a large dose, nausea and vomiting with a general weakness of the voluntary muscles, but with no direct action on the heart. In fatal cases of poisoning death follows from paralysis 322 DENTAL MEDICINE. of the respiratory muscles causing asphyxia. The antidotes are nux vomica, picrotoxin, and active muscular exercise. It is quickly decomposed by heat. Therapeutic Uses. — Conium is employed in mania, chorea, tetanus, hydrophobia, whooping-cough, asthma, laryngismus stridulus, diseases of the eye and strychnine poison. For nerve-pain with muscular spasm, the best results may be ex- pected from the combined administration of morphine and Conine, subcutaneously applied, as the effects of conine are greatly heightened by morphine. Conium is also used in dislocations to relax muscles. Dose. — Of Abstractum conii, gr. ss to gr. ij ; Extractum conii alcoholicum, gr. ij to gr. iv ; Extractum conii fluidum, ITLij to Htv ; Tinctura conii, HTLx to f5j ; Conine, tTL yV to 1Ttij. Dental Uses. — Conium is employed in neuralgias, locally applied ; inflamed dental pulps ; also in cases of artificial teeth lodging in the oesophagus, to produce relaxation of the muscles. CREASOTUM— CREASOTE. Formida. — CgH-ioOg. Sp. gr. 1.071. Derivation. — Creasote is a product of the distillation of wood tar, its name being derived from the Greek xp^aQ, " flesh," and ocoz'f]<;, "preserver," as animal substances, when saturated with it, are preserved from putrefaction. It is also obtained from crude pyroligneous acid. Creasote, when fresh and pure, is a colorless, oleaginous fluid, with a strong, empyreumatic odor, resembling closely carbolic acid, and a caustic, burning taste. After exposure, it has a yellowish or brownish tinge. Its purity may be tested by strong acetic acid, which dissolves the creasote, and leaves behind the impurities floating above the creasote solution. It may also be tested by dropping it on paper, when, if pure, it will, after being volatilized by heat, leave no stain. Creasote may be distinguished from carbolic acid, which it closely resembles in many respects, by not coagulating collodion when mixed with it, and by not imparting a blue color to CREASOTE. 323 a piece of pine wood dipped first into an alkaline solution of creasote, and then, after drying, into muriatic acid. Medical Properties and Action. — Creasote is stimulant, sedative, rubefacient, escharotic, styptic and antiseptic. It possesses the property of immediately coagulating albumen, and to this property is ascribed many of its effects on the living system. In large doses it is an acro-narcotic poison : but in small doses, it is styptic and astringent, and for the latter property it is more generally administered than for any other. When creasote comes in contact with the blood, the latter changes from a bright red to a reddish-brown color, with small spots of coagulated albumen, and also becomes thicker. Applied to the tongue, it causes severe pain, but without redness or tumefaction ; it also causes a strong taste of smoke, and a copious flow of saliva. When administered internally in small doses, it causes a sensation of warmth in the stomach, and exercises a decided sedative action. In large and poisonous doses it produces profound stupor, flushed countenance, fixed eyes, slow and labored pulse, irri- table stomach, nausea, vertigo, but has no effect, such as dila- tation or contraction, on the pupils. The treatment in cases of poisoning by creasote consists in administering albumen, such as white of eggs, milk, or wheat flour ; also the administration of ammonia and other stimulants, mustard, emetics, etc. Death from creasote is caused by its coagulating the albumen of the blood, and preventing its circulation through the arterial system. Therapeutic Uses. — Creasote is administered internally for gastric irritability and vomiting, flatulence, diarrhoea, diabetes, haemoptysis, pulmonary consumption, chronic bronchitis, epi- lepsy, neuralgia, etc. Externally, it is applied to ulcers^ eruptions, diseases of the skin, wounds, hemorrhage from wounds or leech bites, warts ; also in putrid sore throat, as a gargle. Dose. — Of creasote, gtt. j or gtt. ij, several times a day, cither in mucilage, in the proportion of half a fluid ounce to a drop of the creasote ; or it may be given in pill form. For external 324 DENTAL MEDICINE. use, from gtt. ij to gtt. vj, or more may be added to a fluid ounce of water. Creasote Water. — Aqucz Creasoti (creasote, 5j, distilled water, Oj). Dose of creasote water, f5j to f5iv. Solidified Creasote. — For the purpose of making the^ application of creasote to the teeth more convenient, and pre- venting the effects upon the mucous membrane of the mouth when applying it to carious cavities in teeth, a gelatinous solid- ity may be given to it by adding lO parts of collodion to 15 parts of creasote. Dental Uses. — Creasote, like carbolic acid, is a valuable agent in dental practice, although the use of the latter has, in some respects, superseded that of the former, the two being very similar in their action, with some advantages in the case of carbolic acid. Creasote is employed for the relief of odontal- gia, obtunding the sensitiveness of dentine, alveolar abscess, periodontitis, suppurating pulps of teeth, devitalizing pulps of teeth, treatment of exposed pulps of teeth, mercurial, and other forms of stomatitis, ulcers of the mouth, diseases of the gums ; as a styptic for hemorrhage from the gums, mucous membrane and leech bites, and after the extraction of teeth. Creasote, like carbolic acid, has a peculiar power as an anti- septic, hence it is a valuable application in cases attended with offensive purulent discharges. It promotes the growth of healthy granulations, and hastens the healing of wounds, and arrests the process of suppuration. When applied to ulcerated surfaces, it should be repeated as pus is formed, or fungous growths appear. It is a painful escharotic upon mucous mem- brane, with, however, a soothing reaction. An ointment — Ungitentuin Creasoti — is composed of creasote, fSss, lard, §j, and is useful in cutaneous affections. For the treatment of exposed pulps it is employed either diluted or in its full strength ; for periodontitis and alveolar abscess, in its full strength, or in combination with such agents as glycerine, iodine, etc. ; also in devitalized teeth, and as an antiseptic application in ulceration of the mouth, and reces- sion of gums from the neck of the teeth. When used as a CREASOTE. SO ol^O styptic after the extraction of teeth it is applied on lint or cot- ton, with pressure ; and diluted with water, it is employed in the treatment of caries and necrosis of the maxillary bones. To dilute it for injections it is often mixed with alcohol, and the strength reduced by adding water. Mixed with an equal quantity of oil of cloves its odor and taste are modified. Cre- asote is also employed to neutralize any acid remaining in the cavity of a tooth about to be filled, and to harden and render imperishable the contents of the dentinal tubuli, for which purpose it is applied to the walls of the cavity on a pellet of cotton. Equal quantities by bulk of creasote and oil of cloves are applied to aching teeth, painful gums, ulcerous surfaces, and also where pulps are not exposed ; also for saturating cavities before the insertion of fillings, as a disinfectant and coagulant. DENTAL FORMULAE. For Pulpitis. For Odontalgia. Garretson. R- Creasoti gij Morphinse acetatis . gr. xx. M. SiGNA. — To be applied, on cotton, to R. Creasoti gtt-vj Tinct. iodinii . . . . zi • •. ^■; canous cavity Liq. plumb, subacet . ^j Chloroformi Tinct. opii . . aa . . 5 ss. M. SiGNA. — Apply on cotton to exposed For Odontalgia, B . Creasoti, Chloroformi, Liquidi opii . . aa . . 3 iij Tinctura benzoini . . ^j M. For Alveolar Abscesses. SiGNA.— To be applied on a pellet of cotton, to carious cavity. R. Creasoti, „ r^J , , ■ . ... ., For Odontalgia. Lmimenti lodi, partes sequales. M. „ „ SiGNA. — To be used as an injection. Chloroformi For Odontalgia. Morphinae hydrochlo- ratis . . . aa . . . ^iij R. Creasoti Jss Tinctura benzoini . . gj. M. Camphorse gr. x. M. SiGNA. — To be applied, on a pellet of SiGNA. — To be applied, on a pellet of cotton, to carious cavity. (See for- cotton, to carious cavity. mulse of Carbolic Acid.) GuiACOL is a derivation of wood creasote, in the form of an oily liquid with an odor of cassia and resorcin. It po.sscs.ses the active principle of creasote, and the power to 326 DENTAL MEDICINE. destroy microbes in the human mouth. It is claimed to pos- sess the same therapeutic value as creasote and to be a better disinfectant, especially in cases of decomposed pulps. " Gui- acol may be sealed up in a pulp cavity from one to three months or more, and the contents be found perfectly disin- fected." CRETA PR^PARATA— PREPARED CHALK. PRECIPITATED CHALK, CARBONATE OF LIME. Formula. — CaCOg. Derivation. — Prepared chalk is obtained by freeing chalk from such impurities as gritty and flinty substances and solu- ble saline matter, by elutriation, and afterward drying it. It is the only form in which chalk is used medicinally. Medical Properties and Action. — Prepared chalk is antacid, absorbent and astringent. It diminishes the secretion of the mucous membrane, and at the same time acts as an antacid in correcting any acidity present. When internally administered for a considerable time, like magnesia, it accumulates in the bowels and forms intestinal concretions ; hence an occasional aperient is necessary. Therapeutic Uses. — Prepared chalk is an excellent antacid in diarrhoea from acidity, in acidity attending dyspepsia and gout, chronic bronchitis in advanced stages, rachitis, etc. Externally, it is employed in the treatment of ulcers, burns, excoriations and skin diseases. It moderately stimulates ulcers and absorbs the discharge, thus preventing them from spreading. It is an antidote for poisoning by oxalic and most of the vegetable and mineral acids. Dose. — Of prepared chalk, gr. v to 3j, in powder or sus- pended in water by the aid of mucilage and sugar Chalk Mixture — Mistura Cretcs — (prepared chalk, 5ss ; acacia gr. cxx ; water, fBiv) is often combined with opiates and astringents, such as laudanum and tincture of kino, or of catechu, in the treatment of diarrhoea. Dose, 5j to Sss. PREPARED CHALK. 327 D£7ital Uses. — Prepared chalk is used in dental practice chiefly for its antacid property, and generally as an ingredient of dentifrices ; it is also employed in the form of powder as an antacid in acidity of the oral fluids, for which purpose it is rubbed between the teeth and permitted to remain during the night ; it is also employed to obtund the sensitiveness of dentine, on account of its absorbent and antacid properties ; for such a purpose it should be applied repeatedly, for several days, to the sensitive surface. In the dental laboratory it is used as a polishing powder for metal and plastic work ; also for polishing the surfaces of gold fillings. The precipitated chalk of the Pharmacopoeia is the preparation to be preferred, on account of its freedom from gritty particles. DENTAL FORMULA. Dentifrice in the form of Troches. R. CretcC preparatJE Sodii boratis (pul Saponis Castil ' Sacch. albse ' Ossis sepise * Olei rosae . . . Millefleurs . . Essentise jasmin fb.iv Ib.iss R).iX gtt.xxx I) Mix with a solution of gum syrup. Dentifrice in the form of Camphorated Paste, (Keller Medicine Co.) Pts. by Wt. B . Magnes. carb 2 Glycerini i Potas. chlorat 3 Tr. camphora I 01. gaultherise q. s. Cretse prxp q. s. To make desired number of parts. Syr. simplic q. s. M. To make a thick paste. R. Dentifrice. (Am. Dent. Association.) Cretas praeparatae Ibiij Pulv. cinchonse Ibj Pulv. radicis iridis . . . .Ibj Pulv. sacchari albi . . . Ibiss Pulv. saponis cas • • • • ^j Sodii carb ,^j Olei sassafras gtl.lxxx. Dentifrice. (Am. Dent. Association.) R. Cretae praep. . . . Pulv. cinchonae . . Pulv. radicis iridis . Pulv. sacchari albi Pulv. saponis cas . Sodii carb Glycerini Mellis q. s And form into a paste. Dentifrice, Pulv. radicis iridis . Cretae pracparatce . Sodii carb Pulv. cinchonae . , Pulv. sacchari albi Pulv. myrrhae . . . Pulv. ossis sepiae Otto rosae With rose pink, q. s. to color. R tbss gtt.iv. 328 DENTAL MEDICINE. Dentifrice in the form of Glycerine Tablets. (Keller Medicine Co.) Pts. by Wt. R . Solut. magnes. carb ... 2 " sodii bicarb ... I " potas. chlorat. ... 3 " sapo. cas. albi ... 6 Glycerini i Cal. carb lo 01. gaultheria, Cassias. . . . aa q. s. M. To flavor. R. Dentifrice. Cretse prsep Pulv. radicis iridis . Pulv. sacchari albi . Pulv. cinnamon . . Pulv. saponis cas. . Pulv. myrrhse . . . 01. gaultheriae , . . gtt.x. M. Dentifrice, (A. W. Harlan.) R . Crete prasparatae, Pulv. radicis iridis . aa . ^ij Pulv. saponis cas., Pulv. sodii biboratis aa ^ ss Pulv. myrrhse ^ij Mellis et glycerini . . . q. s. To make a soft paste. Color rose pink. Perfume to suit. Dentifrice. (Chapin a. Harris.) R . Creta praeparatae . . . . ^ iv Pulv. radicis iridis . . • §iv Pulv. cinnamon . . . . ^iv Sodii carbonatis exsiccatae g ss Pulv. sacchari albi . . • ^j Olei limonis gtt. xv. Olei Rosae gtt. ij SiGNA. — Ingredients to be thoroughly pulverized and well mixed. Dentifrice . R . Cretas praeparatae .... floiss Pulv. sodii boratis, Pulv. radicis iridis . aa . R)ss Semen cardamom . . . ^j Pulv. sacchari albi . . . R)ss Otto rosas q. s. M. To flavor. Dentifrice. (W. D. Miller.) R. Precipitated carbonate of calcium . . gi"^ Cinchona bark "5^^ Prepared oyster shell . . ^ xv Powd. myrrh S^^X " cloves 3"j^ Oil of cinnamon .... gtt. x to xv Mix well. Dentifrice in the form of a Paste for Compressible Tubes. (Keller Medicine Co.) Pts. by Wt. R . Magnes. carbonat. ... 2 Sodii bicarb 3 Potas. chlorat 5 Calcii carbonat . . . .20 Sapo. cas. pulv 6 Glycerini i Olei gaultheriae, Olei limonis . . aa . . q. s. Syr. simplic q. s. SiGNA. — To make a paste. For Fetor of Breath. (Milliron.) R. Sulphur powd., Creta prep. pulv. . . aa . ^j Spts. rectificatus . . . ■ ^jss Aquae distill §iij Peppermint q. s. M. SiGNA. — ^After removal of all calcic de- posits, use with a tooth-brush morn- ing and evening. CROTON-CHORAL HYDRATE. 329 Dentifrice, (Dr. Darby.) R . CretK prxparatne .... 5 ^iij Pulv. radicis iridis . . . 3iv Pulv. ossis sepipe .... Pulv. sacchari albi . . . Saponis castil . . . . aa^j Sodoe bicarb 5 ss Pulv. cinchonce flava • • §j Cochineal 5J Olei rosK gtt. xx. M. Dentifrice. (Rose.) R . Cretae praeparatse . . . . 3 xv Pulv. saponis 3J Saccharin gr. x Thymolis gr. xv Camphorse gr. xxx Vanillin gr. v Olei Rosse gtt. vj. M. Rub the camphor and thymol together in a mortar, and warm gently so as to render the mixture liquid ; then add the chalk in small portions at a time, reserving about one ounce ; next add the other ingredients, the perfumes being first separately rubbed with the remainder of the chalk. Dentifrice, Antacid, Tonic and Antiseptic R . Cret£B prseparatje . . . . ^ iv Quininse disulph . . . . gr. iv Pulv. ossis sepise . . . . 3 iv Otto rosse gtt. iv. M. Dentifrice. (Dr. a. W. Harlan.) R . Cretae praeparatae .... Pulv. radicis iridis . aa . 3 iij Resorcin ^j Saccharine gr. v Pulv. ossis sepias . . . . 3J Olei menthce piperitas . . y(\v M. SiGNA. — Use on a brush moistened with tepid water. Dentifrice. (Dr. a. W. Harlan.) R . CretK praeparataa . . . . .^ iij Sodium fluo. silicate . . ,^ ss Acidi tannici gr. xxx Pulv. sacchari albi . . . ,^jss Pulv. ossis sepise . •. .3 ss Olei gaultheriae .... TTL^- M. To make a paste of the above, add glycerine 2 parts and honey i part. Dentifrices may be pleasantly flavored with wintergreen, cassia, sassafras, lemon, peppermint, anise, lavender, penny- royal, cloves, calamus, attar of roses, oil of neroli, etc. croton-chloral hydrate. BUTYL-CHLORAL HYDRATE. Formula. — C4H5CI3OH2O. Z)mz;«//^«— Croton-chloral Hydrate is obtained by the action of chlorine upon aldehyde. It is in the form of small, brilliant, white, silvery crystals of a sweetish taste, like that of melons. It is slightly soluble in water, and resembles hydrate of chloral in its hypnotic effects; but its action in this respect is not -so powerful, nor so certain. It differs from hydrate of 330 DENTAL MEDICINE. chloral in the singular property of causing anaesthesia of the head. To ^ relieve pain and induce sleep, the best effects are obtained from a combination of the two agents. Medical Properties and Actio?!. — It is a sedative, hypnotic and anaesthetic. It resembles chloral hydrate, but is not so certain in its effects as a hypnotic. Its action commences in the head and face. Therapeutic Uses. — Croton-chloral hydrate is highly recom- mended in dysmenorrhoea, sciatica, chronic cough, and in neuralgia as an anodyne. One or two grains will relieve severe neuralgia of the fifth pair of nerves ; it is frequently necessary, however, to administer from five to fifteen grains, but it is not safe to exceed this amount at one time. Dose. — Of croton-chloral hydrate, gr. j to gr. x ; as an anaesthetic, gr, xv, dissolved in warm water. Dental Uses. — It is employed with effect in facial neuralgia, in doses of from two to five grains every hour or two, until fifteen grains have been taken ; also as a sedative, in doses of from three to five grains, in periodontitis, pulpitis, etc., etc. DENTAL FORMULA. For Neuralgic Odontalgia. Von Kirchbauer. R. Croton chloral ^j Glycerini ^vj Aquae destill § iiss Syr. aurantii 5 iv Oleum foeniculae g't. vj. M. SiGNA. — A tablespoonful, and if pain continues severe, repeat the dose in an hour. CUPRI SULPHAS— SULPHATE OF COPPER. BLUE VITRIOL, BLUE STONE. Formula. — CuS04,5H20. Derivation. — Sulphate of Copper is obtained by roasting the native sulphuret, or by the combination of oxide of cop- per and sulphuric acid, filtering and crystallizing. It is in the form of blue prismatic crystals which, after exposure to the air, efifloresce to a slight degree, and become covered with a greenish-white powder. It has an astringent, metallic taste. SULPHATE OF COPPER. 331 Medical Properties and Action. — Sulphate of Copper is emetic, tonic, nervine, stimulant and astringent, and is quite soluble in water, but insoluble in alcohol. It is a prompt and efficient emetic, the emesis commencing a few minutes after it reaches the stomach, and the copper comes up with the vomited matter. Little or no depression follows its adminis- tration as an emetic, and it is especially adapted to cases of narcotic poisoning. Therapeutic Uses. — Sulphate of Copper is employed as a prompt and efficient emetic in cases of poisoning; it is also administered in intermittent fever, neuralgia, diarrhoea, dysen- tery, croup, epilepsy, hysteria, etc., etc. Externally it is ap- plied in ulcerative and gangrenous affections, superficial hemorrhage, leucorrhoea, gonorrhoea, ringworm, purulent ophthalmia, mucous discharges, diseases of the skin, indolent ulcers, fungous granulations, warts, etc. Dose. — Of sulphate of copper as an emetic, gr. iij to gr. v; or dissolve 20 grains in two ounces of distilled water and give a tablespoonful every 15 minutes until vomiting oc- curs. For internal use other than emetic the dose is gr. \ to gr. ss. in pill. Dejital Uses. — Sulphate of copper is employed in dental practice, in the form of the ammoniacal solution, for long- standing cases of neuralgia ; and externally it is applied to ulcers of the mouth, cancrum oris, aphthous ulceration, ulceration of the gums and mucous membrane of the mouth, hemorrhage from leech bites, fungous growths of the gums, etc., etc. Dr. Templeton recommends powdered sulphate of copper for suppurating teeth, applying it on a stick of wood which is wet and dipped in the powder, which is thus thoroughly ap- plied to the diseased parts; the mouth is then rinsed with tinct. of gaultheria or tinct. of krameria. 332 DENTAL MEDICINE. DENTAL FORMULAE, For Cancrum 'Oris, Aphtha and Gan- For Gangrenous Ulcers of the Mouth grenous Affections of the Mouth. afid Cancruin Oris. R. Cupri sulph. (powdered) gr. V R. Cupri sulph ^ij Mellis §ss. M. Pulv. cinchonse . . . . §ss SiGNA. — Apply as a lotion, or by means Aquae ^^ iv. M. of a camel's hair brush. Signa. — Bnish over ulcerated surface twice daily. For Ulcerative Stomatitis. For Caries of the Maxillary Bones. R. Cupri sulph gr.x (Bartholow.) Pulv. cinchonse 5 ij R . Cupri sulph, Pulv. gum acacias , . . . gj Zinci chloridi . . aa . partes xv Mellis ^ ij Liquor plumbi .... " xxx Aquse ^iij. M. Aquae destillatse ... " cc. SiGNA. — Apply, by means of a camel's- Signa. — To be applied for 30 minutes hair brush, to the ulcerated surface. at a time. ERGOTA— ERGOT. Derivation. — Ergot is a fungous growth which replaces the grain of the common rye. It is bitter, and excites heat and dryness, followed by pain in stomach, thirst, vomiting and intestinal pain and sometimes purging. Small doses, long continued, cause spasms and death by coma and asphyxia; gangrene of the lower extremities may follow its prolonged use. Medical Properties ajid Action. — Ergot causes contraction of the involuntary muscular fibre, the uterus, and smaller blood vessels, and dilates the pupils. It is employed to pro- duce contraction of the uterus in child-birth. It is also ad- ministered in chronic diarrhoea,^ and dysentery, enlarged heart without valvular lesion, gonorrhoea, acne rosacea, etc., etc. It is very serviceable in the hemorrhagic diathesis where there is a want of tonicity of the vessels ; also used in epistaxis, uterine, renal, and intestinal hemorrhage, and in hsemoptysis ; bleeding of hemorrhoids, etc. Dose. — Of the fluid extract for internal use, fSss to ij ; of the wine of ergot, 5j to oss ; of the aqueous extract dissolved in water the hypodermic dose is gr.^ to gr. iij. Dental Uses. — Ergot is useful in the treatment of hemor- rhage of the gums, and that following the extraction of teeth when it is excessive and persistent. ESSENTIAL OILS. 333 ESSENTIAL OILS. The volatile or essential oils are compounds of carbon and hydrogen, and differ from the fixed oils, which are compounds of carbon, hydrogen and oxygen, the molecular arrangements of which are similar to the metallic salts and compound ethers — possessing the radicals of certain acids united with hydro- carbons. The essential oils are generally absorbers of oxygen, and such of them as the oils of peppermint, cloves, caraway, cajeput, mustard and turpentine are useful obtunders of hyper- sensitive dentine ; and some are also efficient germicides and antiseptics. From experiments noticed by Dr. Harlan, the essential oils are not miscible with water; hence when they are used as a root-dressing they are not contaminated or dis- sipated by the saliva or the mixed fluids of the mouth. They are capable of depositing vaporizable camphors that are pow- erful disinfectants, and are soluble at a temperature below body heat. They are good menstrua for iodine compounds, and oily dressings, M^hen not too tightly confined in a pulp-chamber, are not vitiated like substances which are soluble in water. They may be allowed to remain for longer periods in the roots of teeth, when it is not possible to fill such roots at once. When an oily dressing (such as oil of peppermint or oil of cassia) is applied in a root canal, after the removal of a pulp by extirpation or its devitalization by arsenic, it acts as an ano- dyne and also as an antiseptic, preventing the formation of mephitic gases. The oily dressings may be pumped through roots and fistulous tracts with impunity, and will not clog delicate canals. The solutions of the essential oils are all made as follows (Dr. Black) : "An excess of the oil is mixed with water by violent shaking continued for some minutes. It is then placed in the incubating oven, where the temperature is 99° F., for twelve hours. It is then again violently shaken and returned to the oven for another twelve hours, twenty- four hours in all. It is then carefully filtered, and if not per- fectly clear and free from all appearance of oil, it is rcfiltcred until it is clear. The filtrate is then used as the solution of the oil. The same plan is used in making saturated solutions of the crystalline substances." 334 DENTAL MEDICINE. The prominent essential oils are those of cajeput, cassia, cinnamon, "cloves, eugenol, eucalyptol, fennel, mustard, cara- way, peppermint, sassafras, turpentine, thyme, pennyroyal, valerian, wintergreen. In dental practice the oil of cassia diluted with a bland oil like that of wintergreen is a valuable dressing for putrid root canals and abscesses. Dr. Black recommends the following mixture : ^. Carbolic acid (melted crystals), i part ; oil of cassia, 2 parts ; oil of wintergreen, 3 parts. Mix the oils and add the melted crystals of carbolic acid. This is known as the i, 2, 3 mixture. Dr. Black also says : " After thorough cleaning with the watery form of the antiseptic we need something that will be more enduring in its effects, and according to conditions should choose between the oils and the powders. If it is an abscess with which we have to deal, an oil which is in itself an antiseptic, or an oil holding the antiseptic drug in solution in effective proportions, may be introduced into the cavity and so agitated as best to bring it in contact with all of its parts. This will, on account of its sparing solubility, remain in posi- tion very much longer than the watery forms, and the essen- tial oils are very much more diffusible than the fixed oils, or, indeed any other of the simple forms of the antiseptics with which I am yet acquainted. At the same time a suflficient amount for very extended work is contained in small compass. These are of especial value in such positions as the roots of teeth. In this position any but the most irritating of the antiseptic essential oils may be used to good advantage, and may be relied upon for many days together. In the choice of the essential oils it is by no means necessary that the most powerful of them be. selected. It should be remembered in making the choice that the more powerful antiseptics are the more irritating, as a rule. It is therefore often best to choose antiseptics of very moderate range, especially where it is only required to preserve a condition of asepsis. For instance, when a very foul root canal is opened such an antiseptic as the oil of cassia is indicated. After appropriate cleaning, and ESSENTIAL OILS. 335 especially in case cleaning is to be deferred for fear of forcing poisonous material through the apical foramen, it may be used in full strength ; in which form it may be relied upon as a dis- infectant as well. But afterward, when it is only a matter of holding an aseptic condition during the healing of the parts, an antiseptic of shorter range, that is not so liable to injure the tissues, is to be preferred. For this purpose the eucalypti extract in substance is a very useful agent. Its range of actual inhibition is very short, but its injurious effects on the tissues are also very slight, so that the healing process may go on in its presence without hindrance. Furthermore, this oil has a very extended range of restraining influence beyond its range of actual inhibition that is undoubtedly of much use. This oil may be exchanged for terpinol where a little more stimulating effect is regarded as beneficial. The oil of cloves and the oil of cinnamon seem to occupy a middle ground and may be made useful in a large class of cases if the others are in any wise distasteful to the dentist or his patient. The oil of mustard, though a good antiseptic of short range, has an irritant action that limits its use. Yet in cases where it is de- sirable to arouse the tissues from a state of inactivity this action, in a high degree, is combined with the antiseptic prop- erty. It is also one of the most diffusible of the antiseptic oils thus far studied. " Any of these oils may be used in the emulsion, if, for any reason, it is not thought well to use the oil in substance. This form is especially recommended for surfaces of suppurating wounds and the washing of abscesses. In this way small quantities of the oil may be widely diffused and left in a multi- tude of minute globules to gradually dissolve where it is most wanted, forming a kind of connecting link between the true solutions and the oils in substance. For this purpose a little of the oil selected may be diffused through water by severe shaking, or better, by repeatedly filling and violently emptying the syringe. The milky emulsion thus formed may be used in the same manner as the solution. " I have said that all antiseptics are poisons. I wish to 336 DENTAL MEDICINE. emphasize this statement. They are antiseptic by virtue of their power of restraining hfe forces ; and their use as anti- septics is permitted only by shades of difference in the action of certain poisons toward the different forms of hfe, by which they affect the fungi more prominently than the animal tis- sues." ETHIDENE DICHLORIDUM— DICHLORIDE OF ETHIDENE. Foj'mula. — C2H4CI2. Sp. gr. 1.225. Derivation. — Bichloride of Ethidene is obtained in the preparation of chloral, from the waste products, and is very much like chloroform in appearance, odor and taste. It has a variable boiling point of about 115° F., and is readily soluble in alcohol, sparingly soluble in water, and but slight- ly soluble in chloroform. It is inflammable, but less so than alcohol. Medical Properties and Action. — Dichloride of ethidene is a general anaesthetic, and is said to occupy an intermediate rank between chloroform and ether. It reduces the action of the heart to a less degree than chloroform, with, however, consid- erable depression of the pulse. It has been somewhat employed in England, where it is regarded as being safer than chloroform for inhalation, and requiring less quantity to produce anaesthesia than ether. Methods of Administration. — It is recommended to admin- ister nitrous oxide until the patient is nearly unconscious, and then to add the vapor of ethidene. The effects of this agent are described as follows : The pupils dilate, and at the same time stertorous breathing commences ; the pulse falls, and should be carefully watched, and insensibility to pain con- tinues for some time after the patient becomes conscious. It is also claimed for this agent that there are no unpleasant after-effects, the patient recovering as if from a natural sleep, with a clear mind and a distinct utterance. It is also recom- mended to combine the vapor of ethidene with that of nitrous oxide, by loosely inserting a sponge containing half an ounce of ethidene in the nitrous oxide gas-inhaling tube, or in the BROMIDE OF ETHYL. 337 rubber supply-bag, when the effect is said to be more profound and agreeable than when nitrous oxide alone is administered, with no nausea and but little lividity of the lips. It is also said to produce relaxation of the muscles rather than rigidity, differing in this respect from nitrous oxide gas. Bichloride of ethidene is also employed as a local anes- thetic, in the same manner as chloroform, aconite, etc., for the relief of facial neuralgia, etc. It has not been introduced to any extent into this country. ETHYL BROMIDUM— BROMIDE OF ETHYL. HYDROBROMIC ETHER. Formula. — CjHjBr. Sp. gr. 1.420. Derivation. — Bromide of Ethyl is obtained from bromide of potassium, sulphuric acid, alcohol and water, by distilla- tion, and is re-distilled by chloride of calcium. It is a color- less and very volatile liquid, boiling at 40° C, heavier than water, and possesses an agreeable ethereal odor, and a pungent taste, strong and sweetish, with a somewhat burning after-taste. It is readily soluble in alcohol and ether, and but sparingly soluble in water. Medical Properties and Action. — Bromide of ethyl is con- sidered to be a very effective and pleasant general anaesthetic, but, like all other agents of this class, it must be administered with great care, and a pure article employed. There is no doubt but that it is pleasanter to inhale than chloroform, ex- ceedingly rapid in producing complete unconsciousness, and very evanescent in its action. That it is any safer than some other and older agents of this class, clinical experience has not demonstrated, as several deaths occurred in a very limited number of the administrations attending its introduction. Bromide of ethyl is not inflammable, nor caustic, nor even irritant, in this respect being preferable to chloroform, which is very caustic, and to sulphuric ether, of which the ingestion is nearly impossible. Dr. Isaac Ott, comparing bromide of ethyl with other anaesthetics, says : (rt) Chloroform increases the pulse, then slows it by a cardiac inhibitory stimulation ; '838 DENTAL MEDICINE. ether increases the pulse ; nitrous oxide also increases it by paralysis of cardiac inhibitory apparatus ; whilst bromide of ethyl increases the pulse by an action on the heart itself, [b) Chloroform reduces the blood pressure by paralysis of the main vaso-motor centre, and cardiac debility; ether greatly increases it and keeps it increased ; and nitrous oxide also increases it ; bromide of ethyl increases it either by a stimula- tion of the spinal or peripheral vaso motor system, [c] Chlo- roform increases, and then decreases, respiration ; nitrous oxide reduces it ; bromide of ethyl decreases it by central action." He also draws the following conclusions: '' i. Bromide of ethyl, either by inhalation or subcutaneous uses, kills, by a toxic action on the centres of respiration. 2. That the decrease offeree and frequency of the heart contributes to the paralysis of the respiratory centres. 3, That injections of ethyl into the jugular, towards the heart, kill, by cardiac arrest, probably due to an action on the cardiac muscle. 4. Bromide of ethyl, in toxic doses, depresses momentarily the frequency of the heart, which is followed by a subsequent rise to a normal rate. 5. Bromide of ethyl, in toxic doses, depresses the arterial tension, due, in major part, to the depressant action of the drug upon the heart, and in a minor part, to a partial loss of tone of either the spinal vaso-motor centres of the peripheral vaso-motor system. 6. The inhibitory power of the pneumo- gastric is not paralyzed." Introduced into the stomach, bromide of ethyl does not produce anaesthesia, as when absorbed by the respiratory organs, and does not increase the pulse over its normal heat ; and in the second stage, causes an intermission of the pulse every second b'eat. Administration. — Bromide of ethyl is best administered in a folded starched napkin, so as to cover the face, and having inside of it a soft linen handkerchief. On the linen handker- chief one measured drachm of the agent should be poured, and the patient directed to take long, deep inspirations, or, what is better, to make prolonged and forced expirations. In two minutes from the time of administration of the first BROMIDE OF ETHYL. 339 drachm, a second should be given, and this should be re- peated at intervals of two minutes. Like all general anes- thetics, however, the quantity of inhalation differs according to the susceptibility of the patient. One drachm (or in some cases two drachms may be required, according to the suscep- tibihty of the patient) of the bromide of ethyl will generally, in from one to three minutes, produce an anaesthesia as pro- found as that produced by an ounce of sulphuric ether. As it produces an anaesthetic effect on the muscles of the throat and upper parts of the pharynx, it is useful for operations on the mouth and throat. The effect of an anaesthetic, however, is to be more regarded than the mere quantity of the agent poured upon a napkin or sponge, as the degree of anaesthesia should be governed, in most cases, by the nature of the operation to be performed under its influence. Prof. Chisholm says : " I have found the action of bromide of ethyl so very evanescent that it can never take the place of either chloroform or of sulphuric ether for any surgical opera- tion which requires some time for its performance; but for all quick work, which can be done in one or two minutes, the use of this anaesthetic agent leaves nothing to be desired. These really magical effects must be obtained from the first inhala- tion, what I call the primary anaesthesia. If the operation be protracted, and a second or even third dose of the bromide of ethyl be inhaled, and I find nausea, vomiting and heaviness in all respects as if chloroform or ether had been used — under this repetition, bromide of ethyl loses all its advantages." The odor of bromide of ethyl is more rapidly removed, and is more agreeable than that of sulphuric ether, and its effects more rapid than even those of chloroform, as it is eliminated by respiration, and by the kidneys, more speedily than any other general anaesthetic agent. It requires excessive quanti- ties to affect thQ heart and respiration to any great degree. Having no caustic action, it can be safely applied subcuta- neously, and also to the external auditory meatus and to the mucous membrane. It evaporates upon the skin very rapidly, 340 DENTAL MEDICINE. producing a very sensible feeling of cold. As a rule, its general effects are as follows : Moderate acceleration of the pulse and respiration ; slight excitement or talking, and seldom any struggling ; flushing of face ; dilatation, sometimes preceded by contraction of pupil ; diaphoresis, generally profuse ; com- plete anaesthesia in two or three minutes ; recovery of con- sciousness in from one to two minutes after the withdrawal of the anaesthetic agent ; no after- vomiting. Any specimen of bromide of ethyl which has a disagreeable odor, or which, on standing, becomes brown, or any that will explode and burn, is impure and should not be employed for inhalation. A common impurity is bromoform, produced by the action of bromine and caustic potassa on alcohol or wood spirit. Bromide of ethyl possesses properties intermediate between those of chloroform and ether. As a local anaes- thetic it is highly spoken of, and, owing to its non-inflamma- bility, is the only anaesthetic which can be used in connection with the actual cautery. Dr. Byrd strongly recommends an anaesthetic mixture of bromide of ethyl i part, chloroform 3 parts and alcohol 4 parts, a drachm of which is poured upon the sponge of the inhaler, which the patient is allowed to inhale with the stopper out, after which the stopper is re- placed and the full strength of the mixture inhaled. Gen- erally in five minutes the patient is fully anaesthetized, when the stopper may be taken out to permit a greater admix- ture of air, and replaced as the judgment of the operator may dictate. This mixture, it is claimed, is safer and less disagreeable in its effects than the bromide alone. For use as a local anaesthetic, the bromide of ethyl is atomized with the "spray apparatus," which should furnish enough of the liquid to moisten the skin. The extremity of the tube should be held some two or three inches from the surface on which the spray is to be thrown. Within two or three minutes after its first application, anaesthesia of the part occurs, which is shown by the appearance of a white spot. The formation of this spot may be hastened by superficially punc- turing or scratching the skin. The sensation of cold thus EUCALYPTUS. 341 produced is sometimes disagreeable, but is rarely painful. The skin, or even the thin layer of the subjacent tissue, may be painlessly incised while the white spot lasts. This anaesthetic appears to be very well adapted for short opera- tions, requiring simple anaesthesia and not complete resolu- tion ; hence it is now preferred by some, for the extraction of teeth, to either chloroform or ether. Internally, bromide of ethyl has lately been recommended for whooping cough, in the form of a solution of i part of bromide of ethyl in 200 parts of water ; also in angina pectoris, the dose being one- half to two ounces. Given internally, it is also said to relieve gastric pain with- out affecting the appetite. Inhalations readily relieve con- vulsive cough ; and, introduced on cotton wool into the ex- ternal meatus, it relieves the pain of otalgia, without causing any irritation. EUCALYPTUS. Source. — Eucalyptus is obtained from the eucalyptus globu- lus, a tree of large size, and of the natural order Myrtacese, found originally in Australia, and known as the '' Blue Gum Tree." These trees are now growing in the southern parts of Europe and the United States, and northern Africa, and their presence is thought to be preventive of malaria. The leaves, which are ensiform, of a grayish-green color, and parchment-like, are the only part which possesses medicinal qualities. They have a pleasant, aromatic odor, with a warm, bitter and somewhat pungent taste, like that of cubebs, the fresh being more active than the dried leaves. Their medi- cinal virtue is owing to a volatile oil — Oleum Eucalypti — which contains three principles, called eucalyptene, turpene, and cymol. Tannic acid, and a peculiar crystalline fatty acid, are also found in eucalyptus ; but eucalyptene is the most im- portant con.stituent. Medical Properties and Action. — Eucalyptus is antiseptic, disinfectant, sedative, tonic, diaphoretic and somewhat astrin- gent. When taken into the mouth, it excites a flow of .saliva, and leaves a hot, pungent, persistent and disagreeable odor. 342 DENTAL MEDICINE. When introduced into the stomach, it causes a sensation of warmth, and promotes the secretion of the gastric juice. Being stomachic, it increases the appetite and the digestive action, with increased intestinal secretion. Large doses pro- duce offensive eructations, a feeling of weight and tension at the epigastrium, and indigestion, followed by diarrhoea, and irritation and congestion of the kidneys. It increases the ac- tion of the heart, lessening the arterial tension, and causes a feverish condition. It accelerates the respiratory movements, and although it induces sleep in the weak and anaemic, it has the opposite effect on the strong and healthy. The secretions of the skin, mucous membrane and kidneys are increased by it, and become strongly odorous, owing to the presence of eucalyptol, a name given to the oil. The inhalation of large quantities of the vapor produces effects analogous to those of the agent when taken in substance, and the essential oil is readily diffusible and readily impregnates the blood. Therapeutic Uses. — While the internal use of eucalyptus is contra-indicated in inflammatory conditions, it is a very effi- cient remedy in atonic dyspepsia ; chronic, gastric and intes- tinal catarrh, cachectic conditions, flatulence, palpitation of the heart, hysteria, chorea, asthma, catarrhal broncho-pulmonary affections, chronic diseases of the liver and bladder, etc. It is also employed in intermittent fever, and during convalescence from remittent fever. Externally, it is an efficient application to chronic forms of angina and tonsillitis, to foul ulcers and wounds, etc. Dose. — Of the fluid extract of eucalyptus, 5ss-5j ; of the tincture of eucalyptus — Tinctura Eucalypti — f5ss to f5ij ; of the extract — Extractuin Eucalypti — gr. j to 3j ; of eucalyptol, the dose is TTLv to oss, in capsules or emulsion. Dental Uses. — In dental practice, the decoction of the leaves is an efficient local application in the different forms of stoma- titis, after the acute stage has subsided. The tincture and the distilled water o{ eucalyptus, or fluid extract, are used as dis- infectant applications in indolent offensive ulcers of the mu- cous membrane of the mouth, stomatitis, pharyngitis, etc. The EUCALYPTUS. 343 tincture of eucalyptus has been employed with advantage to obtund the sensibility of dentine. The oil of eucalyptus, either alone or combined with iodoform, forms one of the most effective antiseptics in use, for the treatment of putrescent pulps of teeth, alveolar abscess, of the chronic form, pyorrhoea alveolaris, foul ulcers of the mouth, etc. No other preparation appears to prove more efficient as an antiseptic than the combination of eucalyptus oil and iodoform, in the treatment of suppurating conditions, putrescent pulp- canals, necrosis, and caries of the bones of the jaws, etc. The oil can be introduced as an injection, with an abscess syringe or by means of a fine broach armed with cotton, taking care that the agent is carried to the seat of the disease, and the application repeated as often as necessary. It may also be applied by dipping a pledget of cotton in the oil and then in finely pulverized iodoform (Truman), and carried to the tooth, as in cases of putrescent pulps. It is also employed as a local anc-Esthetic for odontalgia, and as an astringent or styptic in superficial hemorrhages, mucous discharges, ulcerating mucous membrane of the mouth, and for spongy, ulcerating gums. Eucalyptus has a solvent effect upon gutta percha, a fact which should be remembered when using it in connection with temporary fillings of the former material, or of Hill's stopping. DENTAL FORMULiE. For Abscess of Antrum. For Root Canals as an Antiseptic. R. Olei eucalypti . . . . ^ij R. D. Pedley. Acidi carbolici . . . gtt.x oi. eucalypti 2 parts Glycerini 5 ij Ol. caryoph 3 parts Olei gaultheriae . . . ^ss. M; Creasoti .... . 10 parts M. SiGNA.— Use as an injection. I„jq ^^iK dissolve gum mastich to For Suppurating Pulps, Ulcers, etc. saturation, filter through cotton- R. Olei eucalypti . . . . jj wool and thoroughly incorporate lodoformi gr-xv M. with iodoform in a mortar until it SiGNA. — Apply as an injection, by means becomes a solid mass of a syringe; or on cotton wrapped Signa. — Introduce on floss silk or wisps on the end of a fine broach; or on a of cotton, and cap it with a disk of strand of floss-silk, metal and insert temporary filling. 344 DENTAL MEDICINE. For Abscess of Antrum. For Alveolar Pyorrhcea. Geo. L. Parmele. {Riggs Disease.) ^' ^-':-y\- 3J G.V. BLACK. lodoformi gr. x Aquae §j M. R. Olei eucalypti . . . HXxc SiGNA. — To be used as an injection in Acidi carbolici . . . TTLxc connection with a tent of floss silk Olei gaultherise . . Tllxxx. M. saturated with glycerine and euca- SiGNA. — Apply by means of an abscess lyptus. syringe. FERRUM— IRON. Chemical analysis demonstrates the presence of iron in the blood, the gastric juice, chyle, lymph, bile, milk, urine and the pigment of the eye ; and, although metallic iron is inert, yet, when it reaches the stomach, it is dissolved by the acids, and thus acquires molecular activity. By its oxidation in the stomach hydrogen is set free, which in its nascent state unites with sulphur, forming sulphuretted hydrogen. Medical Properties and Action. — The salts of iron act through and upon the blood, improving its quality and increasing its quantity, and hence they are termed " haematinic. " These salts of iron are absorbed into the system, and are detected in the blood, urine, etc., and under their use the appetite increases, the digestion is improved, the pulse increases in frequency and fullness, the health becomes better, and there is an increase in flesh and an improvement in color ; hence they are " restora- tives." As these salts of iron in large doses cause nausea and vomiting, being irritant poisons, and even small doses, when administered for a long period, exhaust the gastric glands by over-stimulation, their use is contra-indicated in a plethoric condition, especially when accompanied with a hemorrhagic tendency, or when there is an atheromatous state of the cere- bral vessels. Certain of these salts, such as the sulphates, the chlorides, and the nitrates, possess a high degree of astrin- gency, and when taken internally produce constipation. Brought in contact with the blood, they coagulate it, and solidify the albuminous elements of the tissues, being powerful " haemostatics." Without great care is exercised in the internal administra- IRON. 345 tion of iron, owing to the acidity and astringent property of many of these preparations, injury results to the teeth, upon which they act with great energy. The tincture of the chlo- ride and the sulphate, as shown by the experiments of Dr. Smith, of Edinburg, Scotland, are more corrosive than the wine of iron, and even more injurious than the compounds of iron with the vegetable acids. The use of an alkaline gargle of carbonate of soda, or prepared chalk, or solution of am- monia, before and after the taking of the iron preparation into the mouth, and the subsequent employment of an antacid dentifrice, will obviate the injurious effects of these salts of iron upon the teeth. While the carbonate of iron in the form of pill, nor the reduced iron, are injurious to the teeth by direct action, yet eructations of hydrogen compounds produced by their ingestion may injure the teeth. The use of a tube carried well back in the mouth and the iron preparation well diluted, should be preceded and followed by the alkaline solution. The preparation known as dialysed iron — Ferrnni Dialysatum — which is iron in the colloid state, made by the process of diffusion, is odorless, without the styptic taste of the other preparations, and does not discolor the teeth, being free from irritant action ; neither does it cause constipation, and hence it is the best form in which to admin- ister iron. The dose of dialysed iron is TItv to 5j- Therapeutic Uses of IroJt. — Iron is an efficient tonic, and promotes the appetite and the digestion ; hence it is employed in anaemia, chlorosis, combined with quinine, in chronic mala- rial affections ; syphilitic cachexia, acute rheumatism, ery- sipelas, diphtheria, scrofula, rickets, neuralgia depending on anaemia, epilepsy in weak, anaemic subjects, fatty degenera- tion of the heart, passive forms of hemorrhage due to anaemia, albuminuria, etc., etc. Externally, the styptic preparations of iron are employed to arrest hemorrhage — hemorrhage from leech bites, hemorrhage following the extraction of teeth, hem- orrhage resulting from wounds and surgical operations, etc., etc. [For doses of the various preparations of iron, see "Table of Doses."] 346 DENTAL MEDICINE. Chloride of Iron — Ferri Chloridum — Perchloride of iron. Formula, Fe2Clgi2H20. Is obtained by heating iron wire with hydrochloric acid, and afterwards converting the ferrous chloride thus formed into ferric chloride by heating it with hydrochloric and nitric acids. It is in the form of crystalline masses of an orange yellow color, inodorous and of a strong styptic taste. It is deliquescent and readily soluble in water, alcohol and ether. It is used internally in the form of a tinc- ture — Tinctura Ferri Chloridi. Dose, TTLv-xx. Externally the chloride of iron is employed as a styptic and for an astringent, for the latter purpose being in solution of various strength. Dental Uses. — In dental practice the chloride of iron is used internally for the treatment of neuralgia when it is attended with anaemia ; also externally, for the arrest of alveolar hem- orrhage, although the preference is given to the solution or powder of the subsulphate. The chloride of iron may be used in the semi-deliquesced or crystallized form, or in solu- tion — Liquor Ferri Perchloridi — which is preferred by some to the crystallized. To bleeding surfaces it is applied in the proportion of 5ss to 5vj to the ounce of water. One part of the chloride gradually added to six parts of collodion, in the form of a yellowish-red, limpid liquid, makes a valuable styp- tic. Chloride of iron is also useful as an application to fungous tumors. Reduced Iron — Ferrum Reductum — is metallic iron in the form of a fine powder, obtained by the reduction of ferric oxide by hydrogen. Dose. — Gr. j to gr. v. Solution of Subsulphate of Iron — Liquor Ferri Subsul- phatis — Monsel's Solution — is composed of sulphate of iron, Sxij ; sulphuric acid, oj, and gr. xxx; nitric acid, gr. ccclx. It is of a syrupy consistence and a ruby red or dark brown color, no odor or acrid taste, but possesses powerful astringent properties. When employed for the arrest of alveolar hemor- rhage from tooth-extraction, it is liable to cause sloughing of the bleeding tissues, and if used it should be in weak solution, and carefully watched. IRON. 347 Powdered Subsulphate of Iron — Pulvis Ferri Subsul- phatis — Monsel's Powder — is in the form of a yellow powder, and possesses the same astringent and other properties as the solution, and is applied as a styptic in alveolar hemorrhage with much greater convenience. Medical Properties and Action. — Monsel's solution and powder act topically as powerful astringents and mild caustics, and are considered to be among the best styptics in use. These styp- tics combine with albumen and form a pale yellow compound, and on this property depends their chemical action on the tissues of the body. Internally administered they act like the sulphate of iron, their remote effect being tonic and haemo- static. In small doses they exert an astringent effect on the gastro-intestinal mucous membrane, diminishing the quantity of fluids secreted or exhaled ; hence their constant use will cause constipation. Monsel's preparations of iron are principally used externally for hemorrhage from bleeding vessels. When employed internally it is for the arrest of hemorrhage from remote organs. Therapeutic Uses. — The solution and powder of the sub- sulphate of iron are used internally for hemorrhage from the stomach and bowels. Externally, for hemorrhage, varicose ulcers, etc., etc. Dose. — Of the solution of subsulphate of iron, gtt. v to gtt. x, twice a day in some bitter infusion. Of the powdered sub- sulphate of iron the dose is gr. v to gr. xv. The solution is also given in small doses with the sulphate of magnesia, and as an artificial chalybeate purging water. Dental Uses. — In dental practice Monsel's solution and powder are principally employed for arresting hemorrhage following the extraction of teeth, hemorrhage from leech bites, and also from other causes, such as wounds of the gums and mucous membrane, in the treatment of ulcers of the mouth ; and the solution, diluted with water, forms a serviceable ap- plication for abraded and inflamed mucous surfaces. For Hemorrhage following the Extraction of Teeth. — After carefully cleansing the bleeding cavity as thoroughly 348 DENTAL MEDICINE. as possible, the styptic should be applied on a pellet of cotton, or, in case the powdered subsulphate of iron is employed, on a pellet of cotton previously dipped in sandarach varnish, to which the powder will adhere, and inserted over the mouth of the bleeding vessel at the apex of the alveolar cavity. Cotton should then be inserted over the styptic preparation, and the alveolar cavity be thoroughly filled up. If necessary, a com- press, made from a cork, or softened modeling composition, should be applied over the cotton filling the cavity and held in place by the opposing teeth, when the mouth is closed. DENTAL FORMULA. For Hemorrhage frotn Extraction of Teeth. Steere. R. Liq. ferri persulph., Sodium chlor aa partes sequales. M. SiGNA. — Apply on cotton to bleeding cavity and secure by covering with a roll of cotton cloth. For Hemorrhage after Lancing the Gums of Children. Dr. J. W. White. Where oozing of blood persists in spite of local treatment : R . Tinct ferri chloridi f 3 ss ; Acid.acetic dil f 5J ' Liq. ammonii acet f 3J > Ext. ergot, fid f 3 ij ; Syr. simp f § ss ; Aquae q. s. ad f g iij M. S. — A teaspoonful every 3 hours for a child six months old. GELSEMIUM— YELLOW JASMINE. Source. — Gelsemium is obtained from the root of the gel- semium sempervirens — yellow jasmine — woodbine, belonging to the natural order Apocynacese, which grows plentifully in the southern United States. The root is of a brownish color externally, and a grayish color within, and is sold in small pieces, from one-half to two inches in length, and a quarter of an inch in thickness, being hard and slightly cracked longi- tudinally. It has a bitter taste, and an aromatic odor, some- what like that of green tea. GELSEMIUM. 349 Medical Properties and Action. — Gelsemium has a depress- ing and sedative influence upon the nervous centres, and dim- inishes the force and frequency of the heart's action. It con- tains a very powerful alkaloid, gelseinia or gelscniina, which is colorless, odorless, with an intensely bitter taste Gelsemium, in moderate doses, causes a languid feeling, attended with mental calmness, slow action of the heart, droop- ing eyelids, dilatation of the pupil, and some feebleness of muscular movements. In larger doses it causes vertigo, double vision, amblyopia, paralysis of the muscle that elevates the upper eyelid, so that it cannot be raised, dilated pupil, labored respiration, on account of its effect upon the respira- tory muscles, slow and feeble movement of the heart, great muscular weakness, and a reduced sensibility to pain and touch. Such effects occur about half an hour after the gelsem- ium is taken, and continue for two or three hours, when they disappear. When poisonous doses are taken, all of the symptoms de- scribed above occur in a more intense degree, and there is first an unsteady gait, until all muscular power is lost, the lower jaw drops, the muscles of the tongue are paralyzed, speech being impossible, the respirations are very labored, slight and irregular, and the action of the heart weak, feeble and intermit- tent, and generally the skin is covered with a profuse perspira- tion. Death occurs from asphyxia, but consciousness is preserved until near the end, which is generally calm, and not disturbed by convulsions. Therapeutic Uses. — Gelsemium is internally administered in tetanus, mania, convulsive or spasmodic cough, such as whooping cough ; pneumonia, remittent and typho -malarial fevers, ovarian and other forms of neuralgia, cerebro-spinal meningitis, plcuritis, etc., etc. Dose. — Of the fluid extract of gelsemium — Extractuin Gel- semii Fluidum — the only officinal preparation, X(\y to ITLxv. Of the tincture of gelsemium — Tincttira Gclsemii — (gelsemium 5iv, alcohol, Oj), the dose is gtt. x to gtt. xx. The fluid extract is preferable for administration, but one fluidrachm 350 DENTAL MEDICINE. of this has caused death. Dose of the alkaloid gelsemia, gr. ^O' ^^ S^' To- Dental Uses. — Gelsemium is greatly extolled as a remedy for neuralgia of the fifth nerve, often affording permanent re- lief, especially when the affection is associated with diseased teeth. The dose may be repeated at any time after an hour and a half, if the pain is not relieved ; a third dose is seldom required. In neuralgia of the face or head, three-minim doses of the tincture of gelsemium every half-hour, will often act very beneficially, and leave no ill effects. Owing to the toxic effects of this drug, care is necessary that the dose is a moder- ate one, and the symptoms carefully observed. DENTAL FORMUI.^. For Neuralgia from Devitalized Teeth. R . Tinct. gelsemii gtt.x Tinct. aconiti gtt.v Aquas ^iv. M. SiGNA. — One teaspoonful every hour. For Odontalgia, Internal Remedy. Dr. Dunoycer. IJ. Gelsemine i milligramme; Aconitine (cryst) ^ milligramme; Valerianate of quinine 5 centigrammes. For one pill. S. — Give one to three pills to an adult in the twenty-four hours. GLYCERINUM— GLYCERIN. Formula. — C3H53HO. Sp.gr. 1.25. Source. — Glycerin is obtained from the saponification of fats and fixed oils, and contains a small percentage of water. It is a colorless, inodorous, syrupy liquid, of a sweet taste, and freely soluble in water and alcohol, but not in ether or chloroform. Medical Properties and Action. — Glycerin is nutrient and emollient, possessing considerable power as a solvent and pre- servative. The addition of ^, yi, or even Jg- part of glycerin to a lotion or poultice, or an external application, renders it particularly emollient and soothing. It keeps the parts moist- GLYCERIN. 351 ened and soft, and corrects or prevents the disagreeable odor of discharges, and it does not evaporate or dry at an ordinary temperature. Glycerin dissolves carbolic acid, creasote, tannic acid, borax, iodine, quinine, iodide of potassium, gallic acid, etc., and its uses as a solvent and a vehicle for other remedies are very numerous. It has been prescribed as a substitute for cod-liver oil, where the latter nauseates. Officinal solu- tions of medicinal agents in glycerin are known as glycerites [glyceriia). Therapeutic Uses. — Glycerin is rarely used alone as an internal remedy, its chief use being external, or in combination with other medicinal substances. It has been prescribed in phthisis, diabetes, acne ; externally, as an emollient in acute coryza, chronic follicular pharyngitis, chapped hands and face, fissures, skin diseases, dressing for wounds and ulcerated sur- faces, and as a vehicle for the application of astringents to the eye ; also to soften cerumen and for the removal of insects from the ear, and for diminishing the secretion of pus ; also in burns, abraded surfaces, erysipelas, etc. It has also been employed in smallpox as an emollient and to prevent pitting, a mixture of one part of glycerin and two parts of rose water being ap- plied, after the pustules have broken and the discharge has commenced to dry. It is applied for a few days until the scabs begin to loosen. Glycerin is also used in croup, locally applied to the glottis ; also in deafness, where the auditory canal is dry and inelastic. For an emollient application it is frequently combined with other agents, and used in the form of an oint- ment or embrocation. Five parts of glycerin rubbed up in a mortar with four parts of yolk of tgg, forms a compound which prevents the action of the air on irritated broken or abraded surfaces, and is soothing in erysipelas, cutaneous affections, etc. Although glycerin is so bland in its general character, yet it produces a smarting sensation when first applied to an abraded surface of the skin ; such an effect is thought to be due to the affinity of glycerin for moisture, which it abstracts from the skin so rapidly as to cause the smarting sensation ; mixing the glycerin with a little water 352 DENTAL MEDICINE. will obviate this. Pure glycerin, when mixed with water, will raise the temperature eight or ten degrees, and hence the two should be combined previous to the application. Dose. — Of glycerin, 5j to 5ij. Dental Uses. — Glycerin is a useful agent in dental prac- tice as a solvent and emollient, as a solvent alone, and as both solvent and emollient, when combined with other substances. It is employed with great benefit in such diseases of the mucous membrane of the mouth, as the different forms of stomatitis, ulcers of the mouth, aphthae, alveolar abscess, abraded surfaces from the irritation of acrid substances, arti- ficial teeth, etc. In the treatment of inflamed and ulcerated conditions of the mucuous membrane, it is frequently combined with borax, and for chronic alveolar abscess, after the use of more active agents, and diseases of mucous membrane, it is com- bined with carbolic acid, iodine, sulphite of soda, etc. As an anodyne and emollient application, glycerin is combined with morphine, atropine, acetate of lead, etc., etc. To form oint- ments and embrocations, it is combined with gum tragacanth, lime water, oil of almonds, rose water, etc., etc. DENTAL FORMULAE. For Chronic Abscess, Ulcerations, etc. For Chronic Alveolar Abscess, Ulcera- _ . tion of Mucous Membrane, etc. R- Glycerini gj ^ Glycerini partem! Tinct. iodi. comp. . . m^lv ^^.^ ^^^^.^. _ _ . p^^es 2. Acidi carbolici cryst . . TlXvj Aquae destillatse . . . . ^v. SiGNA. — Apply as a lotion or injection For Pulpitis. Aquae destillatse. . • • gv. M. ^ Glycerini gtt. ij Acidi carbolici . . . . gr. v. Tr. aconit. rad., For Inflammation and Ulceration of the ^^_ ^^^^^ ^.^^ _ ^^ _ ^^^ .._ Mucous Membrane. » • ,• ^ Acidi tannici . . . . gr. j R. Glycer.ni . §j Ol. menth. pip., Sodii boratis ^ij M. qj_ caryophylli . aa . gtt. xxv. M. SiGNA. — Apply as a lotion. SiGNA. — Apply on cotton. For a Sedative Application in Inflamed For Aphthous Ulceration of the Mouth. Mucous Membrane. R. Glycerini §j R. Glycerini Sodii sulphitis 3J. Chloroformi . . aa . . §ss M. SiGNA. — Apply as a lotion. SiGNA. — Apply as a lotion. HAMAMELIS. 353 For Pulp Canals of Abscessed Teeth. For Aphthous Sore Mouth of Infants. Faught R . Glycerini, R . Glycerini f 5 ij Aquae . . . aa . . . . ^ss Acidi tannic! ^ij Sodium sulph . . . gr. xxx M. Morphi?e acetatis . . . 5J SiGNA. — Use on swab, every 2 hours. lodoformi ^j. M. SiGNA. — Apply on floss silk or cotton. GLYCEROBORATE OF CALCIUM. Glyceroborate of Calcium is a powerful antiseptic, and is pre- pared by mixing equal parts of borate of calcium and glyce- rine, and heating the mixture to about 160°, with constant stir- ring, which is kept up until a drop of the mixture falling from the end of a stirring-rod upon a glass plate solidifies, on cool- ing, to a clear, colorless, brittle bead ; the mass is then poured out, and after cooling, is broken up and the fragments at once put into a well-stoppered and dry bottle. It is soluble in all proportions of water, and on exposure to the air will rapidly become liquid, taking up its weight of water. Even when in a very dilute solution it is a powerful antiseptic, with no odor and no poisonous properties. GLYCEROBORATE OF SODIUM. Glyceroborate of Sodium is prepared in the same manner as the glyceroborate of calcium, simply substituting the borate of sodium. It possesses the same properties as the glyceroborate of calcium, and is somewhat preferable to the latter, as even concentrated solutions of the glyceroborate of sodium can be applied to the eye without inconvenience. Both preparations will preserve meat for a long time. HAMAMELIS. WITCH HAZEL. Source. — Hamamelis Virginica is an indigenous shrub, com- mon to all parts of the United States and Canada, and usually found in stony places and on the banks of streams. The bark and leaves are the medicinal portions. Medical Properties and Action. — It is tonic, astringent, seda- tive, and anodyne. The bark has a bitter, astringent, and 23 354 DENTAL MEDICINE. somewhat sweetish and pungent taste, and was first employed by the Indians as a sedative and discutient application, in painful tumors and other cases of superficial inflammation. The bark contains from eight to ten per cent, of tannic acid, and also a bitter principle. Therapeutic Uses. — Hamamelis Virginica, although not until recently officinal, has for some time been employed in hemorrhage of the lungs, haematemesis, and in phthisis. Externally, it is applied to tumors, inflamed and painful parts, etc., etc., in the form of a fluid extract, decoction and tincture. Two minims of the tincture of hamamelis every half hour, will often control hemorrhages from nose, uterus, and from hemorrhoids. Dose. — Of the fluid extract of hamamelis, 5ss to 5ij ; of the decoction, oss to Sj. Dental Uses. — Hamamelis is employed in dental practice as a sedative or anodyne application, in incipient periodontitis, in the form of the fluid extract, applied warm on lint or cotton, as a lotion ; also as an anodyne, to irritated and painful exposed pulps of teeth ; also for passive hemorrhage from the mucous membrane of the mouth ; also for the soreness arising from the removal and effects of salivary calculus. The tinc- ture may be applied as a sedative lotion, in the proportion of one part to ten of water. HYDRARGYRUM— MERCURY. QUICKSILVER. Formula. — Hg. Sp. gr. 13.5. Sources. — Mercury is a metal of a nearly silver-white color, and a very high degree of lustre. It is liquid at all ordinary temperatures, and only solidifies when cooled to 40°. It fuses at 39° F., and readily volatilizes at 66° F. ; it boils and yields a transparent, colorless vapor, of great density. It also volatil- izes somewhat at ordinary temperatures, and especially above 68° F. The ordinary ore from which metallic mercury is ob- tained is the mercuric sulphide, although it is occasionally met with in globules disseminated through this native sulphide, MERCURY. 355 and which is noted as cinnabar. There is also a form known as horn silver or native calomel, and a native amalgam of silver and mercury. California furnishes metallic mercury of a peculiar purity, in large quantities. The metal is obtained from the sulphide by the process of " roasting." When pure, metallic mercury does not readily tarnish in the air, and it can be purified by re-distillation, or by adding to it a small quan- tity of a strong solution of nitrate of mercury. The impurities are generally dirt, dust, lead, tin, bismuth or zinc. Dental Uses. — Metallic mercury is employed in dental prac- tice, as an ingredient of amalgam filling material, being com- bined for such a purpose with silver, tin and zinc, and some- times with gold and platinum, in addition to the other metals named. Hydrargyri Chloridum Corrosivum. — Corrosive Chloride of Mercury — Corrosive Sublimate. Mercury Chloride, Bichlo- ride of Mercury. Formula, HgClg. Derivation. — Corrosive sublimate is obtained by subliming a mixture of chloride of sodium and mercuric sulphate, the latter made by boiling together sulphuric acid and mercury; double decomposition takes place, forming mercuric chloride and sulphate of sodium. Corrosive sublimate is in the form of colorless crystals, or crystalline masses, which are inodor- ous, fusible and sublime without residue, and of an acrid, styptic taste. It is readily soluble in 15 parts of water, 7 parts of alcohol and ether. Medical Properties and Action. — It is one of the most active salts of mercury, and is a corrosive poison, but the therapeutic dose now used is less liable to cause the disagreeable and dangerous effects of mercury than almost any other preparation employed for the same purposes. It is in the form of colorless crystals, and is entirely soluble in water. Corrosive sublimate is an effective germicide in the strength of one part to 2500 parts of water, being 250 times more powerful than carbolic acid. An aqueous solution of i in 20,000 destroys the spores of bacilli in ten minutes, and a solution of 1-5000 is a certain 356 DENTAL MEDICINE. disinfectant, when the exposure is very short, and it is now regarded a:s one of the most powerful germicides in use and is very extensively employed in antiseptic surgery. Dr. F. Abbott regards the bichloride of mercury as being the simplest antiseptic in use. Dr. W. D. Miller, of Berlin, also testifies to the power of the bichloride as an antiseptic in the treatment of the oral cavity as follows : " The experiments show that bichloride of mercury is about two hundred times as powerful as carbolic acid, and demonstrate very clearly the mistake of substituting weak solutions of this antiseptic (i-iooo, as I have seen recommended) for concentrated car- bolic acid. One one-thousandth is only one-fifth as powerful as pure carbolic acid, which in many cases may be used with impunity. It is consequently useless to attempt to introduce the sublimate solution for the purpose of sterilizing root-canals, cavities before filling, etc., unless we may use at least a }^ per cent, if not a one per cent, solution. I see no reason why this may not be done. In a few cases I have used a i per cent, solution for treating root-canals, and do not hesitate, partic- ularly vvith the rubber dam adjusted, to wipe out cavities be- fore filling with a two per cent, solution, and see no possible evil which would result from it." "As a mouth wash I have fre- quently used a -^ per cent, (i.ooo) solution myself, and have seen no bad results from it ; I would not, however, recommend it to my patients in this strength. It is often employed in solution in water, i part to 2000, which would aproximate i grain to 4}^ ounces of water. Dr. Black recommends the following combination : Mercuric chloride, gr. ij ; peroxide of hydrogen, fSj. M. For use as an injection in alveolar abscess and the pus pockets of pyorrhoea alveolaris. As a solution of bichloride of mercury is prone to undergo chemical changes, powders or tablets containing equal quantities of the bichloride and ammonium chloride may be prepared and a solution made by adding one of these to an ounce of distilled water. Another method is to take one drachm each of the bichloride and hydrochloric acid, and add enough of distilled water to MERCURY. 357 make one ounce, which forms a permanent solution, strong enough in the proportion of a teaspoonful to a pint of water, to make a sterilizing and disinfectant solution of i to lOOO, for washing out pus sacs and pus pockets in alveolar abscess and alveolar pyrrhcea. Referring to the bichloride of mercury, benzoic and salicylic acids and listerine, Dr. Miller says : Of these four, which are available for the prophylactic treatment of the oral cavity, par- ticularly of the teeth, the bichloride is, without doubt, the most effective, because its action continues longer; and he further says : " Unfortunately the bichloride of mercury possesses one great disadvantage in its highly poisonous character. It seems, however, scarcely possible that any harm could result from its use in so dilute a form." (See Hydrargyri Chloridum Mite.) TJierapeiitic Uses. — Corrosive sublimate is alterative in small doses, and in large quantities it is a powerful irritant poison, corroding the stomach and causing death in a very few hours. Its continued use has caused salivation, but it has a less tendency to produce such an effect than the other preparations of mercury. Internally it is employed in second- ary syphilis, chronic diarrhoea and dysentery. Externally in diseases of the eye, diseases of the skin, ulcers, gonorrhoea and gleet, etc., etc. The external application to large surfaces is dangerous. Its use is contra-indicated in patients affected with pulmonary disease. Drs. Yates and Kingsford report three cases of cancrum oris in children cured by wiping the affected parts with a solution of the bichloride of mercury (l to 500) and afterwards dressing them with lint soaked in a similar solution (i to 1000). Healthy granulations soon made their appearance and the wound quickly contracted. For cases of poisoning the antidotes are albumen, white of ^^•g, wheat flour, milk, etc. Dose. — Of corrosive sublimate gr. ^^ to gr. y'jj, in pill or solution. Dental Uses. — It is employed as a lotion, injection or gar- gle, in chronic diseases of the mucous membrane, ulcers, ulitis, etc. Dr. C. T. Stockwell reports a case of acute ulitis 358 DENTAL MEDICINE. in which bichloride of mercury, in solution i-iooo, was used to bathe the parts, and the pockets about the teeth injected with it, the result being very satisfactory ; and the same solution used as a sterilizing agent is considered to be very efficient. Test for Bichloride of Mercury. — Dr. Chas. Mayr recom- mends the following to determine whether a solution of bi- chloride of mercury is still reliable or not; Saturate a nice grade of paper with a solution of a given amount of iodide of potassium in water ; with the proper gauging of this solution, after it has dried on the paper, a drop of the solution of the bi- chloride (i to 5000) will produce a scarlet spot when dropped on the paper ; a solution of i to 1000, a yellow spot; a more dilute solution, no spot at all. To obtain this result, a certain strength of the solution of iodide of potash gauged for the paper to be used is required. The solution of iodide of pot- ash should be made slightly alkaline which will prevent, to a great extent, the papers from turning blue. Diluting a solu- tion of bichloride of mercury with lime water will remove the disagreeable taste. For Chronic Alveolar Pyorrhcea. A. W. Harlan. R. Bichloride of mercury grs. ij Tartaric acid grs. x Distilled water f ^ iv. M, SiGNA. — First cleanse with injections of peroxide of hydrogen, and then inject the above with a hypodermic syringe. Antiseptic Solution. Emil Rotter. R- Corrosive sublimate , I to 20,ocx) gr. j- Sodii chlorid gr. vss. Acid, carbolic gr.xxx Zinci chlorid Zinci carbolat aa.^] ^. Acid, boric gr.xl Acid, salicylic gr.x Thymoli Kt^ij. Acid, citric gr.ij Aquae q. s. ad 1,000,00. M. Said to be powerful, yet not toxic to any dangerous extent, and to have a more potent effect on pyrogenic microbes than sublimate in solutions of I to 1000. If a weak solution is desired the sublimate and carbolic acid may be omitted. MERCURY. 359 Antiseptic and Stimulant Mouth Wash. For use especially in Alveolar Pyorrhoea. Dr. Chas. B. Atkinson. R. Hydrarg. bichlor gr.ij Tinct. Calendulae ^iv Aquae dest. q. s. ; ad §^"j- ^• S. Use daily. To Disinfect Softened Dentine in Cavities. Dr. a. W. Harlan. R, Corrosive Sublimate gr- ij Peroxide of hydrogen ^j Tartaric acid X({y. M. Aqueous solutions of Labarraque's solution, permangan- ate of potash or boro-glycerine, may also answer. Prof. W. D. Miller, of Berlin, in a list of remedies with which he made care- ful experiments, places the relative powers of well-known agents in preventing the development of fungi as follows : Bichloride of mercury Peroxide of hydrogen I- 50.000 Iodine I- 6,000 Iodoform Salicylic acid Eucalyptus Carbolic acid Chloride of zinc Permanganate of potash Listerine 5,000 2,000 1,600 1,500 1.250 1,000 120 Hydrargyri Chloridum Mite — Mild Chloride of Mercury. Calomel. Meratroiis Chloride. Formtda, HgCl. Derivation. — Calomel is obtained by subliming a mixture of mercurous sulphate and chloride of sodium, a double decom- position taking place, by which mercurous chloride and sul- phate of sodium are formed. The mercurous sulphate thus employed is obtained by boiling mercury in sulphuric acid .and triturating the resulting mercuric sulphate with mercury. To remove any corrosive sublimate which the calomel may contain, it is washed with hot distilled water until the ab- sence of a white precipitate with ammonia shows that the poisonous ingredient has been removed. Calomel is in the form of a white, inodorous, tasteless powder, insoluble in 360 DENTAL MEDICINE. water, alcohol and ether, and wholly volatilized by heat. Calomel is, incompatible with the alkalies, and alkaline earths and alkaline carbonates, with lead, copper and iron. When nitro-muriatic acid is combined with it, corrosive sublimate is formed; neither should it be given in combination with iodine. Medical Properties and Action. — Calomel and the other mercurials are employed as alteratives, sialagogues, purga- tives, diuretics, etc., and moderate doses increase the action of the secreting glands and organs, stimulating the salivary glands in a very decided manner. When large doses are ad- ministered the effects are manifested on the gums, which be- come tender and swollen, the salivary glands take on in- creased action, the saliva and buccal mucus flow profusely, the mucous membrane of the mouth becomes inflamed and ulcerated, the tongue swollen and the breath fetid, with a me- tallic, copper taste, and the teeth become loose ; such symp- toms constitute the condition known as salivation. When the use of the drug is discontinued these symptoms disap- pear, but the mucous membrane and gums are ever after more susceptible to irritation, and the stability of the teeth is more or less impaired, as is shown by the recession of the gums and the absorption of the alveolar processes. In many cases the gums, especially about the necks of the teeth, re- main somewhat, tumefied, with a tendency to ulceration. If the use of the mercury is continued beyond the stage which the symptoms just described indicate, or even as the effects of small doses in persons very susceptible to the influence of mercury, an excessive salivation ensues, with serious ulceration of the gums and mucous membrane of the mouth, loss of the teeth, and even necrosis of the bones of the jaws. Mercury has also the effect of causing considerable emaciation, from the absorption of fat, and sometimes a peculiar febrile state known as mercurial fever; and also diarrhoea, skin diseases, rheumatism, neuralgia and disorder of nervous system. Mercury, after it is absorbed, has a decided effect upon the blood, which it impoverishes, destroying the red MERCURY. 361 blood globules (hematine and globuline) ; the blood contains more water, is more prone to putrefaction, and the unnatural fluidity predisposes to hemorrhage, which may become dangerous. Therapeutic Uses. — Mercury in the form of calomel, blue mass [Pihdce Hydrargyri — pills of mercury — mercury 5ij; confection of rose Siij, and powdered liquorice root Sj,) are employed as sialagogues, indirect tonics and cholagogues, and purgatives in syphilis, diseases of the skin, bilious derange- ments, dyspepsia, acute glandular affections, diarrhoea and dysentery of infants, hepatic disorders, croup and membranous laryngitis, cholera, etc., etc. Dose. — Of calomel, gr. ^5" to gr. x ; of blue pills, or mass, gr. ss to gr. xv. Mercurials are administered by the mouth, by inunction, by fumigation, and by the hypodermic method. Mercurial Ointment — Ungiientum Hydrargyri. Blue oint- ment is made by rubbing two parts of mercury with one part of suet and lard each, until the globules disappear. When rubbed into the skin, it produces the constitutional effects of mercury, and is applied to tumors, syphilitic sores, blistered surfaces, and is used to destroy pediculi, and also to prevent pitting in small-pox. Mercury with Chalk — Hydrargyrum cum Creta, a gray powder, consists of mercury, three parts, prepared chalk, five parts. It is a gentle laxative, when given in full doses, and is antacid, and employed chiefly as an alterative in infantile diarrhoea, etc. Dose. — Of mercury with chalk, for adults, gr. v to xx; for children, gr. ss to ij, iij or x. The effect of mercurial preparations upon children is some- times very serious, as a profuse, or even gentle salivation will, at times, cause mortification and destruction of the bones of the jaw, the teeth, the cheek, and lip ; and although such cases may not be common, yet, to avoid such a powerful action, the gums should be frequently and carefully examined, when a course of such remedies is being pursued. 362 DENTAL MEDICINE. Protiodide of Mercury — Hydrargyrum lodidtim Viride, known also, as Green Iodide of Mercury — is prepared by- rubbing mercury and iodine together with the addition of a little alcohol. The formula is Hgl, and it is in the form of a greenish-yellow powder, insoluble in water and alcohol, but soluble in ether. Exposure to the light partially decomposes it, when it becomes of a dark olive color. Protiodide of mercury is internally administered in scrofula and scrofulous syphilis. It exercises a specific influence over the lymphatic and glandular system. It should never be given at the same time as iodide of potassium, as it converts it into biniodide and metallic mercury. Dose. — Gr. i to j. Externally, protiodide of mercury is applied, in the form of ointment, to syphilitic ulcers, acne, pityriasis, etc., etc. Biniodide of Mercury — Hydrargyri lodidum Rubrum. — Red Iodide of Mercury. Mercuric Iodide. A red powder which becomes yellow when heated and red again when cold. It is wholly volatilized by heat, and condenses in scales, which are first yellow, but afterwards red. It is insoluble in water, but soluble in boiling alcohol and solutions of iodide of potas- sium and chloride of sodium. Poisonous. Dose. — Gr. -^ to -j^. It is a powerful germicide. Red Sulphuret of Mercury — Hydrargyri Sidphidum Rub- rum. — Vermilion. Cinnabar. In brilliant crystalline masses of a deep-red color and fibrous texture. It is entirely volati- lized by heat. It is not soluble in either nitric or muriatic acid, but a mixture of the two acids will dissolve it. Cases have been cited in support of the asserted poisonous effects of vermilion, where it has been used as a coloring-matter for dental vulcanite, but a careful analysis as well as evidence based upon scientific investigation, fails to establish the truth of such a theory. Vulcanite composed only of pure caoutchouc and sulphur, known as " black vulcanite," possesses advantages over the red vulcanite, in being of finer texture, more dense, and less spongy, and consequently less liable to absorb and retain the secretions of the mouth, in the case of an artificial denture constructed of it. IODOFORM. 363 DENTAL FORMULA. For Diarrhcea »f Dentition. For Venereal Sore Mouth and Throat. R . Calomel gr.ij ad vj R ■ Hydrar. chlor. corrosi . gr.j Cretje ppt gr.xviij Mellis despumati . . . . f g ss Ipecacuanhas pulv . . gr.ij Aquae destillatoe . . . . f § iv. M. Extract hyoscyami . . gr.iij ad vj Signa. — To be used as a gargle. F. chart, No. vj. SiGNA.— One every two or three hours, ^^^ Warts, Condylomata, etc. according to circumstances. R . Hydrar. chlor. corrosi . gj Collodii ^j. Solve. For Febrile Excitement of Dentition. c^xt. t^ u v j ■' SiGNA. — io be applied as a caustic, R. Calomel gr.ij ad iij with a camel's-hair brush. Magnes. calc gr.xxiv Ipecacuanha pulv . . . gr.ij to iij ^^^ Diarrhcea of Teething Children. F. ch. No. xij. R. Hydrargyri cum cretse, SiGNA.— One to be given every three ^"1^- iP^cac. et opii aa gr. j. M. hours. Signa. — One powder. lODOFORMUM— IODOFORM. TERIODIDE OF FORMYL. Formula . — C H I3. Derivation. — Iodoform is a preparation of iodine, being obtained by the action of chlorinated Hme upon an alcohoHc solution of iodide of potassium, heated at 104° F., the product being iodoform and iodate of lime, the iodoform being sepa- rated by boiling alcohol. It is in the form of small, pearly crystals, of a yellow color, with an unpleasant odor, like that of saffron, and a sweetish taste, and soft to the touch. It is volatile, and soluble in alcohol, chloroform, ether and the fixed and volatile oils, but insoluble in water. Medical Properties and Action. — Iodoform has no irritant action, and, in small doses is tonic, stimulant, anodyne, alter- ative and disinfectant, having great influence on the nervous system ; it is also anti.septic. In large doses, it causes a form of intoxication, followed by convulsions and fatal effects. In the form of vapor, it possesses anaesthetic properties, but not equal to those of the general anaesthetics in common use. It has also been used as a local anaesthetic, aud also as an anti- .septic. Its odor can be detected in the blood, the brain and the muscles. 364 DENTAL MEDICINE. Therapeutic Uses. — Iodoform produces the constitutional effects of iodine, but is chiefly used externally for painful cancerous and phagedenic ulcerations, irritable ulcers, ill-con- ditioned wounds, obstinate skin diseases, scrofulous glandular enlargements, to allay the pain of gout and neuralgia, and for phthisis, mixed with starch and spread on paper, so that the vapor may be inhaled. Dusted over a diseased surface, it allays pain and changes the morbid action. A saturated solution of iodoform in chloroform is recommended for neu- ralgia ; also a saturated solution in any of the essential oils is used for the same affection. In the form of an ointment, it is used as an application to irritable ulcers. For ulcerated surfaces, it may be sprinkled over the part, and lint, coated with glycerine, applied as a dressing. Dose. — Of iodoform, gr. j to gr. iij, three times a day, in the form of a pill. Dental Uses. — Iodoform is highly recommended in dental practice, as an antiseptic, either alone, or what is better, com- bined with eucalyptus oil. It possesses no escharotic property sufficient to cause irritation or the destruction of parts. In the treatment of alveolar abscess, iodoform, in combination with oil of eucalyptus, has given great satisfaction ; also in cases of putrescent pulps, applied as an injection. It is recommended to be used as follows: First, an injection of eucalyptus oil, followed by the introduction of the mixture of iodoform and eucalyptus into the root canal, on cotton, or on a strand of floss silk, which is charged by first dipping it into the oil, and then in the iodoform ; or the two may be combined in a solu- tion (see Eucalyptus), and in this form introduced into the sac or root canal. Dr. C. N. Pierce recommends iodoform ground up with equal parts of oil of cloves and oil of eucalyptus, which forms a substance of a soft cheesy consistence, a portion of which can be introduced to the inflamed part, on the point of a small broach. Iodoform is also a very serviceable appli- cation in alveolar pyorrhoea. A saturated solution in euca- lyptus oil is also serviceable as an external application in neu- ralgia. Iodoform is also employed as an anodyne, for the IODOFORM. 365 relief of the pain following the extraction of teeth affected with periodontitis and alveolar abscess ; also as an injection in diseases of the antrum, and as a packing for the pus pockets in alveolar pyorrhoea, for which purpose it is often combined with oil of eucalyptus, or oil of cinnamon. Also for filling the canals of pulpless teeth, for which purpose a paste of iodoform and carbolic acid is used, and allowed to remain for a few days, and, if no soreness follows, a permanent root-filling can then be introduced. When iodoform is used alone, a pellet of cotton or a strand of floss silk may be dipped into glycerine, and the iodoform be thus taken up. To disguise the unpleasant odor of iodoform, it may be incorporated with a little oil of rose, as one drop of the oil will remove the odor of half a drachm of iodoform ; the odor is also disguised by balsam of Peru, oil of cinnamon, oil of lavender, or oil of sassa- fras. Three grains of cumurin (a derivative of the Tonka bean) will disguise the odor of one drachm of iodoform ; or the addition of attar of rose, one minim to the drachm ; or of essence of rose geranium, three or four minims to the drachm. Creolin is also a very good deodorizer of iodoform ; also aqua heliotrope, for the hands also, one or two drops of creasote or carbolic acid to the ounce of iodoform, is also recommended. According to some, it is not a matter of indifference whether iodoform be applied as a dressing for wounds and ulcers, in the form of crystals, as amorphous powder dissolved in ether, or as an ointment. Iodoform acts not only as a chemical combination, allowing the escape of iodine in a free state, but it has certain mechanical properties. When the surface of an ulcer or wound is covered with a layer of iodoform in cry.stals, a certain degree of absorption of the fluids secreted takes place. These products of secretion penetrating the interstices between the minute crystals of iodoform soon lose the liquid form, and produce with them an impermeable crust. Under this crust cicatrization soon occurs, without any retraction of the tissues ; hence they suppose that the best form in which to employ iodoform for ulcers and wounds is that of the crys- tals. As toxic effects have followed the internal administra- 366 DENTAL MEDICINE. tion of iodoform, it should be prescribed with care, and also the application of it to extensive surfaces should be avoided. The toxic symptoms have been manifested as follows, the maximum dose which caused them in a certain case being 12^ grains : " Giddiness, vomiting and deep sleep, from which the patient could be roused with difficulty. The somnolence was inter- rupted by periods of excitement, each lasting several hours, and was followed by delirium, intense headache, sense of im- pending death, spasmodic contractions of the facial muscles, and in the case of the younger patient, diplopia. The functions of the other sensory organs were not disturbed, and the pupils, presented a normal reaction. Deep inspirations alternated with apnoea of about a minute's duration. After five or six days, the toxic symptoms gradually lessened and passed away." Iodoform has been used for odontalgia, on account of its gently caustic and anodyne action on exposed pulps of teeth. Combined with arsenious acid and creasote in a devitalizing mixture, iodoform is supposed to lessen the pain caused by the arsenical paste. M. Rummo, of the Academy of Science, regards iodoform as exerting an anaesthetic action when applied to wounds, but without the power to destroy germs in putrescent matter, al- though it prevents their development ; but dissolved in oil of turpentine, it will destroy bacteria in their fullest proliferation. M. Sauvat says that iodoform, when applied to wounds, reduces effusion and favors cicatrization, and exerts an anaesthetic action ; but if carelessly used it may cause erythema or even erysipelas. Iodoform in powder is now a popular dressing for wounds. IODOFORM. 367 DENTAL New Methods for Deodorizing Iodoform, I. — Carbolic acid i part. Iodoform 2 parts. Powder and mix well. No change appears to take place in the iodoform, but the odor is marked by that of carbolic acid. 2. — Iodoform loo parts Oil of peppermint .... 5 parts Oil of neroli I part Oil of lemon 2 parts Tinct. benzoin 2 parts Acetic acid i part. Powder the iodoform, and mix thor- oughly with the other ingredients. Transfer to a well stoppered flask, and keep at a temperature of from 120° F. to 140° F., over a water bath, for two days. The mixture has a pleas- ant odor of Eau de Cologne. 3. — Camphor 5 parts Charcoal 10 parts Iodoform 15 parts. Powder and mix intimately. For Pulpless Teeth. R. lodoformi gr.x Acidi tannici gr.iij Glycerini gtt.xv. M. SiGNA. — Apply on floss silk, or by syringe. Preparation. — Rub iodoform to fine powder, in a mortar, and add the tannin, and after mixing thoroughly, add the glycerin. One drop of oil of cinnamon will disguise the odor, . For Devitalizing Pulps of Teeth. B . lodoformi gr.v Acidi arsenics .... gr.x Creasoti q.s. M. To make a paste. SiGNA. — Apply on cotton, or on point of a broach. FORMULiE. For Putrid Pulps. A. P. Johnston. R . lodoformi ^-^^ Camphorse 5 ^ Alcoholis ^j. Misce by dissolving the camphor in the alcohol, and then add the iodoform. SiGNA. — Use as an injection. As a capping for an exposed pulp, it is suggested to dissolve the filings of celluloid in the above mixture and form a thick paste. For Odontalgia. ScHAFF. R. Pulv. lodoformi .... gr.lx Kaolin gr.lx Acidi carbolic! .... gr.viij Glycerini q.s. Olei menthre piperit . . gtt.x. Triturate the iodofonn, kaolin, and oil of peppermint, with enough glycerine to form a thick paste. SiGNA. — Apply to exposed surface of pulp. For Pulpless Teeth with a Fistulous Opening. Faught. R. lodoformi ^j Acidi tannici ^\^ Glycerini f^ij Morphinje acetat .... jj. M. Signa. — Apply on floss silk. For Neuralgia and Tumors of the Gums. R. lodoformi grxv. Bals. Peru gr.xxx Glycerini vel vaselin . . q.s. M. To make a solution or ointment. Signa. — To be applied as a solution; or, if the vaseline is used, as an oint- ment. 368 DENTAL MEDICINE. For Pulpitis, as a Capping. For Pulpless Teeth — Canal- Dressing. Easchkis. Pierce. B . lodofonni pulv., R . lodoformi, Kaolin pulv . . aa . . gr.lx Olei caryophilli, Acidi carbolici (cryst.) gr.viij. Olei Eucalypti . aa . . ^vj. M. Mix, and add sufficient glycerine to SiGNA. — Apply by injection or on form a paste, then add : — floss-silk. 01. menth pip .... gtt.x, SiGNA. — Apply, on point of broach For an Ointment of Iodoform and Eu- over inflamed portion. calyptus. R. Pulv. iodoformi . . . ^ss For Tumors, Enlarged Glands, etc. Olei eucalypti . . . . f^ss R . lodoformi part, j Vaselin ^ iv. M. Collodii part, x, M. Signa. — To be used as an ointment. SiGNA. — To be applied as a lotion. lODOL— TETRAIODOPYRROL. Fonmda. — QH NI4. Derivation. — lodol is obtained by the action of iodine on certain constituents of animal oil. It is in the form of a grayish-white powder, which becomes dark on exposure to light. It is odorless and has little taste, and contains 90 per cent, of iodine. It is quite soluble in alcohol, ether, chloroform, carbolic acid, olive oil and alkaline solutions, but insoluble in water; combination with an equal part of glycerine does not affect its properties. Medical Properties and Therapeutic Uses. — lodol is anti- septic, deodorant and anaesthetic. It is an efficient germicide without poisonous effects, and is free from the disagreeable ' odor and taste of iodoform. Its physiological action and therapeutic uses are the same as those of iodoform. When applied to an abraded or wounded surface, it can soon be de- tected in the urine and saliva ; also the same effects are appa- rent when it is administered by the stomach. Its action is slower than that of iodide of potassium, but more prolonged, and its elimination is slower. It has a slight caustic action, but a larger quantity can be used when 'it is substituted for iodoform ; no quantity applied to a wound will cause toxic symptoms. lODOL. 369 It is used on wounds, ulcers, etc., in the form- of an impal- pable powder, which is dusted on the part. It is also em- ployed in the form of an ethereal solution, and also in solu- tion with alcohol and glycerine ; also in the forms of iodol cotton and gauze, pastils, bougies and ointments. It improves morbid conditions, and can be advantageously substituted for iodoform. It has been administered with good results in the treatment of laryngeal tuberculosis by insufflation of the powder ; and the loss of appetite, so common as a re- sult of the use of iodoform, does not occur, ulcers become rapidly clean and the tendency to form scars is scarcely ob- served. Iodol is also employed internally, in the form of pills of 3 grains in the treatment of substernal struma. In the treat- ment of syphilitic ulcers, round ulcers, suppurating buboes, and after opening the pustules of acne, it has also given favor- able results, as it lessens the secretion, possesses great disin- fectant power and is non-irritating. Dose. — For internal administrations, gr. ^^^ to gr. v. in wafer pill, or pellet, or in powder. Dental Uses. — Same as those of Iodoform (which see). For a Topical Application. For Root-Canals of Abscessed Teeth. Mazzoni. Van Wort. R. Iodol I part. R. Iodol gr.x. Alcoholis 16 parts. Zinci oxidi .... gr.xx. Glycerini 34 parts. Vaseline carbol. q.s. to form a SiGNA. — Apply with a camel's-hair thick paste. M. brush or in the form of spray. SJGNA. — Place in canal and seal with an oxyphosphate filling. Dental Varnish. R. Saturated solution of iodol in al- For a Topical Application. cohol I part. Evaporating quickly. Hubbard's negative varnish R. Iodol I part. 6 parts. M. /Ether sulph .... 8 parts. M. A good, quick drying varnish. lODUM— IODINE. Formula. — I. Derivation. — Iodine is a non-metallic, metalloid element, obtained principally from kelp (made by burning seaweed, and 24 370 DENTAL MEDICINE. in the form of impure soda), which is subjected to distillation in iron retorts, after which it is mixed with sulphuric acid and black oxide of manganese. It is evolved in the form of vapor, which is condensed. The vapor is readily recognized by its beautiful violet color. Iodine is usually in the form of bluish- black crystalline scales, with a metallic lustre, a strong, peculiar odor and a hot, acrid taste. It is slightly soluble in water and soluble in alcohol, ether, solution of chloride of sodium and a solution of iodide of potassium. Medical Properties and Action. — Iodine in small doses is alterative, stimulant and tonic, and acts locally as an irritant, causing redness, itching and desquamation ; exhaled in the form of vapor, it excites cough and warmth in the air pas- sages. Taken internally it excites a sensation of heat or burning in the stomach, and in large doses is an irritant poison, inflaming the mucous membrane of the stomach and causing superficial eschars. The internal use of the iodides gives rise to an eruption of acne, especially on the face, thighs and shoulders ; they have also anaphrodisiac powers when long continued. The influence of the iodides in producing iodism may be prevented by large draughts of water being used during their administration. The odor of iodine can be detected in the blood, brain and muscles. When combined with potassium its local irritant effect is diminished ; hence, the preparation known as Iodide of Po- tassium, Potassii lodidum (obtained by treating an aqueous solution of potassa with iodine), is employed whenever the constitutional effects of iodine are desired, as the iodide of potassium possesses many advantages over iodine for internal use, such as being less irritant, and for this reason may be ad- ministered in larger doses and for a greater length of time ; it is also more soluble than iodine alone, and when taken into the stomach is absorbed much more rapidly. The formula is Ki, and it is in the form of white crystals, of an acrid, saline taste. Some persons are peculiarly susceptible to the influ- ence of iodine, even small doses causing unpleasant effects, IODINE. 371 such as headache, vertigo, derangement of the digestive or- gans, etc. Iodide of potassium, like iodine, produces a very decided effect on the secretions, increasing them, and occasionally to the degree of ptyalism. The antidote for poisoning by iodine is starch. Therapeutic Uses. — Iodine and its preparations are valuable resolvents in the treatment of glandular enlargements, indura- tions, tumors, thickening of membranes, etc., etc.; also in scrofula, scrofulous ophthalmia, tubercular meningitis, ad- vanced stage of pleurisy, chronic affections of the liver, etc., etc. Iodide of potassium is much employed in mercurial poison- ing and in syphilis, especially in the secondary and tertiary forms, and after the employment of mercury has proved use- ful ; also in affections of the nervous system of a syphilitic origin, together with the other affections already referred to as indicating iodine. Externally iodine is used in the form of tincture in the treatment of enlarged scrofulous glands, cuta- neous affections, erysipelas, rheumatism, gout, phlegmons, syphilitic gummatae and nodes, phagedaenic ulcerations, car- buncles, diseases of the joints, wounds and parts poisoned; and as a counter-irritant in pneumonia, phthisis and pleurisy ; and as injections in hydrocele and bronchocele. The vapor is inhaled with benefit in chronic bronchitis and phthisis. Iodine also ranks highly as a disinfectant. Dose. — Of iodine alone, gr. ^ to gr. j two or three times a day, in the form of a pill, directly after eating, on account of its irritant effect; the best form of administration, however, is iodide of potassium. Dose of the iodide of potassium, gr. iij to gr. X. Tincture of Iodine — Tinctura lodi (iodine, 5j ; alcohol, Oj). Dose, inj to 1TLv. Compound Tincture of Iodine — Tinctura lodi Coinposita (iodine, .^ss ; iodide of potassium, .5j ; alcohol, Oj). Dose, Itlij to ntx. Colorless Iodine — Iodine is bleached by carbolic acid, and 372 DENTAL MEDICINE. the colorless carbolate combines all the advantages of both base and acid. One of the easiest methods to decolorize iodine is to add forty minims of a saturated solution of hypo- sulphite of soda to each fluid ounce of the tincture of iodine. Forty minims of the saturated solution contain about thirty- two grains of sodic hyposulphite. Another method of decol- orizing iodine is to put into an open vessel a drachm of the tincture of iodine and six ounces of hot water ; add twelve grains of phenol and stir with a glass rod, when the solution will be at once bleached. De7ital Uses. — In dental practice iodine and its preparations are valuable agents, the official and compound tinctures being employed in the treatment of periodontitis, alveolar abscess, mercurial stomatitis and other forms of stomatitis, inflamma- tion and ulceration of the gums, fungous growths of gum and tooth pulp, necrosed teeth and suppurating pulps of teeth, diseases of the antrum, caries of maxillary bones, den- tigerous cysts, recession of gums and absorption of alveolar processes. For the different forms of stomatitis, and especially mercu- rial stomatitis, the tincture of iodine is used in the form of a gargle ;, for an injection in alveolar abscess it is diluted or combined with carbolic acid, glycerine and other agents ; for fungous growths it may be used alone, or combined with rec- tified alcohol; for ulcerations of gum and mucous membrane it is generally combined with carbolic acid ; for periodontitis it is combined with the tincture of aconite root, and is regarded as being almost a specific for the incipient stages of this affec- tion, as it relieves the inflammation by retarding the circulation and stimulating lymphatic action. Either the officinal or com- pound tincture is employed with an equal quantity of the tincture of aconite, the preparation being applied to the gum over root of affected tooth, which should be previously dried of moisture, by means of a camel's-hair brush or cotton on the point of an excavator. The mouth should be kept open and the part protected until a metallic pellicle is formed. Iodine is also a valuable disinfectant and germicide in the treatment IODINE. 373 of alveolar abscess (in the form of the compound tincture), used as injections throughout the pus tract, and for root canals and the pus-pockets of alveolar pyorrhoea. A valuable combination of iodine, carbolic acid, glycerin and water is known as " Boulton's Preparation," and is a useful application in the form of injections, gargles and lotions. For the chronic form of alveolar abscess, and also for the acute form, after more powerful agents have been employed, it is a useful remedy, possessing antiseptic and stimulant properties in a marked degree ; it also possesses the property of modify- ing mucous membrane and diminishing sensibility ; hence it is useful in ulcerations, etc. Tincture of iodine combined with creasote or carbolic acid is a powerful application in peri- odontitis, suppuration of necrosed teeth, ulceration of margins of the gums and for fungous growth, as it stimulates debilitated parts and destroys such as are too weak to be restored. A colorless tincture of iodine is composed of glycerin and aqua ammonia in combination with the iodine, but the presence of the ammonia restricts its use. Another colorless tincture, in which sulphate of soda is substituted for the ammonia, is less irritating in its effects. The addition of water and honey to the officinal tincture of iodine will render it suitable for a gargle for inflamed and ulcerated parts. The iodide of potassium is employed inter- nally in mercurial stomatitis, dental exostosis, facial neuralgia, convulsions of dentition, periodontitis, looseness of the teeth, tumefaction and sponginess of the gums, syphilitic and scrof- ulous ulcerations of the mouth, caries and necrosis of the maxillary bones. Tincture of iodine mixed with glycerin is claimed by Dr. Hammond to be more effective as a local application than the plain tincture. This is due to the retardation of the dissipa- tion of the iodine, or more probably to the skin remaining soft, and therefore in a better condition for absorbing the drug. 374 DENTAL MEDICINE. DENTAL FORMULAE. For Chronic Alveolar Abscess, Ulcera- tions, Inflammations, etc., etc. BOULTON. R • Tinct. iodi. comp . . . TH.^l''' Acidi carbolici (cryst) , "tTLvj Glycerinse §j Aquse destillatae . . . . ^ v M. It becomes colorless in from 8 to lo hours. SiGNA. — To be used as an injection, gargle or lotion. For Ulceration of Gums. R . Tinct. iodi Hlxlv Acidi carbolici . . . TT^vj Glycerini ^j Aquse destillatse . . ^ v. SiGNA. — Apply as a lotion. M. R. For Periodontitis. Tinct. iodi ^j Creasoti vel., Acidi carbolici . . .-^ss, M. SiGNA. — To be applied to gum about neck of tooth, as a counter-irritant. For Ulcerated Gums and Mucous Mefnbrane. R . Tinct. iodi .... partem j Mellis partes ij Aquse partes vij. M. SiGNA. — To be used as a gai^le. For Periodontitis. R. Tinct. iodi ^x Potassii iodidi . . . . § ss Camphorae ^\] Spiriti rectificati . . . f§x. M. SiGNA. — Apply with a camel's hair brush to gvmi over root of affected tooth. For Fungous Growths and Suppurating Surfaces. R . Tinct. iodi ^!^ ij Spiriti rectificati . . . ^j. M- SiGNA. — To be applied with a camel's- hair brush. For Mercurial Stomatitis . R . Tinct. iodi . . . . 5 iij vel vj Potassii iodidi . . gr.xv vel xxx Aquse Oss. M. SiGNA. — To be used as a gargle. For Periodontitis. R. Tinct. iodi., Tinct. aconiti . . aa . . ^ss. M. SiGNA. — To be applied by means of a camel' s-hair brush until a metallic pellicle is formed, three times daily. For Excessive Sweating of the Hands. R . Tinct. iodi ^^ j Lin. camphorae comp., Glycerinse . . aa . . . ^iss Lin. belladonna comp . ^j Eau de cologne . . . . ^j. M. SiGNA. — Apply as an embrocation twice a day, having previously well bathed the hands in warm water, in which is dissolved two drachms or half an ounce of chloride of ammonia and four drachms of carbonate of soda crystals, enough water being used to well cover the hands. For Putrescent Pulps and Chronic Alveolar Abscess. R. Iodi . . Alcoholis 3iJ M. For Same and Pyorrhxa Alveolaris. R. Iodi, Acidi carbolici (crystals)aa;:5J Alcoholis f^ij.M, TRICHLORIDE OF IODINE. 375 IODINE TRI-CHLORIDE— TRICHLORIDE OF IODINE. Formtda.— ICI3. Derivation. — Iodine tri-chloride is obtained by the action of chlorine on iodine. It is an orange-red powder, whose odor strongly irritates the mucous membrane. Usual dilution 1 : 1 200. Medical Properties and Therapeutic Uses. — Tri-chloride of iodine is antiseptic and disinfectant, being highly efficient as such, through the liberation of chlorine whose nascent ener- getic effect is still further enhanced by the presence of iodine. The antiseptic power of tri-chloride of iodine was officially tested by the Imperial Sanitary Bureau of Germany, and the following result was ascertained : "An aqueous solution of i in 1000 destroys resistant bacillus- spores within a compara- tively short time ; but only the aqueous solution does this. Alcoholic or oily solutions proved ineffective. Iodine tri- chloride far surpasses carbolic acid, and is next to corrosive sublimate (bi-chloride of mercury), in antiseptic power." It may be obtained in quantities of ten grammes in hermetically sealed tubes, and is best kept in five per cent, aqueous solu- tions which appear to remain unchanged for some months. Langebuch claims that a o.i to 0.15 per cent, solution is equal in antiseptic action to a 0.5 to i.o per cent, solution of bi- chloride of mercury ; in other words that it is about five times as efficient as the bi-chloride. It is also claimed to be rela- tively the least poisonous of all antiseptics. Behring found that in aqueous solutions, having equal action upon the spores of anthrax bacilli, sublimate is five to six times, and carbolic acid and creasote seven to eight times, as poisonous as the tri-chloride. Dental Uses. — Dr. W. D. Miller says : " We have con- sequently reasons to hope that the tri-chloride of iodine may prove a valuable remedy in the treatment of diseased con- ditions of the teeth and mouth." Its efficiency as a disinfect- ant for carious dentine has been clearly shown in the experi- ments of Dr. Miller, and his impression was that the five per cent, solution of the tri-chloride of iodine is one of the 376 DENTAL MEDICINE. most active agents for sterilizing carious cavities, and disin- fecting carious dentine preparatory to filling teeth. lODOPHENACETIN. Derivation. — A new derivation of phenacetin described by Dr. Scholvein, obtained when a cold-saturated solution of phenacetin, acidulated with hydrochloric acid, is treated with iodine. It first forms as a gray precipitate, which afterwards appears as a mass of crystalline needles or an amorphous mass. It forms, when dry, a chocolate-brown powder. When recrystallized from glacial acetic acid, it may be obtained in steel-blue crystals. By dissolving the phenacetin in glacial acetic acid and afterwards diluting with water, less quantities of liquid are required in its preparation than would be the case if a mere aqueous solution of phenacetin was employed. The resulting product, called " zWij^/Zz^rnVz," melts at I30°C., decomposing at the same time. It contains one portion of its iodine in a more intimate combination than the other. It is soluble in 20 parts of cold glacial acetic acid, more easily in the same liquid when hot, and is soluble in alcohol, but not readily soluble in benzole and chloroform. If heated with water, it is decomposed. It has a strong odor of iodine, and a burning taste. Ordinarily it contains 50.5 per cent, of iodine. Medical Properties and Therapeutic Uses. — lodophenacetin is an antiseptic, and possesses marked powers as a bactericide; but when given subcutaneously it produces marked local irri- tation, and when given internally it forms combinations with the alkalies of the intestinal canal, and consequently, from the readiness with which iodine is given up, iodine-poisoning may readily follow the administration of even small doses. IRIDIS RHIZOME— ORRIS RHIZOME— ORRIS ROOT. Source. — The plant from which Orris Root is obtained is a native of Italy and the south of Europe. It belongs to the natural order Iridaceae, of which there are three varieties of the species of Iris — Iris Rhizoma, Iris Florentina and Iris Ger- GUTTA PERCHA. 377 manica. The root, which is the officinal portion of the plant, is of various forms and sizes, often branched, usually knotty and flattened, white, heavy, and of the thickness of the finger. It has a pleasant odor, like that of violet, and a bitter, acrid taste. Medical Properties and Action. — Orris root is cathartic and diuretic, and in large doses emetic. It has been employed with some benefit in dropsies, but is not often administered as a general remedy at the present time. It is valued for its pleasant, violet odor. Dental Uses. — In dental practice it is employed as a very common ingredient of dentifrices, and also to correct an offensive breath. DENTAL FORMULA. Dentifrice, Dr. Sewell. R . Pulv. radicis iridis ^ ss Pulv. saponis cas 3 ij Pulv. sodii boratis 3 ij Cretse preparatoe ,^ij. M. Flavor with a few drops of oil of cloves and lavender. Or, add a few drops of carbolic acid to each ounce of the powder, and flavor the whole with eucalyptus oil. ' ISONANDRA GUTTA— GUTTA PERCHA. Source. — Gutta Percha is the inspissated juice of the tree Isonandra Gutta, extensive forests of which are found in the East Indies. It belongs to the natural order Sapotacece. It is in the form of tough, flexible pieces, which have been freed from impurities by cutting it into thin slices, and then washing and tearing it into shreds by heavy machinery while it is soft- ened in boiling water. It may be more thoroughly purified by dis.solving it in either chloroform, benzol or hot turpentine, thus causing the impurities to separate, when it is evaporated to dryness. Crude gutta percha is of a chocolate or reddish- brown color; commercial gutta percha is of a grayish-white color, and the variety which has been purified by dissolving it in chloroform, etc., is almost white, greasy to the touch, and of 378 DENTAL MEDICINE. a leathery smell, like that of India rubber. It is insoluble in water at any temperature, and is a bad conductor of heat and electricity. At ordinary temperatures it is tough, hard and inelastic, but toward 120° F. it softens, and at 150° it becomes soft and plastic, and may be moulded into any form, which it will retain on cooling, having, however, a perceptible shrink- age. Gutta percha is dissolved cold by chloroform and sul- phide of carbon ; benzol requires the aid of heat and oil of turpentine requires to be quite hot. The alkalies have no action upon it ; but concentrated nitric acid attacks it rapidly, with effervescence and the escape of nitrous fumes. Dental Uses. — Combined with mineral substances it forms a plastic material for temporary fillings of teeth, and, colored with vermilion, is used for taking impressions of the mouth and for the base plates of plastic work. It is often employed as a filling material, on account of its non-conducting property, protecting a partially exposed pulp or sensitive dentine sur- face from irritation when metallic fillings would not be tolerated. Gutta percha has also been used for interdental splints. The preparation known as " Hill's Stopping" is composed of gutta percha, quicklime and feldspar, the mineral ingredi- ents being incorporated with the gutta percha while the latter is in a plastic condition from the effects of heat. Solution of Gutta Percha — Liquor Gutta Percha, Chloro- percha, is composed of gutta percha, Siss ; chloroform, 5xvij; or a thick solution may be made by dissolving as much gutta percha in chloroform as will give the desired consistence (like that of thick cream). Solution of gutta percha is a useful application for the relief of odontalgia arising from an exposed and inflamed pulp ; also for capping an exposed pulp, a more durable material being inserted over it. The chloroform of the solution quickly evaporates, leaving an impermeable covering of the gutta percha, which is non-irritable, non-conducting and protective. It is also a useful application for inflamed or abraded surfaces, chaps, skin affections, etc. Gutta percha dissolved in chloro- KRAMERIA. 379 form is a popular and efficient material for root fillings, as are also cones of gutta percha softened by heat or in chloro- form. KAXDOL. Kandol is a product formed by the distillation of naphtha, and is a perfectly clear, colorless fluid, extremely volatile, burns easily, and has a slight odor of benzine. It can be mixed with a small quantity of water or alcohol, and its preparation is cheap and simple. Dr. Njuschkon advocates the use of kandol in the place of ether or cocaine as a local anaesthetic in the form of spray. In one minute kandol will reduce the temperature to 10° C, and keep it nearly uniform at that temperature for some time, while ether reduces the temperature to 17° C. As an effect of the spray of kandol, the skin be- comes very hard and is completely anaesthetized, and there is no bleeding, or else the blood coagulates as soon as it makes its appearance, so that all operations may be performed with ease and rapidity. KRAMERIA. RHATANY. Source. — Krameria is obtained from the root of the shrub krameria triandra, of the natural order Polygale O Cj H^ NH(C0-CH3.) Medical Properties and Therapeutic f/^rj.— Phenacetine is slightly soluble in water, but freely soluble in alcohol, and has proven to be a most reliable antineuralgic without deleterious effects. It causes no nausea, vomiting or diarrhoea ; no col- lapse, no cyanosis or depressing after effects. It is thought to produce its effects by slowly dissolving in the lactic acid of the stomach. Prof Rumpf considers phenacetine to be not a narcotic, but an antineuralgic acid from its strong antipyretic action. The mode of action is probably a direct influence on the central nervous system— that of the vaso-motor more espe- cially, for phenacetine acts especially on the vaso-motor neu- roses, which indicates a powerful effect on the circulation. Phenacetine is a strong analgesic, and thought to be more powerful in its action than either antipyrine or antifebrin, and it acts very rapidly notwithstanding its insolubility in the'gas- tnc juice. About twenty minutes after its administration its effects may be observed. It is employed in the various forms of neuralgia, hemicrania, acute rheumatism, vaso-motor neu- roses, neurasthenia, locomotor ataxia, etc., etc. Dose. — As an antineuralgic the dose ranges from eight to twenty-two and a half grains (one-half to one and one-half grams). Fifteen grains is the average dose. Good results are obtained by administering phenacetine in gr. v doses, once in an hour until gr. xv-xx are taken. Dental Uses. — Phenacetine is employed in neuralgias of dental origin, acute periodontitis, and pericemental irritation. 432 DENTAL MEDICINE. PHOSPHATES AND PHOSPHITES. The Phosphates are ingredients of most of the animal and vegetable foods, and a sufficient amount of phosphorus is, under normal conditions, appropriated by digestive action for the supply of the system. Every part of the body contains phosphate of lime, and rickets and softening of the bones and defective teeth result when too little is supplied during the formative period. The blood, saliva, gastric juice, urine, milk and the entire intercellular fluid contain phosphate of lime in solution. When this agent is administered by the stomach, diffusion into the blood results as a consequence of its being to some extent soluble in lactic and hydrochloric acids; hence it is very essential to the nutrition of the body, and small doses are as effective as large ones, as all in excess of the quantity soluble in the acids of the stomach is not appropri- ated, but passes off or forms concretions in the intestines. Phosphate of sodium is also a constituent of the blood, and by removing morbid states of the mucous membrane it pro- motes digestion and improves nutrition and the tone of the nervous system. Large doses, on the other hand, when ad- ministered in health, will impair digestion. Phosphorus exists generally as a phosphate, and has a strong affinity for oxygen, compounds being rapidly formed in the stomach ; but some of it may enter the blood uncombined. It is a powerful irri- tant poison, the dose being no larger than j^ to -^ of a grain. The preparations of the Phosphates and Phosphites are : Syrupiis Calcii Lacto-phosphatis. — Syrup of the lacto-phos- phate of lime. Dose. — foj to foj. (See Syrup of lacto-phos- phate of lime.) Compound Syrup of the Phosphates. — Each drachm contains two and a half grains of phosphate of iron and one grain of phosphate of lime. Sodii Phosphas — Phosphate of Sodium. — In the form of large, colorless, transparent prisms, v.'ith a cooling saline taste, feebly alkaline and no odor, and a slightly alkaline reaction. Soluble in six parts of water at 60° F. and in two parts of boiling water. Dose. — f5j to fSj. JABORANDI. 433 Calcii Phosphas PrcEcipitatus. — Precipitated Phosphate of Lime. In the form of a white powder, with no taste or odor and insoluble in water or alcohol. Dose. — Gr. ij to gr. v, Syriiptis HypophospJiitiini. — Syrup of Hypophosphites. Com- posed of hypophosphites of calcium, sodium and potassium. Dose. — foj. Sodii Pyrophosphas. — Pyrophosphate of Sodium. In the form of colorless, translucent prisms, with a cooling saline taste and a feeble alkaline reaction, but no odor, soluble in water, but insoluble in alcohol. Dose. — f5ss to fSss. Calcii Hypophosphis. — (See Hypophosphite of Lime.) Sodii HypopJiosphis — Hypophosphite of Sodium. In the form of small, colorless or white prisms, or a white granular powder with a sweetish saline taste, and a neutral reaction, and solu- ble in water. Dose. — Gr. v. to gr. x. Therapeutic Uses. — The phosphates are useful in rickets, mollities ossium, non-union of fractures, soft teeth of children, caries and necrosis of bone, anaemia of nursing mothers, chronic bronchitis, leucorrhcea. The phosphate of soda in bilious sick headache, hepatic colic, jaundice, carbuncles, boils, etc., etc. The hypophosphites in phthisis, emphysema, fibroid lung, chronic tuberculosis, dilated bronchi, skin dis- eases, and all diseases characterized by mal-nutrition. Phos- phoric and hypophosphoric acids are frequently combined with many vegetable and mineral tonics. The hypophosphites fulfill nearly all the indications of phosphorus itself. PILOCARPUS-JABORANDI. Source. — From the leaflets of the Pilocarpus pennatifolius, a Brazilian plant. The alkaloid on which the properties of the substance depends is pilocarpine, which combines with acids to form salts. Another alkaloid is jaborine, both having the same chemical composition, C,iH,gN202, and pilocarpine "by heat, merely by concentration of an acid solution," is con- verted into jaborine ; washing with absolute alcohol will sepa- rate them when united: The principal preparations are : Hy_ drochlorate of pilocarpine — pilocarpines hydrochloras, — which 28 434 DENTAL MEDICINE. is in the form of white crystals, dehquescent, with a slightly bitter taste, a neutral reaction, and no odor. It is very soluble in alcohol, but not soluble in ether or chloroform; and the fluid extract of pilocarp us — extractuin pilocarpi fluidum. Bella- donna and its alkaloid atropine are antagonistic to pilocarpine. Medical Fropej^ties and Therapeutic Uses. — Large doses of crude jaborandi cause nausea and vomiting on an empty stomach, and the use of the alkaloid appears to have the same effect under similar circumstances. It increases the perspira- tion and saliva. Ringer stating that the secretion of the sali- vary glands is augmented as much as twenty-seven fluid ounces as the result of a full dose. The nauseating effects of the alkaloid pilocarpus appear to depend upon its action on the muscular layers of the stomach and intestines ; and the increased secretion of the mucous membrane doubtless results from the stimulation of the pancreas and the glands of the mucous membrane. Children do not appear to experience its influence to the same degree, in regard to salivation, perspiration and tempera- ture, as do adults. As a general rule, drowsiness follows the profuse perspiration, and pallor the flushings caused by the drug : and the languor and debility it occasions continue for some hours. The pupil of the eye is contracted, but this organ generally recovers from its diminished vision after the space of one hour and a half. Jaborandi is employed in drop- sies of the heart and kidneys, mumps, diseases of the eye, to increase the secretion* of milk, diabetes insipidus, diphtheria, skin diseases, etc. It is also employed in ptyalism with ad- vantage, in the form of the hydrochlorate of pilocarpine, one- third of a grain three or four times daily. Dose. — Of Infusion, Infusum Pilocarpi^ Sss to oij. Of Fluid Extract — Extr actum Pilocarpi Fluidimi, 5ss to oij- Of Tinc- ture — Tinctiira Pilocarpi, 5ss to 5ij. Of Hydrochlorate — Pi- locarpince Hydrochloras, gr. ^2" to gr. ss. JAMAICA DOGWOOD. 435 PINUS CANADENSIS— ABIES CANADENSIS, Hemlock, hemlock spruce of the United States and Canada. The medicinal portions are the juice and bark. The concrete juice, which is known as Plx Canadensis — Canada pitch, is a yellowish or faintly greenish, transparent, viscid liquid, when fresh, but afterward becomes an opaque, reddish-brown, hard and brittle mass, which contams resin and a volatile oil. It is used to make rubefacient plasters. The bark is rough and deeply furrowed, and is very astringent, possessing properties similar to those of the white-oak bark. An extract prepared from the bark is used as a topical astringent, but it is not con- sidered to have any advantages over other common vegetable astringents For Inflamed Mucous Membrane, and for Use after the Removal of Salivary Calculus. A. W. Harlan. R . Pinus canadensis (white) 5 ss Aquae rosEe ,f iijss Eugenol KTLxxx. M. SiGNA. — Use as a lotion or on a tooth-brush, three times daily. PISCIDIA ERYTHRINA— JAMAICA DOGWOOD. Source. — Jamaica Dogwood is a plant indigenous to the West Indies, where it has been used as an intoxicant in taking fish. The bark is the officinal portion, and is smooth and bright-colored. Medical Properties and Action. — Jamaica dogwood is a pow- erful narcotic, and, in a measure, tonic and diuretic. Its nar- cotic properties are supposed to be superior to opium, as it does not cause the disagreeable after-effects common to that drug. When chewed, Jamaica dogwood has an unpleasant, acrimonious taste. It yields its virtues to alcohol, but not to water. Its internal use is generally followed by a sensation of heat, gradually extending to the surface, and succeeded by profuse perspiration, with profound sleep. In large doses it produces general paralysis, and death from asphyxia. It has 436 DENTAL MEDICINE. been used as a substitute for morphine, which it resembles in many respects. Therapeutic Uses. — The principal use of Jamaica dogwood is in neuralgia, in the form of a tincture composed of Jamaica dogwood 5J, rectified spirits fSiv. It is effectual in acute pains usually, and is said to be efficacious in lunacy, and cough of phthisis. Dose. — Of the tincture of Jamaica dogwood, f5j. Dental Uses. — Jamaica dogwood, in the form of the tincture, is efficacious in trigeminal neuralgia, and in odontalgia result- ing from an irritable pulp, for which purposes a fluid drachm in cold water may be taken internally, and externally in the case of odontalgia, introduced on a dossil of cotton into the carious tooth. PLUMBI ACETAS— ACETATE OF LEAD. SUGAR OF LEAD. Formula. — Pb2C2H302, 3H2O. Derivation. — Acetate of Lead is obtained by immersing lead in distilled vinegar, or litharge in pyroligneous or crude acetic acid ; when the acid has become saturated, the solution is per- mitted to cool and crystallize. Acetate of lead is a white salt, in the form of beautiful, brilliant, needle-shaped crystals, like long prisms, which effloresce on exposure to the air. It has a sweet, astringent taste, and an odor of acetic acid, and is soluble in water and alcohol. Medical Properties and Action. — Acetate of lead is sedative and astringent, checking the secretions and reducing the activ- ity of the capillary system, and diminishing the force and fre- quency of the pulse. Like all the salts of lead, it is an irritant and corrosive poison, causing gastro-enteric inflammation. It requires, however, a large quantity (not less than half an ounce) of the acetate of lead to destroy life, as much of it is rejected by vomiting. The symptoms of lead poisoning, when the lead is slowly introduced into the system, are loss of ap- petite and strength, wasting of flesh, paleness of the face, con- ACETATE OF LEAD. 437 stipation, pain in the joints, dry colic, which is reHeved by pressure, neuralgia of the abdominal muscles, contraction of the intestines, belly drawn toward the spinal column, contrac- tion of the liver, jaundiced skin, yellow conjunctiva, urine colored with biliary coloring matter, a blue line along the margin of the gum, about the incisor teeth ; also at times a bluish discoloration of the mucous membrane of the lips and mouth, dimness of vision, paralysis of the extensor muscles of the fingers and arms, death resulting from the gradual failure of nutrition and the paralysis of the muscles of respiration. When the poisonous dose is large, there is intense gastric irritation, numbness, paralysis, coma and collapse. Iodide of potassium in large doses, also Epsom salts and sulphur baths, are the antidotes in chronic cases of lead poisoning, and for the lead colic, alum in doses of one or two drachms every three or four hours, dissolved in some demulcent liquid, is considered to be the best remedy. For the treatment of lead paralysis, strychnia and electricity are employed. The blue or slate-colored line on the gums is supposed to be due to a deposition of the sulphide of lead. Therapeutic Uses. — Acetate of lead is internally adminis- tered in dysentery, diarrhoea, cholera, cholera morbus, phthisis, chronic bronchitis, pneumonia, diseases of the heart, hemorrhage from the lungs, stomach, kidneys, nose, etc. ; dis- eases of the eye, erysipelas, skin diseases, chronic gastric ca- tarrh, gastralgia, pyrosis, summer diarrhoea of children, humid asthma, whooping cough, etc. : but the danger of producing toxic effects must be remembered in its internal use. Externally, solutions of lead are employed to relieve super- ficial inflammations, arrest morbid discharges, and allay the pain of acute inflammations. Lead should not be given with natural waters containing lime, carbonic acid, mineral acids and salts, vegetable acids, or vegetable astringents, iodide of potassium, and preparations of opium. Dose. — Of plunibi acetas, gr. ss or j to gr. v, two or three times a day. 438 . DENTAL MEDICINE. Liquor Plumbi Subacetatis Dilutus — Diluted Solution of Subacetate of Lead. — Lead water is composed of subacetate of lead solution, f5ij ; distilled water, Oj ; and is a mild astringent and sedative when applied externally ; it is never prescribed internally. It arrests discharges from suppurating and ulcer- ated mucous surfaces, and promotes the resolution of acute superficial inflammations. De7ttal Uses. — Lead water is employed in dental practice, to relieve inflamed gums and mucous membrane of the mouth ; as an application to indolent and foul ulcers ; also in the treat- ment of teeth after the devitalization and removal of the pulps, to prevent peridental trouble. It proves serviceable when applied to chapped hands and lips. A good ointment for such a purpose is composed of a combination of lead water, camphor, white wax and oil of almonds. DENTAL FORMULA. For Acute Inflammation of the Mucous For Chapped Hands and Lips, Membrane of the Mouth and the ^ _ yXo,. plumbi subacetatis '^«''"- dilutus gvj R. Plumbi acetatis . . . 3J Camphorse gr. xl Tinct. opii gss Ceris albre ^viij Aquae §x. M. Olei amygdala dulcis. Oj. M. SiGNA. — Apply as a lotion, on lint. Y\2.t cerat. _ „ -J J -J- SiGNA. — Apply as an ointment. For Fertodontitis. ^^ ^ McQuiLLEN. For Inflamed Gums and After Tooth Rf . , ,. , i ,.• -N- Extraction. . Liq. plumbi subacetatis ^j Tinct. opii . . . . ^ij. M. B- Plumbi acetatis . . . gr. xv SiGNA. — Apply to cavity on cotton and Tinct. opii f^ij to gum externally. Aquae f§iij- M- SiGNA. — Use as lotion and mouth- wash. PODOPHYLLUM— MAY APPLE. Source. — The rhizoma and rootlets of Podophyllum peltatum, or May Apple. It contains the alkaloid berberine, which is also peculiar to other plants, and two resinous substances soluble, one in alcohol and ether and the other in alcohol only, and on which its medicinal properties depend. Both are purga- tives. It has a bitter taste, with a sense of acidity. CAUSTIC POTASH. 439 Medical Properties and Therapeutic Uses. — Podophyllum is a useful cathartic and cholagogue. In cases of constipation, due to deficient secretions of the intestinal canal and liver, it is a useful cathartic, and for habitual constipation small doses combined with belladonna are very effective. It is also em- ployed in catarrhal and malarial jaundice, ascites, hemorrhoids, bleeding from stasis of the portal circulation, and torpidity of liver, as a substitute for calomel and blue mass. It is slow in its action and is therefore often combined with other cathartics. PodopJiyllin is the resin a podophylli. Dose. — Of Resina Podophylli — Resin of podophyllum, gr. J to gr. j. Of Extr actum Podophylli Fliddiini — Fluid extract of podophyllum, TTLj to 5ss. Oi Abstractunt Podophylli — Abstract of podophyllum, gr. \ to gr. j. POTASSA CAUSTICA— CAUSTIC POTASH. HYDRATE OF POTASH FUSED POTASH — OXIDE OF POTASSIUM. Fornnda. — H KO. Derivation. — Caustic Potash is prepared by boiling a solution of potash until ebullition ceases, and the potassa melts or as- sumes a solidified consistence, when it is poured into suitable moulds and kept in well-stoppered bottles, as it rapidly deli- quesces when exposed to the air. It dissolves in water and alcohol, and attracts moisture. Its officinal form is that of sticks of a white and somewhat transparent color, but upon exposure to the air, or if it is impure, it becomes a dingy gray, greenish or bluish color, and has the odor of slaking lime. When it is digested in alcohol, so as to free it from such impurities as are insoluble in alcohol, it is called alcoholic potassa. Medical Properties and Action. — Caustic potash is the most powerful caustic and escharotic in use, and, when taken inter- nally, is a corrosive poison. It is only employed externally. When applied to a part, it rapidly destroys its vitality to a considerable depth, differing in this respect from nitrate of silver (lunar caustic), as the latter is more limited in its action, and does not liquefy when it comes in contact with the tissues. 440 DENTAL MEDICINE. From the penetrating action of caustic potash, it is necessary to use it \vith great care. It is very deliquescent, which is a great objection to its use in some cases, but when mixed with an equal quantity of lime, the deliquescent action is in a measure prevented ; it is then known as potassa ciini calce — potassa with lime, and is in the form of a grayish- white powder, which is sometimes made into a paste, under the name of Vienna Paste, which is milder and less deliquescent. Therapeutic Uses. — Caustic potassa is chiefly employed to open abscesses, and in the treatment of chancres, hospital gan- grene, eczema, malignant growths, to arrest the sloughing of carbuncles ; in tetanus, applied to the spine ; bites of rabid animals and venomous reptiles ; phlegmons and incipient car- buncles, to arrest their progress ; to form issues, etc. To prevent its coming in contact with neighboring parts, a piece of adhesive plaster is used, with an opening corresponding in size to the surface on which the caustic is to act. When mixed with water, in the proportion of caustic potash, 5iss to water, fSij, it forms a rubefacient solution. Dental Uses. — In dental practice, caustic potassa is employed in gangrene of the mouth (cancrum oris), malignant growths, fungous growths of gum, ulcers, etc. ; for opening abscesses, when it is not prudent to use the lancet. POTASSIUM BICARBONAS— BICARBONATE OF POTASSIUM. Formula. — K H CO3. Derivation. — Bicarbonate of potassium is obtained by pass- ing carbonic acid through an aqueous solution of carbonate of potassium, until it is completely saturated. The solution is then filtered and evaporated, the product being bicarbonate of potassium, in the form of transparent, colorless crystals, of the shape of irregular eight-sided prisms. It is inodorous, with a saline and somewhat alkaline taste, and is soluble in water, but insoluble in alcohol. Its incompatibles are acids and acidulous salts, etc. Medical Properties and Action. — Bicarbonate of potassium BROMIDE OF POTASSIUM. 441 is antacid, diuretic and antilithic. In large quantities it is a corrosive poison. Therapeutic Uses. — It is employed internally in acute rheu- matism, gout, and uric acid lithiasis, diseases of the skin, calculous affections, etc., etc. Dose. — Of bicarbonate of potassium, gr. v to 3j. Dental Uses. — Bicarbonate of potassium is employed in dental practice, as an antacid, a solution being serviceable as a mouth-wash, to prevent injury to the teeth from acid medicines. DENTAL FORMULAE. For Facial Neuralgia. For Neuralgia. Wales. J. E. Garretson. R. Potassii bicarb . . . . ^ss R. Ferri sulphatis exsic. Ext. ergotas fluidi . . . f^j Potassii carbonatis. aa . gr.ccl Infusi ergotze f^vj. M. Syrup acaciae q.s. M. SiGNA.— Two tablespoonfuls every four Ft.pil. No. loo. jjQyj.s_ SiGNA. — Begin with three a day and increase to six; take several hun- dred. POTASSI BROMIDUM— BROMIDE OF POTASSIUM. Formula. — KBr. Derivation. — Bromide of Potassium is obtained by adding a solution of pure carbonate of potassium to a solution of bro- mide of iron. The iron being precipitated, the bromide of potassium is obtained from the solution by evaporation. It is in the form of white crystals, without odor, wholly soluble in water, and but sparingly soluble in alcohol, and having a pun- gent, saline taste. Medical Properties and Action. — Bromide of potassium is stimulant, sedative, narcotic and antispasmodic, and, being ab- sorbed into the system, can be detected in the blood, urine, faeces and mucus. If administered in considerable quantity, the action of the heart, respiration, and the temperature are depressed, and although in some cases a transient excitement may be caused by large doses, the effect of this agent is to induce a sound and refreshing sleep, and if its use is long continued, a constant drowsiness is experienced. Bromide of 442 DENTAL MEDICINE. potassium has also the power of lessening the sensibility to pain, especially causing a loss of sensibility of touch in the case of the mucous membrane and skin, which is due to the local action of the salt as it is eliminated, The long- continued use of this agent also causes a loss of motion, and if it is injected into the tissues of a limb, it will cause paralysis of motion and sensibility. It also diminishes the sexual feeling, and the condition which a long course of the bromides develop is known as bromism, which is characterized by weakness of mind, confusion, headache, pallor and anaemia, uncertain gait, etc. Therapeutic Uses. — Bromide of potassium is employed as an internal remedy in cerebral affections, acute rheumatism, cholera infantum, sea-sickness, vomiting of pregnancy; affec- tions of the heart, as shown by increased action; neuralgia, maniacal excitement, tetanus, strychnia poisoning, epilepsy, spasmodic asthma, spasmodic cough, etc., etc. Dose. — Of bromide of potassium, gr. v to 5j. Dental Uses. — Bromide of potassium is a useful remedy in infantile convulsions from the irritation of dentition, and is also efficacious in preventing such conditions by relieving the irritation ; also in neuralgia, due to diseased teeth, and in facial neuralgia when congestive in character. As its local effect is to diminish sensibility, it has been ap- plied to the pharynx and velum palati, in order to prepare such parts for the taking of impressions for artificial palates, and to overcome extreme susceptibility of the mucous mem- brane of the roof of the mouth in first wearing artificial den- tures. For such purposes the agent is administered in one- half drachm doses 3 times daily for two or three weeks previously ; or doses of grs. xx to xxx may be given, repeated two or three times. DENTAL FORMULA. For Infantile Diarrhcea from Reflex Nervous Impress io?is. Dr. Jas. W. White. R . Potassi bromidi gr. xviij to ^ ss Potassi nitratis gr. vj. Sacchari lactis 3 ss. M. Ft. pulv. vj. S. — One powder every 3 or 4 hours to a child one year of age. CHLORATE OF POTASSIUM. 443 POTASSII CHLORAS— CHLORATE OF POTASSIUM. FovDuila. — KCLO3. Derivation. — Chlorate of Potassium is obtained by passing an excess of chlorine through a solution of carbonate of potassa and slaked lime ; the chlorine being converted into chloric acid by the hydrogen of the lime and the acid com- bining with the potassa, forming chlorate of potassium. It is in the form of colorless or white crystals, of a pearly lustre, altogether soluble in distilled water, and in twelve parts of cold and two parts of boiling water. It is inodorous, with a cool, saline taste, and when applied to animal fluids does not decompose them nor undergo any change, although perfectly soluble in such fluids. It is absorbed by the blood, and is eliminated by the kidneys. Medical Properties and Action. — Chlorate of Potassium is detergent, refrigerant, diuretic and stimulant, and its action as a refrigerant and diuretic is similar to that of nitrate of potassa. It improves the appetite, and on account of the large quantity of oxygen it contains has been employed in contaminated con- ditions of the blood as an oxidizing agent. Although it may be administered with impunity in very large doses, yet exces- sive quantities have given rise to gastro-enteric inflammation, with fatal effects. Therape7itic Uses. — Chlorate of potassium is employed in continued and typhoid fevers, neuralgia, croup, diphtheria, sore throat, chronic bronchitis, phthisis, scrofula, erysipelas, scurvy, mercurial salivation, etc., etc. Externally, it is em- ployed in the treatment of ozaena, sore throat of scarlatina, pharyngitis, cancerous sores, ulcerated surfaces, fetid and scrofulous ulcers, etc., etc. Poisonous symptoms have re- sulted from the habitual use of chlorate of potassium, and several cases of death have been recorded. Dose. — Of chlorate of potassium, gr. v to .'»)j, every three or four hours; for children, gr. iij in sweetened water every four hours for a child three years of age ; gr. v for one of eight or nine years, with due attention to the bowels and constitution, 444 DENTAL MEDICINE. regulating the former and supporting the latter. In the case of teething children, gr. ij may be administered to a child of one year of age. Troches of Clilorate of Potasshun are prepared by a combi- nation of chlorate of potassium, ov; sugar, oxviij; tragacanth, 5ij ; vanilla, gr. xxx ; mixed together with water into a mass and divided into 480 troches, each of which contains gr. v. of chlorate of potassium ; useful for sore throat, etc. Dental Uses. — Chlorate of potassium is a valuable agent in dental practice as an internal and external resolvent and detergent remedy in the various forms of stomatis, — inflam- mation of the gums, aphthae and other ulcerative affections, gangrenous stomatitis, mercurial stomatitis, erysipelatous in- flammation of the mouth, scurvy, ulcers of the gums, cheeks and tongue, abraded surfaces of mucous membrane, second- ary syphilitic ulcerations of the mouth, indolent and scrofu- lous ulcers, etc., for such purposes being used alone in the form of mouth-washes or gargles, or in combination with tan- nic acid, alum, borax, glycerine, etc. In the treatment of mercurial stomatitis, great benefit is derived from both its internal and external use. For the inflamed gums of teething children it is employed as a lotion, with beneficial efifects. In the form of powder it is a useful application to ulcerated and abraded surfaces. A simple gargle or mouth-wash may be made by dissolving one drachm of chlorate of potassium in four ounces of water, or half an ounce may be dissolved in a pint of water. DENTAL FORMULiE. For Inflamed Gums After the Extraction For Aphthous and Secondary Syphilitic of Teeth. Ulceration of the Mouth and Fauces. R. Potassii chloratis . . . ^ij R. Potass ii chlorat . . . . ^iv Tincturse kramerise, Aquse destillatse . . . . ^ x. M. Glycerini . . aa . . . f§ss SiGNA. — To be used as an antiseptic Aquae rosae ^ viij. M. moutli wash. SiGNA. — To be used as a gargle 6 or 8 for Ulceration of the Mouth. times daily, to harden the gums. Bartholow. For Ulcers and Suppurating Wounds. R. Potassii chloratis . . . ^] R. Potassii chloratis . . . ^] Acidi carbolici . . . . .^ss Glycerini ^ iss M. Aquse destillatse . . . . ^ iv. M. SiGNA. — To be used as a lotion. Signa. — To be used as a lotion. NITRATE OF POTASSIUM. 445 For Ulceration and Inflammation of the Gums and Mucous Membrane. Stocken. R . Potassii chloratis , Sodii biboratis , . Potasii nitratis . . Aquje deatillatae . . 3»j 3J gviij. M. SiGNA. — To be used as a gargle. For InflammcUion of Gums and Mucous Membrane. For Inflamed Gums and Mouth. R . Potassii chlorat . . . . 3 ij PHiIv. aluminis . . . . ^ij Aquae destillatae . . . . ^x. M. SiGXA. — To be used as a gargle. For Inflamed Mucous Membrane. R . Potassii chlorat .... 5 j Aluminse Sulph . . . . 3J Aquae destillatae . . . . ^ iv. M. SiGN'A. — To be applied as a mouth wash. For Periodontitis. R. Potassii chlorat . . . . ^j Plumbi acetas . . . . 5J Aqusefont t^ij. M. SiGX.A- — To be used as a month wash. For Ulceration of Gums and Mucous Membrane of Mouth. R . Potassii chloras . . . . 3 ij Aquae ^ v. M. SiGXA. — A tablespoonfiil three times a day ; also as a gai^le four or five times a day. POTASSII NITRAS— NITRATE OF POTASSIUM. Stocken. R. Potassii chloratis . • . 3ij Sodii biboratis • • 3J Potassii nitratis . . • • 35s Tinct. amicae . . . • -3': Aquae rosae . . . • . |vij. M. SiGNA. — To be used as a gargle. For Inflamed Gums, Mucous Membrane, etc. R. Potassii chlorat . . • • 3i Sodii biboratis . . • • 3J Aquas destillatae . . • • o'J- M. SiGNA. — To be used as a mouth ■^ •ash 01 gargle. -SALTPETRE-NITRE. Form ula. — K N O , Derivation. — Nitrate of Potassium is obtained in the native state in various portions of the world ; but the variety em- ployed for medicinal purposes is prepared by purifying the native production of India. It can also be artificially made by combining decayed organic animal and vegetable matters, or by the double decomposition of nitrate of sodium and chloride of potassium. The crude nitre is refined by re-solu- tion and crystallization. It is in the form of white, crj'stal- line, six-sided prisms, odorless, with a sharp, saline, cooling and slightly bitter taste, wholly soluble in water, but insolu- ble in alcohol. Medical Properties and Action. — Nitrate of potassium is re- frigerant, sedative, antiseptic, diuretic and diaphoretic. It 446 DENTAL MEDICINE. promotes the secretions, lessens the heat of the body and the frequency; of the pulse. For allaying febrile excitement it is frequently employed in the form of nitrous powders (nitre, gr. x; tartar emetic, gr. y% ; calomel, gr. i^ to ^). In overdoses, nitrate of potassium causes pain and heat in the stomach, vomiting and purging of blood, inflammation of the bowels, great prostration, convulsions, and sometimes death. The antidotes are emetics, mucilaginous and demulcent drinks, and stimulants to sustain the sinking powers of the system. Therapeutic Uses. — Nitrate of potassium is employed inter- nally as a refrigerant in febrile affections ; in inflammatory dis- eases, acute rheumatism, scurvy, purpura, haemoptysis, passive hemorrhages, asthma, etc. In fevers it is frequently combined with other remedies. The vapor is used in spasmodic asthma. Dose. — Of nitrate of potassium, gr. ij to gr. x. Dental Uses. — In dental practice, nitrate of potassium has been recommended in the incipient stages of alveolar abscess being introduced into the pulp canal and secured by a tempo- rary filling in the crown cavity of the tooth. It is also em- ployed in inflammatory conditions of the mucous membrane of the mouth and throat in the form of gargles. DENTAL FORMULA. For hifiammation of the Mouth and For Inflamed Mucous Memhrane and Throat. Gums. T iiTT - • 3 ij R. Potassii nitratis . . . gijto ^iv Sodii biboratis . . . 3J Aquffidestillatse . . . Oj. M. Aquse destillatae . . . gviij. M. SiGNA. — To be used as a gargle. SiGNA.— To be used as an antiseptic and refrigerant mouth wash. POTASSII PERMANGANAS— PERMANGANATE OF POTASSIUM. Formula. — KgMngOg. Derivation. — Permanganate of potassium is obtained by the mixture of equal parts of black oxide of manganese and chlorate of potassium, with a slight excess of caustic potassa, dissolving in water, and evaporating to dryness, when it is PERMANGANATE OF POTASSIUM. 447 exposed to a nearly red heat; the chlorate of potassium yields oxygen, which changes the black oxide of manganese into permanganic acid, and this acid, combining with the potassa, gives as a product the permanganate of potassium. It is in the form of dark purple, slender, prismatic crystals, inodorous, very soluble in water, forming a solution of a beautiful lilac color, even in very minute proportion, and with a sweet, astrin- gent taste. Medical Properties and Action. — Permanganate of potassium, when taken internally, is supposed to oxidize the blood. It is a stimulant, mild escharotic, and is a powerful disinfectant, as it has a remarkable power of destroying fetid odors from organic sources, and proves useful in preventing the spread of infectious disease. It yields up its oxygen readily, in the form of ozone, and its use depends upon this property. It is in- stantly decomposed on reaching the stomach. Therapeutic Uses. — Permanganate of potassium is employed with advantage in dyspepsia, flatulence, excessive deposition of fat, uric acid diathesis, acute rheumatism, diabetes, scarla- tina, petechial fever, spinal meningitis. Condy's Fluid is a favorite preparation with some, for both internal and external use. The most important uses for permanganate of potassium are externally, as a deodorizer and disinfectant, to correct the fetor of cancer, abscesses, ulcers, caries of bone, ozaena, otor- rhoea, gonorrhoea, leucorrhoea, ulcerated sore throat, etc., in the form of injections, lotions and spray. It is also used externally in the treatment of diphtheria, in the proportion of a drachm of Condy's Fluid to the ounce of water. In solution, permanganate of potassium is applied m varying strength, according to the effect desired. As a local stimulant, as well as deodorizer, it is useful in chronic and indolent ulcers, car- buncles, hospital gangrene, etc. The powder may be sprinkled on gangrenous surfaces. In concentrated solution permanga- nate of pota.ssium acts as a caustic. A strong solution is composed of lo parts dissolved in 90 parts of water, and is employed in its full strength in cancerous, phagedenic and atomic ulcers. For dressing simple wounds, or as an injection 448 DENTAL MEDICINE. in abscesses, oz^na, leucorrhoea, etc., half a fluid ounce of the solution may be added to a pint of water ; in gangrenous and dipththeritic wounds and scrofulous ulcers, a fluid ounce of the solution to a pint of water. Dose. — Of permanganate of potassium for internal use, gr. y^ to gr. j, three times a day. Cond/s Fluid is composed of 32 grains of permanganate of potassium in one pint of dis- tilled water ; half a fluid ounce contains one grain. Dose of Condy's Fluid, TTLv. For external application, foj, to water, fov to X. Solution of permanganate of potassium — Liquor Potassii Permanganatis , is composed of 64 grains of perman- ganate of potassium to one pint of distilled water. M. de Lacerda has recently discovered that permanganate of potas- sium is one of the most energetic antidotes to the venom of snakes. Dental Uses. — In dental practice the permanganate of po- tassium is employed in the treatment of fetid and gangrenous ulcerations of the mouth, such as cancrum oris, foul abscesses, ulcerations of mucous membrane attended with fetid discharges, offensive breath; as an antiseptic for decomposing pulps of teeth (grs. ij to water Sj) ; in diseases of the antrum, such as abscess, and caries and necrosis of the maxillary bones, Riggs' disease, ulcers of the mouth, pyorrhoea alveolaris, etc. (grs. x to water oj). The powdered crystals introduced into a carious cavity will relieve odontalgia. The stains of permanganate of potassium can be removed by dilute hydrochloric acid. DENTAL FORMULA. For Unhealthy Ulcers of the Mouth, avd For Fetid Perspiration and Foul Breath. Offensive Breath. j^ _ Potassii permanganatis . gr. j J. W. White. Aquae destillatse . . . f,^j. M. R . Potas. permanganatis . Qj to iv SiGNA. — To be used as a lotion and Aquas destillatse . . Oj. M. gargle. SiGNA. — To be used as a gargle. For Gangrenous Ulceration of the Mouth ^or a Disinfectant in Mercurial Saliva- — Cancrum Oris. tion. R . Potassii permanganatis . gr. xxx R • Potassii permanganatis gr. xv Aqua destiUatffi . . . ^j. M. Aqu^ destillatse . . . f gviij. M. SiGNA. — Apply as a lotion. SiGNA. — Use as a gargle PYOKTANIN. 449 For Ulcers, Abscesses, Decomposing Pulps of Teeth, etc. R. Liquoris potassii permanganatis ^j Aquj^ destillatae § vj to x. M. Sigma. — To be used as a gargle or as an injection. PRUNUS VIRGINIANA— WILD CHERRY. Source. — Prunus Virginiana is obtained from the bark of the Prunus Serotina, and is composed of amygdalin an emul- sion, from which, by their reaction, tannic, galHc and hydro- cyanic acids are produced. The preparations of wild cherry are: Infusiim Pnini VirginiancB — Infusion of wild cherry; Ex- tractum Pruni Virginiatice Fluidum — Fluid extract of wild cherry; Syrupiis Pruni VirginiancE — Syrup of wild cherry. Medical Properties and Therapeutic Uses. — Wild cherry is an aromatic bitter stomachic, tonic and expectorant. It is em- ployed as a stomachic, tonic and in catarrhal conditions of the bronchial mucous membrane, phthisis, etc. The syrup forms one of the ingredients of many cough mixtures. Dose. — Of tincture of wild cherry, 5ss to 5ij; fluid extract, 5ss to 5ij ; infusion, 5ss to 5j. PYOKTANIN— METHYL- VIOLET. Derivation. — Pyoktanin is only a name applied to the well known aniline color methyl-violet, an aniline dye, which is in the form of a paste and in crystals. It is without color, but slightly irritant, and non-intoxicating. It has been employed in the form of powder, solution and pencil. The powder is made by mixing 2 parts of pyoktanin or methyl-violet with lOO parts of talc or other inert substance. The solution is of any strength from i part in lOOto i in 20CX). Pyoktanin is also used in the form of ointment containing from 2 to 10 per cent. There is also another aniline color — the yellow — to which the same name has been given ; but the violet is the stronger. Medical Properties afid Therapeutic Uses. — Pyoktanin is con- sidered by many to be an efficient germicide. According to Fessler, the micro-organisms of pus are destroyed by it in fif- teen minutes when the solution is of the strength of i to looo. 29 450 DENTAL MEDICINE. This action is, however, denied by Troje, who considers pyok- tanin to be 'less powerful than bichloride of mercury, or even carbolic acid. It does not coagulate albumen, and when applied to the eye causes dilatation of the pupil without paralysis of accommodation. Pyoktanin is employed topically to disinfect suppurating or ulcerated wounds, to stimulate chronic ulcers. As an application to open buboes, boils, carbuncles, chancroids, etc.; also in the form of weak solution in gonorrhoea, and chronic cystitis. And as a dusting powder in moist eczema, and also in other affections of the eye, the ear, nose and throat. It has no odor, and in this respect is preferable to iodoform, but it stains the skin ; the discoloration may be removed by cologne water, alcohol, dilute hydrochloric or nitric acids. Dental Uses. — Pyoktanin is employed in dental practice in all cases where ordinary antiseptics are indicated, as in gan- grenous pulps, root-canals, disinfecting cavities before filling, alveolar abscess, etc. PYRETHRUM— PELLITORY. Source — Pyrethrum is a native of the Mediterranean coast, and the root is the medicinal portion — pyrethri radix, in the form of cylindrical, wrinkled pieces, of the size of the little finger, hard and brittle, which, when dried, has little or no odor. Externally, it is of an ash-brown color, within white, and pos- sesses an extremely acrid taste, with a burning and tingling sensation over the whole mouth and throat, which continues for some time, and excites a copious flow of saliva. Medical Properties and Action — Pyrethrum root is an irritant and sialagogue, and when it is rubbed on the skin it causes much irritation, and may even excite inflammation. Its activity depends upon an acrid oil and a compound resin called pyrethrin. It is rarely used internally, and only as a masticatory. Therapeutic Uses. — Pyrethrum has been employed as an excitant in paralysis of the tongue and muscles of the throat, relaxed sore throat, spontaneous salivation, certain forms of WHITE OAK BARK. 451 headache; for such purposes being chewed, or employed in the form of a gargle, in tincture or decoction. Dose. — Of pyrethrum as a masticatory, gr. xv to 5j. Tinc- tura Pyrctliri, Tincture Pyrethrum, is composed of py- rethrum Siv, rectified spirit Oj. Dental Uses. — Pyrethrum is employed in dental practice for neuralgic affections of the face, for which it is chewed ; for the relief of odontalgia, in the form of the tincture applied to the irritable pulp on a pellet of cotton ; as a stimulant to the gums and mucous membrane of the mouth in relaxed conditions ; for obtunding sensitive dentine, in the form of a strong alco- holic extract. The ethereal oil of pyreilinmi is recommended as a pleasant and efficacious remedy in odontalgia, applied in the same manner as the tincture ; the fluid extract is also employed as an ingredient for local anaesthetic preparations, combined with chloroform, ether and lavender, (See Chlo- roform.) DENTAL FORMULA. For Relaxed Conditions of Mucous Atembrane of Mouth and Gums. R . Tinctura pyrethri f 3 "j Aquae § viij. M, SiGNA. — To be used as a stimulant gargle. QUERCUS ALBA— WHITE OAK. Source. — White oak, the dried inner bark of which is the medicinal portion, is a common tree of the natural order Amentacecc. The bark has a light-brown color, fibrous texture and an astringent, bitter taste. Its medicinal virtues depend upon the presence of tannic and gallic acids, and a bitter principle known as quercin. Water and alcohol form with it decotions and tinctures. Medical Properties and Action. — White oak bark is tonic, astringent and antipcriodic. It is principally used as an external application. Therapeutic Uses. — White oak bark is employed internally in the treatment of diarrhoea, dysentery and hemorrhoids. Externally in relaxation of the uvula, tonsils, etc. ; gangrene, indolent ulcers, leucorrhoea, atonic menorrhagia, fissure of the 452 DENTAL MEDICINE. anus, etc., etc., in the form of tincture, decoction, gargles, lotions and injections. Decoction of White Oak Bark, Decoctum Quercus Albce, is composed of oak bark, Sj ; water, Oj. Dose. — Of powdered white oak bark, gr. xxx to gr. xl. Of the decoction the dose is fSss to f §j. Dental Uses. — In dental practice the decoction and tincture are employed externally in the various forms of stomatitis, sponginess of the gums, and relaxed condition of the mucous membrane of the mouth and fauces. QUILLAYA SAPONARIA— QUILLAIA BARK. SOUTH AMERICAN SOAP TREE BARK. Source — Quillaia Bark is obtained from an evergreen tree of the natural order Rosace (B — rose order, growing in Chili and Peru, the inner bark being employed. Medical Properties and Action. Quillaia bark, when bruised and macerated in water, imparts to that liquid the property of frothing like soap solution when agitated, which is owing to the saponaria in the bark, the same principle which imparts a similar property to soapwort — saponaria officinalis. Quillaia contains no tannic acid or other bitter principle, and is an article of commerce, being imported in large quantities for cleansing grease from cloth, as it does not change the color of silken or woolen goods ; it is also used for cleansing the hair, which it is supposed to preserve and beautify. When the powder is snuffed up the nostrils, it causes sneezing and a profuse nasal discharge. Therapeutic Uses. — Quillaia bark has been employed as a febrifuge, to arrest excessive secretion, as an application to ulcers, as a remedy for colds in the head, when it is used as a sternutatory, in the form of powder. The tincture is composed of quillaia bark i part ; alcohol 5 parts ; it is also used in the form of infusion and fluid extract. Dental Uses — Quillaia bark, in the form of powder, tincture and fluid extract, is employed as an ingredient of mouth- washes, for its frothy and detergent properties ; it is also used SULPHATE OF QUININE. 453 as an application to chronic ulcers of the mouth, and to ar- rest excessive secretion of the mucous membrane of the mouth. DENTAL FORMULAE. Detergent Mouth Wash. For a Mouth Wash. Am. Journ. Pharm. R . Pulv. quillaiae sapona- R Pulv. potassii bicar- "se | iv bonatis 3 ss Glycerini 5 iij Mellis 5iv Alcoholis dilutus suf- Alcoholis 5 ij ficient for 2 pints. Olei caryophylli . . . q.s. Olei gaultheriie . , . gtt.xx. Olei gaultherise, Olei menthje .... gtt.xx. M. Quillaise saponariM ^ Macerate the soap bark in the rnix- (nuid ext.) . . aa . . 5J ture of glycerine and alcohol for three Aquae destillatje . . . 5ix. M. ^^^^^ ^nd filter through a little mag- To be used after the removal of sali- nesia previously tritiu-ated with the vol- vary calculus. atile oils. For Inflamed Gums and Mucous Membrane. Chapin a. Harris. R . Quillaia; saponarioe 5 viij PjTethri, Radicis iridis, Acidi beruoici, Cinnamom aa 5J Acidi tannici ^ iv Sodii boratis 'J^iv Olei gaultheriae f 5 ij Olei menthae f 3 iv Cochineal ^ iij Sacchari albi Ibj Alcoholis Oiij Aqua purse 0\\ M. Digest for six days and filter. Signa. — To be used as a gargle or mouth wash. QUININ/E SULPHAS— SULPHATE OF QUININE. Formula.— Z^^^fi^, 3H2O. Derivation. — The two important alkaloid principles of cin- chona are qninia and cincJionia, which exists in combination with kinic acid. (See Cinchona.) Sulphate of Quinine is obtained by boiling the powdered yellow cinchona bark in water acidulated with hydrochloric 454 DENTAL MEDICINE. acid, by which the alkaloid quinine is separated from kinic and other acids, and forms a soluble hydrochlprate or muri- ate, the salt being decomposed and the quinine precipitated by the addition of lime ; sulphuric acid is added, after diges- tion in boiling alcohol, which dissolves the quinine, and the solution is boiled with animal charcoal, filtered and allowed to crystallize. Sulphate of quinine is in the form of color- less, very light and silky crystals, which are readily soluble in alcohol and in water acidulated with sulphuric acid, but in- soluble in ether. It has an intensely bitter taste, and is in- odorous. Medical Properties and Actio?i. — Sulphate of quinine is a very valuable tonic and antiperiodic, also antiseptic and stimulant. In small doses it increases the fullness of the pulse and action of the heart, and improves the tonicity of the cap- illary vessels, and is diffused into various parts of the sys- tem with great rapidity. In large doses it depresses the ac- tion of the heart, lowers the blood pressure, and enfeebles as well as diminishes the beats of the pulse. As it accumulates in the brain, it causes a fullness in the head, a constricted feeling about the forehead, a buzzing or ringing in the ears — tinnitus mirium, giddiness, vertigo and deafness, which may be permanent if the agent is taken in excessive quantity ; also amaurosis and amblyopia may be caused by full doses. Poisonous doses cause intense headache, dilated pupils, de- lirium, coma and convulsions. Some five hours are required to bring about the greatest effect of quinine, although it can be detected in the urine in about half an hour after it is taken into the stomach, and elimination, chiefly by the kidneys, is not completed in a less time than 48 hours, although the principal portion is excreted in 12 hours. Therapeutic Uses. — Quinine is extensively employed in periodical diseases of a malarial origin, such as intermittent fever, neuralgia of various forms, as enteralgia, hepatalgia, nephralgia, gastralgia, sciatica, angina pectoris, and in cases of debility, pneumonia, pleurisy, endocarditis, pyaemia, erysipe- las, puerperal fever, cerebro-spinal meningitis, eruptive fevers, HYPOPHOSPHITE OF QUININE. 455 etc., etc., but the most important use of quinia is for the treatment of malarial diseases. Dose. — Of sulphate of quinine, gr. j to 3j, in aromatic water, by the aid of aromatic sulphuric acid, and also as an enema, or hypodermically. Pills may be made by combining 24 grains of sulphate of quinine with 14 grains of clarified honey, and dividing into 24 pills. Pills can also be made with glycerine. Dental Uses. — Sulphate of quinine is internally employed in dental practice in reducing inflammation of the peridental membrane when resorted to in the early stages of the disease, and before effusion of inflammatory products, cell-proliferation and escape of the white blood corpuscles have occurred ; also in hypersensitiveness of dentine — three or four grain doses every four hours until thirty grains have been taken (Klump). The treatment of facial and other neuralgic affections, espe- cially when of malarial origin, in cancrum oris, for its tonic and stimulant effects, in aphthous ulcerations of the mouth and in scurvy, where the system is much debilitated, and externally as an ingredient of dentifrices, for its tonic and stimulating properties. QUININE HYPOPHOSPHIS HYPOPHOSPHITE OF QUININE. Derivation. — Hypophosphite of Quinine is obtained by dis- solving quinine with hypophosphorous acid, or by decompos- ing sulphate of quinine with hypophosphite of baryta, filtering and evaporating the solution. Medical Properties a7id Action. — Same as those of sulphate of quinine, but not so powerful in its action. Therapeutic Uses. — Hypophosphite of quinine is used in all cases where hypophosphites are indicated, and its action is milder, on account of its containing less acid. It is employed as an antiperiodic, and is especially adapted for the treatment of children during the period of dentition when it is accom- panied with emaciation, loss of appetite and strength, and when convulsions are threatened. 456 DENTAL MEDICINE. Dose. — Of hypophosphite of quinine, gr. j to gr. iij. DENTAL FORMULA. For Facial Neuralgia from Dental For Neuralgia from Dental Disturb- Disturbance. ance. Barrett ^* ^^ ■*-"■ Gorgas. R . Quininse sulphatis . . gr.x Ferri sulphat. exsic . . gr.v Acidi arseniosi . . . gr.ss Ext. nucis vomicse . gr.v. M. Ft. pil. No. XX. SiGNA. — One pill every four hours. R . Ferri at quin (cit) . . ^ ij Syrup aurantii ■ . • ^ j Aqua dest f^'] Elixir calisayse . . ^ij M. SiGNA. — Coch. parv. ter in die. For Neuralgia Associated with por Acute Periodontitis, ^'^'^^i'^- R. Quinina; sulph . . . ^ss Garretson. Acidi sulph. aromat. . gij Bt . Tinct. ferri chloridi . . § j Elix. calisaya bark . . 3 xiv. M. Quininse sulphatis . . . ^j M. SiGNA. — A teaspoonful every two or Signa. — Teaspoonful four times daily. three hours. RESORCIN. Derivation. — Resorcin is a chemical compound of the phenol group and aromatic series, to which carbolic acid belongs. It is obtained from certain resins by the action of fusing alkalies, and is of the form of tabular, prismatic, shining crystals some- what sweetish to the taste, followed by a slight pungency. Resorcin is very soluble in water, 95 parts in 100, and to a less degree in alcohol, ether, glycerine and vaseline ; chloro- form and carbon sulphide will not dissolve it. It darkens on exposure to the air, and is phosphorescent when rubbed in the dark. Its odor is somewhat similar to that of phenol, but not so strong. Medical Properties and Uses. — Resorcin acts somewhat simi- lar to quinine, although it differs from the latter in its lethal effects. Quinine, carbolic acid and salicylic acid promote its effects ; atropine antagonizes it. Through its action on the nervous system, it greatly increases in frequency the respira- tion, which becomes convulsive and spasmodic, and afterward weak but rapid. It also increases the action of the heart, causes the pulse to become weak and irregular. It is eliminated by the urine quite rapidly. It has no irritating action on mucous membranes. RESORCIN. 457 Therapeutic Uses. — Resorcin, on account of its less irritating property is considered preferable to carbolic acid for internal use and subcutaneous injection. It is employed internally in catarrh of the stomach, ulceration, gastralgia, fermentative in- digestion, fevers, for its antiseptic and antipyretic actions, and ulcerative endocarditis, etc., etc. Locally on account of its antiseptic properties, in diphtheria, in syphilitic and other sloughing sores, and anthrax, in the form of crystals or powder, and in the form of spray in catarrhal and ulcerating affections of the nose and throat ; in solution, on account of its antiseptic action, it is used for dressing putrid and atonic wounds, and is combined with water, glycerine and alcohol ; it is also used in pomades. A compound composed of resorcin and salicylic acid heated together, is known as "Salicyl Resorcin-Ketone," and is anti- septic to a degree, as it limits the development of, rather than destroys, septic germs. It is soluble in glycerin and alcohol, and is neither poisonous nor disagreeable to the taste. Dose. — Of resorcin, gr. v-xv. Five grains every two hours in an ordinary case. Dental Uses. — Resorcin is a valuable antiseptic in dental practice, and may be applied with advantage in all cases where antiseptics are indicated. A ten per cent, solution of resorcin is recommended in cases of chronic alveolar pyorrhoea (after cleansing the pockets with peroxide of hydrogen) where there is impaired circulation of the tissues. (See Antiseptic Uses of Carbolic Acid.) DENTAL FORMULAE. For Alveolar Pyorrhma. Dr. a. W. Harlan. For Alveolar Pyorrhoea. Dr. a. W. Harlan. R. Resorcin gij Acidi carbolici . . • ,^j Glycerini ^^ iij Aquae , q.s .... ^viij. M. SiGNA. — Use as mouth-wash after re- moving all deposits, and the adjacent carious or necrosed bone. A few drops of oil of peppermint or any other desirable oil may be added to the above. R. Resorcin . . Acidi tannici Olei cassia . Glycerini Aquffi dest . gr. XXX gr. V SiGNA. — Inject with a syringe into the remains of the pockets in the after treatment. 458 DENTAL MEDICINE. For Mucous Patches of the Mouth. Dr. a. W. Harlan. R . Resorcin gr. xl Aquae dest ^ ss. M. SiGNA. — Dry surface and paint with above. RHEUM— RHUBARB. Source. — The root of Rheum officinale. It contains two acids> rheo-tannic and rheumic, a resin, phcEoretin and an acid, chryso- phan or chrysophani. Medical Properties and Therapeutic Uses. — Rhubarb possesses tonic and astringent as well as purgative properties. In small doses, as a tonic, it promotes the appetite and digestive power, and by virtue of the tannic acid it contains, is astringent. The purgative principle it possesses enables sufficient doses of rhubarb to act as a cathartic, producing stools which are of a yellowish brown color, and soft but not watery. It has no ten- dency to cause gastro-enteric inflammation. It is now classed among the cholagogues, as it increases the flow of bile and the intestinal secretions, which is due to phseoretin — rhubarb resin. Its coloring matter not only stains the stools, but also the perspiration, milk of nursing women, to which it gives a bitter taste and purgative principles, and the urine. It is em- ployed with benefit in diarrhoea caused by the accumulation of undigested food in the intestines, hemorrhoids accompanied by constipation, dyspepsia with deficient biliary and intestinal secretions, the summer diarrhoea of children in the form of the aromatic syrup and in catarrh of biliary ducts with jaundice ; and the chewing of rhubarb-root is beneficial in habitual con- stipation; its frequent use, however, is objectionable on account of the astringent after-effect, which in the rhubarb pill is remedied by the soap. Dose. — Of Extractum Rhei — Extract of Rhubarb, grs. x to grs. XV. Of Extractu7n Rhei Fluidum — Fluid extract of rhu- barb, 5ss to 5ij. Of PilulcB Rhei — Rhubarb pills, each pill con- sists of grs. iij of rhubarb and gr. j of soap. Of Pilules Rhei Composites — Compound pills of rhubarb, consisting of rhubarb, PHEXYLIC ETHER OF SALICYLIC ACID. 459 aloes and myrrh. Dose, 2 to four pills. Of Syrupus Rliei — Syrup of rhubarb, 5ss to 5ij- Of Tinctiira Rhei Aromaticus — Aromatic tincture of rhubarb, 5ss to 5ij. Of Tinctura Rhei Dulcis — Sweet tincture of rhubarb, oss to §ij. Of Vimivi Rhei — Wine of rhubarb, 3j to oss. Oi Piilvis Rhei Compositiis — Compound powder of rhubarb, a teaspoonful. RHIGOLENE. Derivation. — Rhigolene is a product of the distillation of petroleum. In its composition it is a hydrocarbon, and is destitute of oxygen, being extremely volatile and inflammable, and is the lightest of all liquids, with a specific gravity of 0.625. It is a petroleum naphtha, and boils at 70° F., and when perfectly pure should be almost odorless ; but it is difficult to procure any specimen that does not have the un- pleasant odor of petroleum. It is colorless, and on account of its great volatility and inflammability requires to be kept tightly stoppered, in a cool place. The storage of large quanti- ties, except in very secure places, is attended with considerable risk, and on this account it is somewhat difficult to procure it outside of the manufactories. It is dangerous to use it at night, or near a light. Dental Uses. — Rhigolene is employed, like absolute ether, to produce local anaesthesia, by dispersing it in the form of spray, with the spray apparatus, being the most rapid in its congealing effects, and also the most easily controlled and con- venient of all of the freezing mixtures. As a local anaesthetic it is employed in the operation of extracting teeth, by apply- ing it, in the form of spray, to the parts about the tooth to be removed until a blanched surface of gum is produced. The spray of rhigolene is also applied to the gum over the root of a tooth affected with incipient periodontitis. SALOL— PHENYLIC ETHER OF SALICYLIC ACID. Derivation. — Salol is obtained by the combination of salicylic acid and phenol, consisting of 60 parts of weight of salicylic acid and forty parts of phenol. It is a white, crystalline powder, 460 DENTAL MEDICINE. insoluble in water, without odor and nearly tasteless. In the system it becomes decomposed, yielding salicylic and carbolic acids in nascent forms. Medical Properties and Therapeutic Uses. — Salol is antiseptic, germicide and antipyretic, and possesses less poisonous proper- ties than either salicylic acid or carbolic acid alone ; large doses of salol, however, cannot be administered without danger of phenol poisoning. It is accumulative, owing to its being absorbed and eliminated slowly, and hence cannot be given too frequently. In acute and chronic renal diseases, salol is contra-indicated. It is employed internally in disorders of stomach, acute gastro- enteritis, tonsillitis, gonorrhoea, skin diseases, gleet, etc. Ex- ternally used, salol is an excellent dressing for wounds, ulcers, burns, erysipelas and skin diseases. Camphorated salol is highly recommended by Cuirllier in the treatment of otitis. It can be mixed with iodoform or iodol, and the action of both be had simultaneously. Dose. — Gr. v to 5j. For Erythema. Dr. a. Eichler. R. Saloli 3ij Zinci oxidi ,• • ■ Pulv. amyli aa 3 iv Lanoline . . . 5J. M. SANDARACA— SANDARACH. Source. — Sandarach is a resinous substance obtained from an evergreen tree — Thuya Articulata — which grows in the northern part of Africa. The gum is in the form of small, irregular, round and oblong tears, of a pale yellow color, some- times brown, and more or less transparent, dry and brittle. It has a faint, agreeable odor, which is increased by warmth, and a resinous, somewhat acrid taste. It melts with heat, diffusing a strong balsam odor, and is inflammable. It is soluble in alcohol and ether, and slowly dissolves in warm oil of turpen- tine. It consists of three resins, varying in their relations to alcohol, ether and oil of turpentine. The sandaracin which SERPENTARIA. 461 remains after sandarach has been exposed to the action of ordinar}^ alcohol is a mixture of two of these resins. Uses. — Sandarach was formerly employed as a medicinal agent, and entered into the composition of various ointments and plasters, but its use is now restricted to such purposes as the composition of a varnish, ingredient of incense, etc. After the erasion of ink marks, its powder, if rubbed on such a sur- face, will prevent fresh ink marks from spreading. Dental Uses. — In dental practice, sandarach, dissolved in alcohol forms a varnish for coating the surface of plaster models, etc. ; it is also used for checking secretions from the gums during the operation of filling teeth, either applied as a coating to the surface, or on bibulous paper saturated with it. It is also employed to saturate cotton to be used as a tempo- rary filling in cavities of the teeth, for the protection of medi- cinal applications. DENTAL FORMULA. Transparent Sandarach Varnish, R . Gum sandarach ^ v. Alcohol qt.j. Mix and digest over a moderate heat until the sandarach is dissolved. SERPENTARIA— VIRGINIA SNAKEROOT. Source. — Serpentaria is prepared from the rhizoma and rootlets of the Aristolochia serpentaria and of the Aristolocliia reticulata, and is composed of a volatile oil, resin and bitter principle. Its preparations are : Infusum Serpentaria — Infu- sion of Serpentaria ; Tinctura SerpentaricE — Tincture of Ser- pentaria ; Extractum Serpentaricz Fluidum — Fluid extract of serpentaria. Medical Properties and Therapeutic Uses. — Serpentaria is a bitter, aromatic, stimulating tonic, employed in typhoid and typho-malarial fevers, and as a stimulant expectorant in capil- lary bronchitis ; also combined with the carbonate of ammo- nia in a low form of pneumonia, chlorosis, anaemia and diph- theria. Large doses cause diarrhoea, nausea, vertigo and headache. 462 DENTAL MEDICINE. Dose. — Of Infusion, oSS to Sj ; Tincture, 5ss to 5ij ; Fluid extract, 5ss to 5ij. SHELL-LAC— SHELLAC. Source. — Lac is a resinous substance, obtained from several varieties of trees which grow in the East Indies, and particu- larly from the Croton Lacciferum, and two species of the Ficiis. It is supposed to be an exudation from the bark, owing to the puncture of an insect belonging to the genus Coccus ; it is also said to be the exudation from the bodies of the insects them- selves. Several varieties are known in commerce, the most common being the stick-lac, the seed-lac and the shell-lac. Lac, in its crude state, consists of resin, coloring matter, and a peculiar principle, insoluble in water, alcohol or ether, and known as lacin, a little wax, and various saline matters in small proportion. Uses. — It is slightly astringent, and has been recommended as an adhesive substance for dressing ulcers, wounds, etc., being used by simply spreading it on the bandages after it is dissolved in alcohol by a gentle heat. Shellac is prepared by melting the crude lac, straining it, and pouring it upon a flat, smooth surface to harden. It is in the form of thin frag- ments of various sizes, from half a line to a line in thickness, and of a light and also a dark brown color, shining, hard, brit- tle and inodorous. It is insoluble in water, but freely soluble in alcohol, especially with the aid of heat. It is employed as a varnish. In dental practice its uses are the same as those of sandarach, but owing to the dark brown color of the solution, it is not so sightly, and does not make a transparent varnish. DENTAL FORMULA. For a Colored Varnish. For an Aqueous Varnish. U . Gum shellac ^ v R . Pulv. shellac .... partes j Alcohol qt.j. Sat. solut. boracis . . partes ij Mix and digest over a moderate heat Mix by shaking together ; it will give until thoroughly dissolved. a starch gloss. Shellac may be dissolved, without the aid of alcohol, by a saturated solution of borax in water. This, however, does not PHENATE OF SODIUM. 463 give a very strong solution. To prevent cracking when the shellac is dissolved in alcohol, add a little castor oil ; if in water, add glycerine. Clear shellac varnish may be prepared by first making an alcoholic solution of shellac in the usual way, and then adding a little benzole, and the mixture well shaken. In from 24 to 48 hours the fluid will have separated into two distinct layers, an upper alcoholic stratum, perfectly clear, and of a dark-red color, while under it is a turbid mixture con- taining the impurities. The clear solution is drawn off with a pipe, or may be decanted. SOD^ PHENAS— PHENATE OF SODIUM. CARBOLATE OF SODIUM — PHENOL SODIQUE. Formula. — NaCgHjO. Derivation. — Phenate or Carbolate of Soda is obtained by mixing caustic soda with carbolic acid and a small quantity of water, and evaporating the solution, the result being a saponaceous mass of acicular crystals of a light pinkish color, which are converted by the heat into a fluid of an oily consistence. It is freely soluble in creasote, carbolic acid and water. Medical Properties and Actiojt, — Phenate of soda is haemo- static, antiseptic and disinfectant. Therapeutic Uses. — It is internally administered in the form known by the PVench name of Phenol Sodique, in doses of gtt. viij or gtt. X in a glass of water, in typhus and typhoid fevers, as a preventive of cholera, in plagues, cholera infantum, etc. ; externally, it is a valuable styptic in local hemorrhage, and as a dressing for wounds, burns, chilblains, excoriations, vari- cose veins, venomous stings and bites, and as a disinfectant in throat affections, leucorrhoea, diphtheria, scarlatina, small- pox, ozaena, etc. Dental Uses. — Phenate of soda is useful in dental practice, as an astringent and styptic in hemorrhage following the ex- traction of teeth, and to relieve the soreness of such an opera- tion, as it promotes the rapid absorption of the extra vasated blood, and the healing and hardening of the gums. It is ap- 464 DENTAL MEDICINE. plied on a pellet of cotton, or in solution with water, and acts as a sedative and antiphlogistic as well as a haemostatic, and has little or no escharotic action. For soft and spongy gums it forms an efficient gargle or mouth-wash, and can be em- ployed for this purpose in its full strength, in- the form of phenol sodique, or diluted with from one to twelve parts of water. When applied on cotton, to an exposed and inflamed pulp, it relieves odontalgia. It is also employed in aphthous ulcerations of the mouth, and as a disinfectant in offensive breath, in the proportion of a teaspoonful to a glass of water. DENTAL FORMULA. Phenol Sodique. Pure melted carbolic acid 5 parts Solution of caustic soda, specific gravity 1 1332 .... I part Distilled water 5 parts. Mix. A Phenol Sodique Preparation. R . Acidi carbolici gr. clxxxviij Sodse caustic gr. xxxj Aquae ^ iv. M. SiGNA. — To be applied on a pellet of cotton, or, as a mouth wash, di- luted to meet requirements of case. SODII BICARBONAS— BICARBONATE OF SODIUM. SESQUICARBONATE OF SODIUM. Formula. — NaHCOg. Derivation. — Bicarbonate of Sodium is obtained by saturat- ing the carbonate of sodium with carbonic acid. It is in the form of a white, opaque powder, freely soluble in water, with a mild, slightly alkaline taste. Medical Properties and Action. — Bicarbonate of sodium is antacid, alterative, lithontriptic, and from its mildness and non-irritating qualities is more pleasant to the taste and to the stomach than the carbonate. It is extensively used in the preparation of soda and seidlitz powders. Therapeutic Uses. — Bicarbonate of sodium is internally ad- ministered in neuralgia connected with acidity of the stomach, cardialgia, flatulence and vomiting, dyspepsia, diarrhoea, dis- BICARBONATE OF SODIUM. 465 eases of the skin, albuminuria, calculous disease, etc. Ex- ternally in diseases of the skin of a scaly and papular nature, ecthyma, ringworm, and sprinkled over burns and scalds, and combined with an equal part of common salt, for stings of venomous insects. Dose. — Of bicarbonate of sodium, gr. v. to 5j, in carbonic acid water, or with sugar and mucilage. Effervescing Powders. — Piilveris Effervescentes, are com- posed of tartaric acid, gr. xxv, in one paper, and bicarbonate of sodium, gr. xxx, in another paper. De7ital Uses. — Bicarbonate of sodium is employed in dental practice to relieve neuralgia of an acid origin, in which a full dose often proves very serviceable ; in aphthae of children it is often combined with a little rhubarb and proves very effica- cious. Externally it instantly relieves odontalgia when a small portion of the powder is applied to the irritable pulp and properly secured. It is also useful for neutralizing the acidity of the oral fluids, especially when such a condition is the result of pregnancy. It also forms an antacid ingredient in dentifrices. Dr. E. C. Kirk recommends a thick paste of sodium car- bonate as a local sedative and obtundent of hypersensitive dentine, its application to be made to a dry cavity and repeated when necessary. In acute periodontitis, applied to the gums after a slight puncture, it will often afford speedy relief from the pain. As a chemical disinfectant and antiseptic, Dr. Leff- man considers sodium carbonate to be of great value in the treatment of devitalized teeth containing semi-putrescent pulps and food debris, to be followed by injections of warm water. DENTAL FORMULA. For Periodontitis, etc. Carl Seiler. B . .Soflii Vjicarb ^ viij Sodii hibor 5 viij Sodii benzoate Sodii salicylate aa gr.xx Eucalyptol 30 466 DENTAL MEDICINE. Thymol aa gr.x Menthol gr.v Ol. gaultheria gtt.vj Glycerine gviiiss Alcoholis §ij Aquae, q.s , i6 pints. M. SiGNA. — Use as an antiseptic spray. SODII BORAS— BORATE OF SODIUM. BORAX. Formula. — 2NaB02, 2HBO2, 9H2O. Source. — Borax is a native salt, but can be obtained artifi- cially by boiling together native boracic acid (found in Italy), and carbonate of soda. California furnishes the borax used in this country. It is in the form of colorless crystals, which effloresce somewhat in dry air, and are freely soluble in water and glycerine, but insoluble in alcohol, with an alkaline reac- tion, and a sweetish alkaline taste. It dissolves fibrine, alb.u- men, casein and uric acid. Medical Properties a?id Action. — Borax is refrigerant, diuretic, detergent, antacid and emmenagogue, and has been employed as a solvent for calculi. It resembles in its action carbonate of soda, and by its mild alkaline qualities it improves the condi- tion of the skin and mucous membranes. In excessive or large repeated doses it is injurious, causing nausea and vomit- ing, and a scorbutic condition of the body. Therapeutic Uses. — Borax is internally administered in infan- tile diarrhoea, in the form of an enema ; also as a solvent for calculi, and in dropsy, etc., but its chief use is as an external application. Externally it is applied as a detergent in cutane- ous affections, ulcerations, pityriasis, to remove freckles, to allay itching, etc., etc. Dose. — Of borate of sodium, gr. ij to 9j. Glycerite of Borate of Sodium — Glyceritum SodiiB oralis — Glycerinum Boracis — is composed of borax, oij ; glycerine, Oss, and is a useful application to the mouth and throat. Honey of Borate of Sodium — Mel Sodii Boratis — Mel Boracis — is composed of borax, 5j ; clarified honey, 5j, and BORATE OF SODIUM. 467 is also useful as a detergent application to the mouth and throat. Dental Uses. — Borax, mixed with sugar or honey, is a very useful application for aphthae and other ulcerations of the mouth, for which it may be mixed with sugar in the propor- tion of one part to seven, or in the form of incl boracis. In mercurial stomatitis, an aqueous solution of borax, or the mel boracis, forms an efficient gargle. Borax is also a useful appli- cation in fissured or cracked tongue. Borax is also added to sage and balm teas, to form gargles. In the dental laboratory, borax is employed as a flux in melting metals, such as gold and silver, and in the process of soldering metals. It is also employed to harden plaster casts or models, the model being well dried and then immersed for a few minutes in a solution of borax in boiling water, which renders it, when cool, hard and durable. (Solutions of carbon- ate of soda and alum are used for the same purpose.) Dr. J. L. Williams considers borax a valuable application to the teeth of pregnant women to counteract acidity of the fluids of the mouth. He recommends the use of the powder applied to the teeth and allowed to remain half a minute or so, and then brushed off by a whirling motion of the brush, not with a horizontal movement. Also useful to sterilize instruments. DENTAL FORMULA. A Mild Detergent Gargle. For Fissured or Cracked Tongue. K- Sodii biboratis . . . . §j R. Sodii biboratis . . . . ^j Glycerini 5vj. M. Glycerini 5J. M. For Aphthous Ulcerations, Parasitic To be used as a lotion or gargle. Formations, and Diphtheritic Condi- c i- j rj, ^ For Fissured Tongue. ""'^' T W White R . Sodii biboratis . . . . 3 ij J • • Syrupi aurantii . . . ^iv »• Sodii biboratis . . . . gr.xl Aquae destillatse . . . 5iv. M. Glycenni l\ SiGNA.-To be applied as a lotion or Aquoe dest.llatce . . . 5iv. M. mouth wash, stimulant and antiseptic. '^^ ^^ "^^^ ^^ ^ ^'"■^'^■ For Aphthous Ulcerations, etc., etc. ^ Detergent Alkaline Gargle. R. Soi g"". subcutane- ously. Mercury succinimate . . Antisyphilitic Methacetin Antipyretic 3 grs. per os. for child- ren. Methylal Hypnotic and anaesthetic 1 5 to 30 grs. per os. Methylene blue . . . .Analgesic 8 to 15 grs. per os. Methylene chloride . . Narcotic anaesthetic Monobromacetanilide . Analgesic i to 8 grs. per os. Myrtol Antiseptic in phthisis 5 min. per os. Naphthalene Antiseptic 2 to 8 grs. per os. Naphtholic acid . . Antiseptic and antiparasitic .... Naphthol Antiseptic Naphlhol camphoratum Antiseptic antituberculotic .... SuI)cutaneously. Orexin hydrochloride Stomachic ^ grs. per os. Paraldehyde Hypnotic and sedative 15 to 45 min. per os. I'henacetin Antipyretic, antincuralgic 8 to 20 grs. per os. 504 DENTAL MEDICINE. Therapeutic Uses. Dose. Phenylurethan .... Antifebrile, antirheumatic 6 to 8 grs. per os. Piperazide hydrochlo- ride General stimulant Externally. Pyoctanin Antiseptic Pyridine Antiseptic i to i j^ drs. by inhala- tion. Pyrodin ....... See acetylphenylhydrazine .... Resorcin Antiseptic antifermentative .... Rubidium ammonium bromide Antiepileptic /^ to i ^ drs. per os. Salipyrin Antifebrile, antirheumatic. ... 15 grs. per os. Salol Antiseptic antigonorrhoic 15 to 30 grs. per os. Sodium theobromine salicylate Diuretic 8 to 15 grs per os. Sodium anisate .... Antipyretic, antirheumatic .... 15 grs. per os. Sodium dithiosalicylate Antipyretic, antirheumatic .... 3 grs. per os. Sodium paracresotate . Antipyretic, antirheimiatic . . . . 8 to 15 grs. per os. Somnal Hypnotic 30 min. per os. Sozoiodol Antiseptic Externally. Sulphaminol Antiseptic Externally. Sulphonal Hypnotic 15 to 30 grs. per os. Terpene hydrate . . . Against pulmonary affections . . . 3 to 16 grs. per os. Terpinol Against pulmonary affections ... 2 min. per os. Tetronal Hypnotic 15 to 30 grs. per os. Thallin sulphate. . . . Antigonorrhoic Injection. Thiol Ichthyol substitute q. v Tribromphenol .... Antiseptic Externally. Trional Hypnotic 15 to 30 gis. per os. Thioresorcin Antiseptic Urethane Hypnotic 15 to 40 grs. per os. ERUPTION OF THE TEETH. TEMPORARY TEETH. (The inferior generally precede the superior by two or three months.) Central incisors 5 to 8 months Lateral 7 to 10 " First molars 12 to 16 " Canines 14 to 20 " Second molars ' 20 to 36 " The following diagram, by Dr. Louis Starr,* shows the grouping, the date of eruption and the duration of the pauses between the appearance of each group of temporary teeth. * Diseases of the Digestive Organs in Children, Philadelphia, 1891. ERUPTION OF THE TEETH. 505 The numbers i to 5 indicate the groups to which the in- dividual teeth belong and their order of appearance, and the letters a and h the precedence of eruption in the different groups. 5^ 3^ ^ ^ -O n u \ p ^y- ^ a 4 % h V 1 V 1 3 4 EXPLANATION OF DIAGRAM. 1, I. Between the fourth and seventh months. Pause of 3 to 9 weeks. 2. 2. 2. 2 Between the eighth and tenth months. Pause of 6 to 1 2 weeks. 3- 3- 3- 3- 3- 3- Between the twelfth and fifteenth months. Pause until the eighteenth month. 4, 4. 4. 4. Between the eighteenth and twenty-fourth months. Pause of 2 to 3 months. 5. 5. 5. 5. Between the twentieth and thirtieth months. PERMANENT TEETH. First molars 5 to 6 years Second bicuspids . 10 to 12 years. Central incisors .... 6 to 8 " Canines 11 to 13 " Lateral ....... 7 to 9 " Second molars ., 12 to 14 " First bicuspids . , . . 9 to 10 " Third molars . . . 17 to 21 " AUTHORITIES CONSULTED. Pharmacopoeia of the United States. Bartholow's Materia Medica and Therapeutics. United States Dispensatory. . Braifhwaite's Retrospect. National Dispensatory. Waring's Practical Therapeutics. Blakiston's Physician's Visiting List. Biddle's Materia Medica. British Pharmacopoeia. American Journal of Medical Sciences. London Lancet. British Medical Journal. Medical and Surgical Reporter. Stille's Therapeutics and Materia Medica. Taylor on Poisons. Tanner on Poisons. Wood's Therapeutics, Materia Medica and Toxicology. Medical Record. New York Medical Journal. Medico-Chirurgical Transactions. Ure's Dictionary. Therapeutic Handbook of the United States Pharmacopoeia. Universal Cyclopaedia — A. McLane Hamilton. Ellis' Medical Formulary. Compendium of Medical Science. American Journal of Dental Science. Dental Cosmos. Dental Register. Ohio State Journal of Dental Science. London Dental Record. British Journal of Dental Science. Garretson's Oral Surgery. Tanner's Index to Diseases. Pareira's Materia Medica and Therapeutics. American System of Dentistry. The Epitome. Western Dental Joiurnal. Items of Interest. Dental Advertiser. Odontographic Joiurnal. Dental Review. International Dental Journal. Therapeutic Gazette. Items of Interest. Merck's Bulletin. Shoemaker's Materia Medica and Therapeutics. Turnbull's Artificial Anaesthesia. 506 INDKX. TO DISEASES AND DENTAL FORMULARY. A BXORMAL Dentition 41 ■^^^ Abnormal Sensitiveness of Dentine 63 Abraded Surface of Mucous Membrane of Mouth, 173, 186, 195, 203, 255 257, 398 Abrasion of Teeth 64, 383 Abrasions by Artificial Dentures 173, 203, 378 Abscess 44, 46, 47, 208 of Antrum 46, 344, 347, 422, 492 Abscess, to abort 208 Abscess, Maxillary 47 Absorption of Process and Recession of Gum 66, 197 Acidity and Pyrosis 263 Acute Tonsillitis 1 86 Alkaline Gargle 386 Alveolar Abscess 44, 325, 352, 356, 364, 374, 417, 429, 478 Hemorrhage 185, 202, 204, 347, 348, 389, 463 Pyorrhoea 58, 173, 180, 181, 195, 199, 255, 257, 299, 302, 344 356, 358, 364. 417. 429. 431, 457. 490 Ulceration 47 Analgesic and Anodyne 248 Anaemia 14 Anaesthetics, General 122, 208, 225 Local 122, 207, 225, 273, 276, 277, 284, 288, 289, 297, 316, 390 459. 483 Anodyne Lotion 298 Antifebrin, Prescription for 248 Antiseptic Dentifrice 181, 329 Gargle or Mouth Wash 204, 233, 359, 403, 431, 478 Lotion or Injection 180, 181, 262, 358, 385 Oils.. 333 Solution for Washing or Spraying Wounds 180, 357 Aphthae 57, 188, 199, 254, 291, 332, 382, 444, 467, 468, 469 Aphthous Ulcerations 173, 199, 352, 353, 467, 469 Astringent Dentifrice 203 Gargle 186, 203, 204, 329, 379 Lotion, Gargle or Mouth Wash 186, 203, 204, 257, 379 Astringent and Antiseptic Gargle 204, 403 BLACK'S Antiseptic Dressing for Pulp Canals and Abscesses.. 182, 334 Bleaching Discolored Teeth 68, 205, 235, 272, 283, 291, 430, 469 Kirk's Method of. 469 507 508 INDEX TO DISEASES AND DENTAL FORMULARY. Boulton's Preparation 373 Bruises , 208, 257 Burns , 195 Burnett's Disinfecting Fluid 487 CANCEROUS Tumors 53, 57, 157, 242, 401 Ulceration 57, 168, 401 Cancrum Oris 52, 157, 263, 271, 291, 332 Carbolized or Carbolate of Potash for Alveolar Pyorrhoea, etc 179 Styptic 181 Caries of Maxillary Bones 191, 199, 279, 332 Chapped Hands and Lips 173, 274, 438, 482 Chemical Bleaching of Teeth 68 Chilblains 181, 200 Chloroform Narcosis 200, 245 Chronic Abscesses and Ulcers 204, 287, 492 Alveolar Abscesses, Ulcerations, etc 44, 204, 279, 492 Inflammation of Gums and Mucous Membrane 188, 203 Inflammation of Dental Pulp 62 Inflammation 30 Cleft Palate 55 Cocaine, To make Solutions or Preparations of. 314, 316, 317 Convulsions of Dentition 42, 277, 490 ■T~\ANGERS of Anaesthesia 219, 245 ■*-^ Dental Caries 70 Exostosis, or Hypercementosis 65 Dental Periostitis 43, 89, 208, 278, 279, 321, 372, 374, 402, 438, 445 456, 465 Dentifrices 181, 203, 302, 327, 328, 329, 377 Dentigerous Cysts 53 Denudation, or Erosion 65 Deodorizers of Iodoform 299, 365 367 Detergent Mouth Wash or Gargle 453, 467 Devitalizing Pulps of Teeth., 163, 167, 168, 169, 367, 398, 478 Diarrhoea of Dentition 42, 199, 263, 363, 422, 442 Digestive Stimulation in Alveolar Pyorrhoea 302 Diphtheritic Conditions 467 Discolored Teeth 66, 68, 205, 235, 272, 283, 291, 430, 469 Disease of Antrum 254 Diseases of Dental Pulp 62, 63 Disinfect Softened Dentine 359 Disinfectant Mouth Wash or Gargle 180, 195, 280, 448 Disinfectant for Carious Dentine 375, 498 Dislocation of Jaw 54 Dressing for Children's Teeth 182 Dry Mouth i8i Dysuria of Difficult Dentition 388 T^ARACHE of Dentition 298 -*--' Ecchymosis 257 Effervescing Powders 465 Electro-Magnetism 90 Emolhent and Antiseptic Gargle 195 INDEX TO DISEASES AND DENTAL FORMULARY. 509 Enlarged Glands 368 Epithelioma 58 Epulis 57 Erosion of Teeth 65, 383 Erythema 460 Excessive Sweating of the Hands 374 Exostosis, Dental 65 Exposed Pulps 277, 288, 289, 316, 378, 397, 490 FACIAL Neuralgia 207, 259, 390, 398, 441, 484, 485 Paralysis 56 Febrile Excitement of Dentition 363 Fetid Perspiration 180, 448 Fetor of Breath 272, 291, 328, 448 Fissured Tongue 173, 467 Flagg's Devitalizing Mixture 167 Foul and Fetid Indolent Ulcers 288 Fracture of Alveolar Process 49, 486 of Jaw 55 Fungous Growths and Suppurating Surfaces 63, 374 GALVANO-CAUTERY 90 Gangrene of Mouth (Cancrum Oris) 52, 157, 263, 272, 291, 332 448, 492 Garretson's Devitalizing Mixture 167 Gingivitis.. ,., 180, i8i, 182 Glycerite of Borate of Sodium 466 Glyceritum Sodii Boratis 466 Glycerole of Thymol Preparation 478 Gutta Percha Solution 378 TT ARE-LIP 55 •*^ -^ Harlan's Devitalizing Mixtures 168, 169 Harris" MouthWash 453 Hectic Fever 29 Hemorrhage from Extraction of Teeth... 185, 202, 204, 347, 348, 389, 463 Hemorrhage from Lancing Gums 348 Herpes Zoster of Mouth and Gums. 69 Hyperaemia 14 Hypercementosis 65 Hypersensitive Dentine 63, 203, 232, 260, 317 Hypertrophy of Gums 58 of Processes 64 of Tonsils 186 Hypnotic 288, 290 IMPACTED Tooth 54 ■*• Incompatibility 91 Indigestion 425 Indolent Ulcers of Mouth.... I57. 4°' Infantile Bilious Diarrhoea 387. 422 Mucous Diarrhoea 3^7, 422 Infantile Paralysis during Dentition 67 Inflamed and Ulcerated Gums 203, 204, 232, 236, 257, 352, 379, 445 510 INDEX TO DISEASES AND DENTAL FORMULARY. Inflamed Fauces and Throat 157, 204, 236, 240 Mucous Membrane and Gums, 156, 186, 203, 204, 232, 236, 240, 254 257, 287, 352, 374, 379, 402, 435, 438 Inflammation 14, 49 of Gums after Extraction of Teeth 236, 438, 444 of Mouth, Syphilitic 51 with Special Reference to the Mucous Membrane of the Mouth.. 14 Inflammatory Fever 23 Inhalation in Syphihtic Ulcerations 180 Injections, Stimulant and Antiseptic 180 Internal Astringent in Hemorrhagic Affections and Dental Hemor- rhage 186 Iodoform, Deodorizing of , 367 lodol. Topical Application 369 Irritation 15 of Teething and Gums 41, 318 of Pulp of Tooth 62 Ischemia 15 Itching of Inflamed Surfaces 398 of the Skin -. 181 77'IRK'S Devitalizing Mixture 168 LEAD Poisoning 49 Local Anaesthetics, 207, 225, 273, 276, 277, 284, 288, 289, 297, 298 316, 317, 390, 459, 483 Loose Teeth and Inflamed Gums 203, 277 Lotion for Soft and Spongy Gums, and Loose Teeth..... 203 MALIGNANT Ulcerations 53, 58, 168, 242 Medicated Filling Material , 192 Mercurial Stomatitis 49, 199, 232, 254, 291, 302, 374, 382, 444, 448 Micro-organisms, Effects of. ...20, 31 Mild Detergent Gargle 453 Mouth Wash, Chapin A. Harris 453 Washes 180, 195, 233, 380, 453 Mucous Patches of Mouth 458 NASAL Polypus 56 Necrosed Teeth 66 Necrosis of Alveolar Process 48, 448 Necrosis of the Jaws 54> 44^ Nervous Cases 250 Neuralgia, 207, 208, 259, 277, 284, 289, 297, 298, 317, 350, 364, 366, 367 411, 441, 456, 491 from Dental Disturbance 259, 350, 456 in Superficial Nerves 259 Neuralgic Affections of the Teeth 207, 208, 284, 297, 330 Odontalgia 317, 330, 350 New Remedies, a List of their Action and Posology 502 OBTUNDING Mixtures, Local Anaesthetics 207, 273, 400 Odontalgia, 181, 182, 204, 206, 207, 208, 233, 236, 276, 277, 287, 288 297, 321, 325, 350, 367, 378, 390, 398, 400, 416, 417, 464 INDEX TO DISEASES AND DENTAL FORMULARY. 511 Odontomes 65 Ofifensive Breath 382, 448 Ointment of Iodoform and Eucalyptus 368 Organic Defects of Structure 65 Osseous Tumors of the Jaws 191 Ossification of Pulp 63 Oxychloride of Zinc Preparations 491 Oxyphosphate of Zinc Preparations 192, 491 TDAIN following Extraction of Teeth 206, 233, 273, 277, 279, 282, ^ . ■ . 365-398 following Separation of Teeth 273 of Difficult IJentition '. 317 Parasitic Skin Diseases 180, 200 Periodontitis 43, 89, 208, 278, 279, 321, 372, 373, 374, 402, 438, 445 456, 465 Perspiration of Hands, etc 195 Phagedenic and Sloughing Ulcers 382, 401 Phenol Sodique Preparations 464 Phosphor Necrosis 48 Pierce' s Devitalizing Mixture 167 Plethora 14 Poisons and Antidotes 104 Pulpitis 62, 181, 182, 204, 206, 233, 236, 287, 288, 297, 317, 325, 368 as a Capping in 368 Pulpless Teeth 287, 353, 366, 368, 402 Pulveris Effervescentes 465 Putrescent Pulps 40, 343, 367, 374, 385, 392, 402, 425, 449, 478 Pyorrhoea Alveolaris (See Formulce under Alveolar Pyorrhoea) 58 Q UININE, Disturbance of Nervous System from 21 RECESSION of Gums 66, 488 Relaxation of Uvula 186 Relaxed Condition of Mucous Membrane of Mouth and Gums 451 Remove Rust on Instruments ,.,,.. 299 Rheumatic Pains, Bruises, etc 208 Riggs' Disease (See Alveolar Pyorrhoea). Ringworm 263 Robinson Remedy 179 Root Canals of Abscessed Teeth 182, 343, 369, 385 SALIVARY Calculus, after Removal of. 203, 435 Salivation 49. 44^ Sandarach Solution or Varnish 46' Scrofula 52 Scorbutic Gums 157- '88, 203, 236 Scurvy 5° Sensitive Dentine 63, 8q, 180, 203, 232, 253, 260, 273, 390, 397, 455 465, 484, 487 Sensitiveness after Removal of Salivary Calculus ^.... 203 Shellac Solution or Varnish 462 Skin Diseases '80, 181 512 INDEX TO DISEASES AND DENTAL FORMULARY. Sloughing and Ill-conditioned Ulcers 189 Soft and Spongy Gums 180, 181, 236, 464 Softened Dentine 359, 498 Sore Throat 203, 236 Sore Mouth of Nursing Women 172 Sterihzed Instruments 274, 299 Stimulant and Antiseptic Mouth Wash and Lotion 180, 181, 380 and Antiseptic Injection 181 and Anodyne Lotion 276 Stomatitis 50, 171, 199, 232, 254, 291, 332, 478 Stomatitis of Dentition '. 171, 317 Strength, to Support the 264 Styptic 253, 321 Superficial Inflammation 232 Suppurating Pulps of Teeth (See Putrescent Pulps) 331, 343, 353 Wounds 180, 181 Suppuration 25, 278 to Hasten 278 Syphilitic Teeth 65 Ulceration of Mucous Membrane of Mouth 51, 181, 183, 236, 444 TEETH deficient in Lime Salts 268, 270 Thrush 56, 57 To make Solutions of Cocaine 314, 316 To render the Hands Aseptic 299, 430 Tonic to Support Strength 264 Tonsillitis 186 Trigeminal Neuralgia 207, 208 Truman's Devitalizing Mixture 163 Tumors of Gums 367, 368, 423 of Jaws 53, 423 T TLCERATED Gums and Mucous Membrane, 188, 203, 236, 257, 302 ^ 325. 352, 374. 382, 445, 492 Ulceration 30, 236, 254, 352 Ulceration and Abrasion of Mouth 203, 302, 352, 445 Ulceration of Mouth and Throat 236 Ulcerous Stomatitis 51, 203, 332 Ulcers of Mouth, 51, 189, 203, 204, 236, 254, 288, 302, 332, 343, 444, 448 449, 486 over Carious Bone 191. 332 Syphihdc 51, 181, 183, 236, 444 Ulitis (See Inflammation of Gums, etc.) 50, 203, 204, 236, 357, 374 TT-ARNISHES, Dental 369 V Shellac 462 Sandarach 462 Venereal Sore Mouth and Throat 363 Vomiting and Painful Digesdon of Teething Children 263, 298 "XTSTARTS, Condylomata, etc 195, 363 * * Wash after Extraction of Teeth 236, 302, 438, 444 Wounds and Ulcers 180, 181, 299, 366, 385, 392, 401 GENERAL INDEX. PAGE ABBREVIATIONS 73 ■^~*- Abies Canadensis 435 Abnormal Dentition 41 Sensibility of Dentine 63 Abrasion of Teeth 64 Abscess 28 Abscess, Alveolar 44 of Antrum 46 Abscess, Maxillary 47 Absolute Alcohol 230 Absorbents 141 Absorption of Alveolar Process 66 Acacia 155 Acetate of Alumina 236 of Ammonia Solution 238 of Lead 436 of Morphine 394 Acetanihde 247 Acetic Acid 156 Acids, Organic 121 Acids, Inorganic 120 Acidum Aceticum 156 Arseniosum 157 Benzoicum 170 Boricum 172 Carbolicum 173 Chromicum 182 Cresylicum 183 Gallicum 184 Acidum Hydrobromicum 186 Hydrochloricum 187 Muriaticum 187 Nitricum 188 Nitricum Dilutum 189 Phosphoricum 190 Salicylicum 193 Sulphuricum 195 Sulphuricum Aromaticum 196 Sulphurosum 199 Tannicum 200 Tartaricum 204 Trichloroaceticum 479 33 PAGE Aconite 205 Aconitine, Duquesnel's 205 Aconitum 205 Action of Medicines 13 Acute Inflammation of Dental Pulp 62 Administration of Anaesthetics 212 vEther 208 Alcohol 230 Alkalies and Alkahne Earths.. 120 Alkaloids 151 Aloe — Aloes 233 Alteratives 1 34 Alpha oxynaphthoic Acid 402 Alum 234 Alumen 234 Exsiccatum 235 Aluminae Acetas 236 et Ammonia; Sulphas 235 Aluminii et Potassii Sulphas... 235 Chloridum 282 Sulphis 237 Alveolar Abscess 44 about to Point Externally.. 45 Alveolar Pyorrhoea 58 Alveolar Ulceration 47 American Hellebore 484 Ammonia 238 Ammonia Alum 235 Aromatic Spirits of. 238 Water 238 Ammonii Bromidum 264 Ammonii Carbonas 240 Chloridum 241 Valerianas 241 Ammonium 238 Amyl Nitris 244 Amylene 242 Amylene Hydrate 243 Anaemia 14 Anaesthetics 122 Administration of, etc 212 513 514 GENERAL INDEX. PAGE Ansesthetic Mixture 340 Analgesics , 141 Aniline 246 Animal Charcoal 279 Anodynes 141 Antacids 135 Antemetics 142 Anthelmintics 140 Anthemis 246 Anthridrotics 142 Antifebrin 247 Antikamnia 248 Antilithics 135 Antiperiodics 1 42 Antipyretics 1 42 , 1 48 Antipyrine 249 Antiseptic Mixtures, Dr. Black's 182 Antiseptic and Styptic Cotton Wool 250 Antiseptics 142, 492 Antiseptics, Forms of. 143 Antiseptics in Dental Practice. 492 Antispasmodics 123 Aphthse 57 Apothecaries' Weight 76 Approximate Measurements... 74 Aqua Acidi Carbolici 179 Aqua Ammonia 238 Camphora 275 Chlori 290 Cinnamomi 303 Creasoti 324 Destillata 251 Fortis -. 188 Aralia Spinosa 486 Argenti Nitras 251 Aristol 254 Aromatic Bitters 145 Spirits of Ammonia 238 Aromatic Sulphuric Acid 196 Arnica 256 Arsenic, Tests for 169 Arsenious Acid 157 Astringents 1 24 Artificial Respiration 221 Atropinge Sulphas , 258 Atropine 258 Aurum Terchloridum 260 Avoirdupois Weight 76 BACTERIA 20, 31, 496 Baths 151 Belladonnae Folia 261 PAGE Belladonnae Radix 261 Benzoate of Lithium 383 Benzoated Lard 171 Benzoic Acid 170 Benzoic Sulphide of Sodium... 261 Bert's Method of Administer- ing Anaesthetics 218 Best Twenty-five Drugs 103 Bicarbonate of Potassium 440 of Sodium 464 Bichloride of Mercury 355 Bichloride of Mercury, Test for 358 Bichloride of Methylene 390 Biniodide of Mercury 355 Bismuthi Subnitras 262 Bleaching Discolored Teeth, 68 430, 469 Blenorrhetics 133 Bloodletting, General and Lo- cal 84 Blue Stone 330 Mass 361 Vitriol 330 Bonvvell's Anaesthetic Method. 228 Boric Acid 172 Lint 172 Ointment 173 Borate of Sodium 466 Borax 466 Boro-glyceride 172 Bromides 264 Bromide of Ammonium 264 of Calcium 264 of Lithium 265 of Sodium 265 of Camphor 277 of Ethyl.. 337 of Potassium 441 Bromol 266 Bromo-Phenol 266 Brucine 410 Burnett's Disinfecting Fluid... 487 Butyl-Chloral Hydrate 329 /^ADMII Sulphas 266 ^^ Calcii Bromidum 264 Calcii Hypophosphis 267, 433 Calcii Lithium 265 Calcined Magnesia 386 Calcium 269 Calendula 268 Calisaya Bark 300 Calomel 359 GENERAL INDEX. 515 PAGE Calx 269 Chlorata 27 1 Campho-Phenique 273 Camphor 274 Liniment 275 Water 275 Camphora 274 Alonobromata 277 Camphorated Tincture of Opi- um 421 Cantharidal Collodion 319 Cajuput Oil 415 Capsicum 277 Carbo Animalis Purificatus 279 Ligni 280 Carbolate of Soda 463 Carbolate of Sodium 463 Carbolated Cosmoline 482 CarboHc Acid 173 Ointment 176 Water 179 Carbolic Acid, Synthetic 179 Carbon compounds 120 Carbonate of Ammonium 240 of Lime 326 of Lithium 382 Caries, Dental 70 Carminatives 145 Carvacrol 280 Cassia Bark 302 Cataplasms 140, 151 Cathartics 128 Causes of Inflammation 17 Caustic Potassa 439 Caustics 138, 145 Cauterants 146 Cautery, Actual and Potential.. 138 Cayenne Pepper 277 Cerates 153 Chalk Mixture 326 Chalk, Prepared 326 Chamomile 246 Characteristic Indications of the Tongue 71 Chemical Bleaching of Teeth, 68 Chinoline 282 Chloral 284 Hydras 284 Chloral-Phenol 287 Chloraiamide 289 Chloralum 282 Chlorate of Potassa Troches... 444 of Potassium 443 Chloride of Aluminium 282 Chloride of Ammonium 241 of Iron 346 of Lime 271 of Methyl 283 of Magnesium 283 of Zinc 486 of Zinc Solution 487 of Tin 283 Chlorinated Lime — Chloride of Lime 271 Chlorine 290 Water 290 Chlorinium 290 Chloroform 291 Chloroform-Cocaine Narcosis.. 296 Chloroform-Morphia Narcosis, 296 Chloroformum 291 Purificatum 291 Chloro-Percha 378 Chromic Acid 182 Chronic Inflammation 30 Chronic Inflammation of Den- tal Pulp 62 Cinchona Flava, Pallida and Rubra... 300 Cinnabar 362 Cinnamomum 302 Cinnamon 302 Oil 303 Water 303 Citrate of Lithium 383 Classification of Medicinal Substances 121 Cleft Palate 55 Chnical Thermometer 1 15 Clysters 152 Cobalt 169 Cocaine 304 Dangers of 315 Cocaine Hydrochlorate 305 Oleate 305 Citrate 305 Hydrobromate 305 -Chloroform Mixture 296 -Chloroform Narcosis 296 Incompatibles 316 Poisoning Treatment of.., 316 Cod-liver Oil 418 Colchicum 318 Collodion 319 CoUodium 319 cum Cantharide 319 Flexile 319 lodidum 320 516 GENERAL INDEX. Collyria 151 Compound Syrup of the Phos- phates 432 Compound Tincture of Iodine.. 371 Coloring Agents 141 Colorless Tincture of Iodine... 371 Condy's Fluid 448 Confections 151 Conium 321 Constringents .-. . 146 Convulsions of Dentition 41 Corrosive Chloride of Mercury 355 Sublimate 355 Cosmoline 481 Counter-irritants .■•.83, 146 Creasote 322 Ointment 324 Water 324 Solidified 324 Creasotum , 322 Creolin 298 Cresylic Acid 183 Creta Prseparata 326 Croton-Chloral Hydrate 329 Cupping 85 Cupri Sulphas 330 DANGERS of Anaesthesia... 219 Deadly Nightshade 261 Decimal System of Weights and Measures 76 Decoction of White Oak Bark 452 Decoctions 152 Decoctum Quercus Albse 452 Definition of Subjects Mate- ria Medica and Thera- peutics 13 of various Classes of Rem- edial Agents 121 Demulcents 1 39 Dental Caries 70 Exostosis 65 Materia Medica and Ther- apeutics 155 Periostitis 43 Dentifrices 203, 261, 281, 322 Dentigerous Cyst 53 Deodorized Tincture of Opium 422 Deodorizers 146 Desiccatives 1 46 Detergents 1 46 Devitalizing Pulps of Teeth.... 162 Dialysed Iron 344 Diaphoretics 131 Diarrhoea Infantile Bilious 387 Diarrhoea Infantile Mucous ... 387 Dichloride of Ethidene 336 Digestibility of Foods ■. .. 71 Diluents .,- 146 Diluted Solution of Subacetate of Lead 438 Dimethyloxyquinizine 249 Discutients 146 Disinfectants 1 47 Disinfecting Instruments 499 Dislocation of Lower Jaw 54 Distilled Water 251 Dithymol Diodide or Biniodide 254 Diuretics 132 Doses of Medicines, Table of... 93 Dover's Powder 421 Dr. Black's Antiseptic Mixtures 182, 334 Drastics 130 Dried Alum 235 ■pCCRITICS 121 -*--^ Effervescing Powders 465 Electricity for Relieving Pain of Extraction of Teeth. .90, 226 Methods of Applying 226 as a Therapeutic Means in Treatment of Disease 85 Electrolysis 89 Electrolysis for sensitive Den- tine and Periodontitis 89 Electro-Magnetism for Extrac- tion of Teeth 90, 226 Electuaries 151 Elementary Substances, Table of 116 EHxir of Vitriol 196 of Vitriol and Tannin...... 202 Emetics 126 Emmenagogues ". 133 Emollients 140, 147 Emulsions 152 Enemata 131, 152 Endermic Method 82 Epispastics , 137 Epithelioma 58 Epsom Salt 387 Epulis 57 Equivalents 79 Ergot 332 Erosion of Teeth 65 Errhines 147 Eruption of the Teeth 504 GENERAL INDEX. 517 PAGE Escharotics 138, 147 Essential Oils 333 Ether 208 Ethidene Dichloridum 336 Ethyl Bromidum 337 Eucalyptol 341 Eucalyptus 341 Eugenic Acid 417 Eugenol 417 Evacuants 148 Excitants 148 Exostosis, Dental 65 Expectorants 147 Extracts 152 Extractum Gelsemii Fluidum.. 349 Krameriae 380 Exudation 24 T^ACIAL Neuralgia 330 -^ Facial Paralysis 56 Febrifuges 1 48 Ferri Chloridum 346 Ferrum 344 Dialysatum 345 Reductum 346 Fever of Inflammation 23 Fineness of Powder 75 Fomentations 152 Formsof Antiseptics for Use 143,492 Forms of Medicinal Substances 151 Fracture of Alveolar Process. . . 49 of Lower Jaw 55 French Decimal System of Weights and Measures 76 Fused Potassa 439 Fungous Growth of Pulp 63 Fumigations 152 GALLIC Acid 184 Galls 184 Galvano-Cautery 90 Gangrene 32 Gargles 152 Galvanism 88 Gelsemium 348 Germicides 148 Glacial Acetic Acid 157 Glacial Phosphoric Acid 191 Gleditschi ne 470 Glycerin 350 Glycerinum 350 Boracis 466 Pepsini 425 Glycerite of Borate of Sodium.. 466 PAGE Glycerite of Carbohc Acid 176 of Gallic Acid 185 of Tannic Acid 203 Glycerites 152, 351 Glyceritum Acidi Carbolici 176 Acidi Galhci 184 Acidi Tannici 203 Sodii Boratis 466 Gingivitis 50 Glacial Acetic Acid 157 Glyceroborate of Calcium 353 of Sodium 353 Glycerole of Thymol 477, 478 Granulation 25 Green Iodide of Mercury 362 Gum Arabic 155 Guiacol 325 Gutta Percha . .. 377 TJyEMATINICS 134 -*■-'■ Hasmetics 121 Haemostatics 148 Hamamelis 353 Hare Lip 55 Harlan's Method of Treating Alveolar Pyorrhoea 429 Hall's (Marshall) Ready Meth- od in Asphyxia 222 Hectic Fever 29 Hemorrhage following the Ex- traction of Teeth 347 Hemlock 321 Herbst's Obtundent 312 Herpes Zoster of Mouth and Gums 69 Hill's Stopping 378 Hoffman's Anodyne 209 Honey of Borate of Sodium... 466 Howard's Method of Artificial Respiration and Resus- citation 223 Hirudo 84 Hyderabad Commission on Chloroform 293 Hydrargyri Chloridum Corrosi- vum 355 Chloridum Mite 359 Hydrargyri Sulphidum Ru- brum 362 Hydrargyrum 354 cum Crcta 361 lodidum Viride 362 lodidum Rubrum 362 Sulphidum Rubrum 362 518 GENERAL INDEX. PAGE Hydragogues... 128 Hydrate of Aniylene 243 of Chloral 284 of Potash , 439 Hydrochlorate of Ammonia... 241 of Morphine 394 Hydrochloric Acid 187 Hydrobromic Acid 186 Hydrobromic Ether 337 Hydrogen Peroxide 426 Hydronaphthol 402 Hyperaemia 14 Hypercementosis 65 Hypersensitive Dentine 63 Hypersthenics 148 Hypertrophy of Alveolar Pro- cesses. 64 of Gums 58 Hypnotics 121, 148 Hypodermic Method 82 Hypophosphites 432 Hypophosphite of Lime 267 of Quinine 455 of Sodium 433 IMPACTED TOOTH 54 ^ Important Points in Diag- nosing Affections of the Mouth 41 Incompatible Antiseptics 501 Incompatibility , 91 Infantile Paralysis during Den- tition 67 Inflammation with, special Ref- erence to the Mucous Membrane of the Mouth 14 of Peridental Membrane 43 of Dental Pulp 62 of Mucous Membrane of the Mouth, Syphihtic... 51 Inhalants 152 Inj ections 152 Infusions 152 Infusum Capsici 278 Ingluvin , 426 Inorganic Materia Medica 120 Iodide of Potassium 370 of Zinc 489 Iodine 369 Iodine Tri-chloride 375 lodophenacetin 376 lodophenin 376 Iodized Collodion 321 Iodoform 363 PAGE lodoformum 363 lodol 368 lodum 369 Iridis Rhizome 370 Iron and Preparations 344 Irritants 136 Irritation , 15 of Dental Pulp 62 of Teething 41 Ischsemia 15 Isonandra Gutta 377 Issues and Setons 139 TABORANDI 433 J Jamaica Dogwood 435 Japanese Camphor 389 KANDOL 379 Kino 382 Kirk's Bleaching Method 469 Krameria 379 T ABARRAQUE'S Solution 381 -^ Lacmus 383 Lacto-Phosphate of Lime Syrup 270 Lanolin 380 Laudanum 421 Laughing Gas 403 Laxatives 1 30, 1 48 Lead Poisoning , 49 Water 438 Leeches 84 Lenitives 1 39 Leopard's Bane 256 Lime , 269 Liniment 270 Water 269 Linirnents 152 Linimentum Calcis 270 Camphorge 275 Saponis 275 Terebinthinae 476 Liquefied Nitrous Oxide ,.. 405 Liquor Ammonii Acetatis....... 239 Calcis 269 Ferri Perchloi'idi 346 Ferri Subsulphatis 346 Gutta Percha 378 Plumbi Subacetatis Dilu- tus 438 Potassii Arsenitis 161 Sodce Chloratae 381 Potassii Permanganatis ... 448 GENERAL INDEX. 0l9 PAGE Liquor Zinci Chloridi 487 Listerian Method 144 Listerine 171 Lithium 382 Lithii Benzoas 383 Lithii Bromidum 265 Lithii Carbonas 382 Lithii Citras 383 Lithii Sahcylas 383 Lithontriptics h 135 Litmus 383 Local Anaesthesia 225, 311 Bloodletting 84 Lotions 152 Lunar Caustic 251 Lysol 384 JY/TAGNESIA 386 ^^^ Magnesii Chloridum 283 Magnesii Sulphas 387 Marigold 268 Marshall Hall's Ready Method 222 Matico 388 Maxillary Abscess 47 May Apple 438 Measurement of Medicinal Substances 74 Meadow Saffron 318 Medicated Oxyphosphate of Zinc fillings 192 Menthol 389 Mel Boracis 466 Sodii Boracis 173 Mercury 354 with Chalk 361 Bichloride of. 355 Mercurial Ointment 361 Poisoning 49 Mercuric Chloride 355 Mercurous Chloride 359 Methyl Chloride 283 Methyl Ether 392 Methyl-I-Lthylic Ether 392 Methyl-Violet 247, 449 Methylene 390 Methyleneblue 247 Metric System of Weights and Measures 76 Microcidin 392 Micro-Organisms 20, 31, 496 Mild Chloride of Mercury 359 Mistura Cretae 326 Mixed Chloroform Morphia Narcosis 296 PAGE Mixtures 153 Monobromated Camphor 277 Monsel's Solution and Powder 346, 347 Morphina 393 Morphinse Acetas 394 Hydrochloras or Murias.,. 394 Sulphas 394 Morphine 393 Narcosis 296 Muriate of Ammonia 241 of Morphine 394 Muriatic Acid 187 Myrrh 398 M yrrha 398 Myrtle Oil 400 Myrtol 400 IVTAPHTHALIN 400 -'■^ NapeUine 205 Naphthalene 400 Naphthol 401 Narcotics 121 Nasal Polypus 56 Natural Distribution of Remed- ies 120 Nausea from Impression Tak- ing 276 Nauseants 128 Necrosed Teeth 66 Necrosis of Alveolar Process.. 48 of Jaw 54. Nelaton's Method of Resusci- tation 221 Nervines 149 Neurotics I2i New Remedies. A List of, Their action and Posol- ogy 502 Nitrate of Ammonia 403 of Potassium 445 of Silver 251 Nitre 445 Nitric Acid 188 Nitrite of Amyl 244 Nitrous Oxide 403 Nitrous Oxide, Action and Ad- ministration of. 407, 408 Nitrous Powders 446 Non-metals Nutritives 149 Nux Vomica 410 520 GENERAL INDEX. PAGE OBTUNDING Mixtures, Use of....^. 227 Odontomes 65 Oil of Cassia 303 of Cajuput 415 of Camphor 276 of Cinnamon 303 of Cloves 416 of Peppermint 390 of Pyrethrum 451 of Sanitas 476 of Sweet Almonds 415 of Turpentine 476 of Vitriol 195 Oils, Essential 333 Ointment of Carbolic Acid.... 176 of Creasote 324 of Galls 185 of Tannic Acid 202, 203 of Vaseline 483 of Veratrine 483 Ointments 153 Oleate of Aluminum 413 of Arsenic 414 of Bismuth 413 of Cadmium 414 of Cocaine 317 of Copper 414 of Lead 413 of Mercury 412 of Nickel 414 of Silver 414 of Zinc 413 Oleates, Medicinal 153, 411 Oleum Amygdalce Dulcis 451 Cajuputi 415 Camphoras 276 Caryophilli 416 Cinnamomi 303 Eucalypti 341 Morrhuae 418 Sanitas 476 Terebinthinae 47 5 Opium 419 Organic Defects of Structure... 65 Organic Materia Medica 121 Orris Rhizome 376 Root 376 Ossification of Dental Pulp.... 63 Oxide of Potassium 439 of Zinc 490 Oxyphosphate of Zinc Filling Material 192, 491 of Zinc Filling Medicated. 192 PAGE Oxychloride of Zinc Filling Material 491 "DAPAIN or Papaiva 422 -^ Paraacetphenitidine 431 Paralysis, Infantile 67 Paraldehyde 423 Paregoric Elixir 421 Pellitory 450 Peppermint Cam,phor 389 Pepsin 424 Pepsinum 424 Saccharatum 424 Perchloride of Iron 346 Periodontitis 43 Permanganate of Potassium.... 446 Peroxide of Hydrogen 426 Peroxide of Hydrogen, Test for 428 Peruvian Bark 300 Petrolatum 481 Petroleum Ointment 481 Phenacetine , 43 1 Phenate of Sodium 463 Phenic Acid 173 Phenol 173 Phenol-Camphor 276 Phenol Sodique 179, 463, 464 Phenylic Alcohol 173 Phosphate of Lime 433 of Sodium 432 Phosphates 432 Phosphites 432 Phosphorus 432 Phosphor Necrosis 48 Phosphoric Acid 190 in the Anhydrous State ... 191 Pills 153 Pilocarpus 433 Pinus Canadensis 435 Piscidia Erythrina.... 435 Pix Canadensis 435 Plasters 153 Plethora 14 Plumbi Acetas 436 Podophyllum 438 Poisons 104 Symptoms and Antidotes for, Acid, Mineral 104 Aconite 105 Alkahes 105 Antimony . 105 Arsenious Acid 105 Argenti Nitras 105 GENERAL INDEX. 521 Poisons Atropine io6 Belladonna lo6 Cannabis Indica io6 Cantharides 1 06 Carbolic Acid 106 Chloral 107 Chlorine Water 106 Chloroform 107 Cocaine 315, 316 Conium 107 Copper, Sulphate of 108 Corrosive Sublimate 107 Creasote 108, 323 Croton Oil 108 Digitalis 108 Hydrocyanic Acid 108 Hyoscyamus 108 Iodine 109 Lead Salts 109 Mercury 109 Morphine 109 Nux Vomica 109 Opium 109 Oxahc Acid no Phosphorus 1 10 Potash and Soda Salts no Silver, Nitrate of 105 Stramonium no Strychnine no Tobacco no Zinc Salts no Poke Root 484 Posological Tables 93 Potassa Alum 235 Caustica 439 cum Calce 440 Potassii Bicarbonas . 440 Potassii Bromidum 441 Chloras , .. ... 443 lodidum 370 Nitras 445 Permanganas 446 Poultices 140, 153 Pulpitis 62 Powdered Subsulphate of Iron 347 Precipitated Chalk 326 Prepared Chalk 326 Preventive Measures against Dangers of Anaesthesia. 220 Prickly Ash 485 Prince's Method of Treating Alveolar Abscess 429 Protecti ves 1 39 Protiodide of Mercury 362 PAGE Protoxide of Nitrogen. 403 Prunus Yirginiana 449 Pulse, the ni Variations in. Frequency of. n2 Pulvis Ferri Subsulphatis 347 Ipecac et opii 421 Purgatives 1 30, 1 49 Purified Animal Charcoal 279 Pus 26 Pyoktanin 449 Pyorrhoea, Alveolar 58 Pyrethrum 450 QUERCUS Alba 451 Quicksilver 354 Ouillaia Bark 452 Ouillaya Saponaria 452 Ouininae 300, 453 Hypophosphis 455 Sulphas 300 Quinine 300, 453 Quinoline 282 RAPID Breathing as a Pain Obtunder 228 Refrigerants 1 49 Recession of Gums 66 Red Sulphuret of Mercury 362 Relaxed Condition of mucous Membrane and Gums 451 Reduced Iron 346 Remedies, Natural Distribu- tion of 502 Resolvents 150 Resorcin 456 Respiration at Various Ages... 1 14 Restoratives 150 Resuscitation, Methods of. 222 Rhatany 379 Rheum 458 Rhigolene 459 Rhubarb 458 Riggs' Disease 58 Robinson Remedy 179 Rubefacients 136 Rules for Administering Anics- thetics 212 for Regulating Doses 80 SACCHARATED Pepsin.... 424 Sal Ammoniac 241 Salicylic Acid .. 193 Salicyl Resorcin Ketone 457 522 GENERAL INDEX. PAGE Salicylate of Lithium 383 Salicylate of Sodium 468 Salipyrine 194 Salivation 49 Salol 459 Saltpetre 445 Sandaraca 460 Sandarach 460 Sanitas 476 Scarifications.. 85 Scurvy 5° Scrofula , 52 Sedatives 126 Sensitive Dentine 63 Serpentaria 46 1 Sesquicarbonate of Sodium 464 Setons and Issues 83, 139 Shellac 462 Sialagogues 150 Soap Liniment 275 Sodas Phenas 463 Sodii Bicarbonas 464 Boras 466 Bromidum 265 Sodii Hypophosphis 433 Pyrophosphas 433 Phosphas 432 Salicylas 468 Sulphis 468 Sodium Silico-Fluoride 470 Solubility of Chemicals in Water and Alcohol 117 Solution of Acetate of Ammo- nia -, 239 of Chlorinated Soda 381 of Chloride of Zinc 487 of Gutta Percha 378 of Permanganate of Potas- sium 448 of Subsulphate of Iron... 346 Soporifics 121 S. Am. Soap Tree Bark 452 Spastics 126 Spirit of Chloroform 296 of Cinnamon 303 of Nitrous Ether 209 of Mindererus 239 Spinants 126 Spiritus Ammonise Aromaticus 238 Spiritus ^theris Compositus... 209 ^theris Nitrosi 209 Camphorae 275 Chloroformi 296 Cinnamomi 303 PAGE Stannum Chloridum 283 Stenocarpine 470 Sterilizing Instruments 499 Stimulants 125 Stomachics 125 Stomatitis 5° Gangrenous $2 Ulcerous 5^ Mercurial 49 Syphilitic 51 Strychnine 410 Strychninee Sulphas 410 Styptic Colloid 202 Cotton 202, 251 Styptics 150 Subnitrate of Bismuth 262 Subsulphate of Iron 347 Sugar of Lead 436 Sudorifics 131 Sulfanol 471 Sulphate of Atropine 258 of Cadmium 266 of Copper 330 of Magnesium 387 of Morphine 395 Sulphate of Quinine 300 of Strychnine 410 of Zinc 491 Sulphate of Aluminium 2^7 of Lime 433 Sulphite of Soda 468 Sulpho-Carbolates of Zinc, So- dium, Potassium, Mag- nesium, Calcium and Quinine 177 Sulpho-Carbohc Acid 176 Sulfonal 471 Sulphonal 471 Sulphuric Acid 195 Ether 208 Sulphurous Acid 199 Suppositories 154 Suppurants 138 Suppurating Teeth 331 Suppuration 25 Sylvester's Method of Resusci- tation 221 Symptoms of Inflammation.. 16, 21 Synopsis of Treatment of Af- fections of the Mouth... 41 Synthetic Carbolic Acid 179 Syphilitic Inflammation of the Mouth 51 Teeth 65 GENERAL INDEX. 523 PAGE Syrup of Lacto-Phosphate of Lime 270, 432 Syrups 154 Syrupus Calcii Lacto-phospha- tis 270,432 Hypophosphitum 433 'T^ABLE of Doses of Medi- -'■ cines 93 of Equivalents 79 Tannic Acid 200 Tartaric Acid 204 Tartrate of Chinoline 282 Terchloride of Gold 260 of Phenol 473 Terebinthina 475 Terebinthene, Terpine, Terpi- nol, Terebene 476 Teriodide of Formyl 363 Terminations of Inflammation 32 Test Papers for Dentists 501 Tests for Arsenic 169 Tetraiodopyrrol 368 Thermometers 1 14 Thiersch's Method of Morphia Narcosis 296 Thrush 56 Thymol 476 Tinctura Aconiti 206 Arnica 257 Calendula 268 Capsici 278 Eucalypti 342 Gelsemii 349 lodi 371 lodi Composita 371 Krameriae 380 M y rrhae 399 Opii 421 Opii Camphorata 421 Opii Deodorata 422 Pyrethri 451 Tinctures 154 Tonics 123 Topical Remedies 82, 121 Treatmentof Dangerous Symp- toms of Anaesthesia 220 of Inflammation 33 Trichloride of Iodine 375 Tri-Iirom-Phenol 266 Trichlorphen ol 479 Trichloroacetic Acid 479 Troches of Chloride of Potas- sium 444 PAGR Troy Weight 76 Tumor of Jaws, Malignant Form of. 52 of Upper Jaws 52 Turpentine 475 Turpentine as a Sterilizer of In- struments, etc 476 T TLCERATION 30 ^ Ulceration, Alveolar 47 Ulcers of Mouth, Syphilitic ... 51 Ulitis 50 Unerupted Impacted Tooth... 54 Unguentum Acidi Carbolici... 176 Acidi Tannici 203 Boricum 173 Creasoti 324 Galte 185 Hydrargy ri 36 1 Verat rina 483 Ureth ran 480 Urethrane 480 WALERIAN 480 * Valerianate of Ammonium 241, 481 Varnish, Colored 462 Aqueous 462 Transparent 461 Dental 369 Vaselin 481 Vaseline 481 Vaseline Camphor Ice 482 Veratrina 483 Veratrine 483 Veratrum Viride 484 Vermifuges 1 40 Vermilion, Effects of, on Mouth 362 Vesicants 137, 151 Vinum Opii 421 Pepsini 425 Virginia Snake Root 461 Vitalized Air 226 Voltaic Narcotism 226 W ALB'S Method of Using Cocaine 312 Obolinskie's Method 314 Raymond's Method 313 Weights and Measures 76 White Oak Bark .. 45' Wliitc Oxide of Arsenic 157 Witch Hazel 353 524 GENERAL INDEX. PAGE Wild Cherry 449 Windle's Methx)d of Admin- istering Ansethestics 219 Wine of Opium 421 Wood Charcoal 280 VANTHOXYLUM 485 PAGE '\/"ELLOW Cinchona 300 ^ Jasmine 348 Yversen's Method of Admin- istering Anaesthetics 219 yiNCl Chloridum 486 ^ lodidum 489 Oxidum 490 Sulphas 491 CATALOGUE No. 1. SEPTEMBER. 1891. CATALOGUE MEDICAL, DENTAL, PHARMACEUTICAL AND SCIENTIFIC PUBLICATIONS, WITH A SUBJECT INDEX, PUBLISHED BY P. BLAKISTON, SON & CO., (Successors to Lindsay & Blakiston) PUBLISHERS, IMPORTERS AND BOOKSELLERS, IOI2 WALNUT ST., PHILADELPHIA. THE FOLLOWING CATALOGUES WILL BE SENT FREE TO ANY ADDRESS, UPON APPLICATION. Thi3 Catalogue, No. i, including all of our own publications. A Catalogue of Books for Dental Students and Practitioners. A Catalogue of Books on Chemistry, Technology, Pharmacy, Microscopy, Hygiene, Sanitary Science, etc. Students' Catalogue, including the " Quiz-Compends " and the most prominent Text- books and Manuals for medical students. 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Cloth, $2.50 VAN NUYS on The ITrine. Chemical Analysis of Healthy and Diseased Urine, Qualitative and Quantitative. By T. C. Van Nuys, Professor of Chemistry Indiana University. 39 Illustrations. Octavo, Cloth, $2.00 VIRCHOWS Post-mortem Examinations. A Description and Explanation of the Method of Performing them in the Dead House of the Berlin Charite Hospital, with especial reference to Medico-legal Practice. By Prof. Virchow. Trans- lated by Dr. T. P. Smith. Third Edition, with Additions. Cloth, $1.00 Cellular Pathology, as based upon Physiological and Pathological Histology. 20 Lectures delivered at the Pathological Institute of Berlin. Translated from the 2d Ed. by F. Chance, m.d. 134 lUus. 8th Am. Ed. Cloth, I4.00 WALSHAM. Manual of Practical Surgery. For Students and Physicians. By Wm. J. Walsham, m.d., f.r.c.s., Asst. Surg, to, and Dem. of Practical Surg, in, St. Bartholomew's Hospital, Surg, to Metropolitan Free Hospital, London. With 236 Engravings. New Series of Manuals. Cloth, I3.00 ; Leather, I3.50 WARING. Practical Therapeutics. A Manual for Physicians and Students. By Edward J. Waring, m.d. Fourth Edition. Revised, Rewritten and Rearranged by Dudley W. Buxton, m.d.. Assistant to the Professor of Medicine, University College, London. Crown Octavo. Cloth, I3.00; Leather, $3.50 WARREN. Compend Dental Pathology and Dental Medicine. Containing all the most noteworthy points of interest to the Dental student. By Geo. W. Warren, d.d.s.. Clinical Chief, Penn'a College of Dental Surgery, Phila. Illus. Being No. ij f Quiz- Compend ? Series. i2mo. Cloth, ^i.oo Interleaved for the addition of notes, ^1.25 WATSON on Amputations of the Extremities and Their Complications. By B. A. Watson, a.m., m.d.. Surgeon to the Jersey City Charity Hospital and to Christ's Hospital, Jersey City, N, J. ; Member of the American Surgical Associ- ation. 250 Wood Engravings and two Full-page Colored Plates. Cloth, ^5.50 Concussions. An Experimental Study of Lesions arising from Severe Con- cussions. 8vo. Paper cover, |i.oo WATTS' Inorganic Chemistry. A Manual of Chemistry, Physical and Inorganic. (Being the 14th Edition of Fowne's Physical and Inorganic Chemistry.) By Henry Watts, b.a., f.r.s.. Editor of the Journal of the Chemical Society ; Author of " A Dictionary of Chemistry," etc. With Colored Plate of Spectra and other Illustrations. i2mo. 595 pages. Cloth, ;5S2.25 Organic Chemistry. Second Edition. By Wm. A. Tilden, d.sc, f.r.s. (Being the 13th Edition of Fowne's Organic Chemistry.) Illustrated. i2mo. Cloth, j^2.25 MEDICAL AND SCIENTIFIC PUBLICA TIONS. 25 "WHITE. The Mouth and Teeth. By J. W. White, m.d.. d.d.s. Editor of the Dental Cosmos. Illustrated. Cloth, .50 "WILSON'S Text-Book of Domestic Hygiene and Sanitary Information. A Guide to Personal and Domestic Hygiene. By George Wilson, m.d., Medical Officer of Health. Edited by Jos. G. Richardson, m.d., Professor of Hygiene at the University of Pennsylvania. Cloth, $1.00 "WILSON. Handbook of Hygiene and Sanitary Science. With Illustrations. Seventh Edition, Revised and Enlarged. 8vo. In Press. "WILSON. The Summer and Its Diseases. By James C. Wilson, m.d. Cloth, .50 WINCKEL. Diseases of "Women. Second Edition. Including the Dis- eases of the Bladder and Urethra. By Dr. F. Winckel, Professor of Gynaecology, and Director of the Royal University Clinic for Women, in Munich. Translated by special authority of Author and Publisher, under the supervision of, and with an Introduction by, Theophilus Parvin, m.d.. Professor of Obstetrics and Diseases of Women and Children in Jefferson Medical Col- lege, Philadelphia. With 150 Engravings on Wood, most of which are original 2d Edition, Revised and Enlarged. Cloth, $3.00; Leather, $3.50 Text-Book of Obstetrics ; Including the Pathology and Therapeutics of the Puerperal State. Authorized Translation by J. Clifton Edgar, a.m., m.d.. Adjunct Professor to the Chair of Obstetrics, Medical Department, University, City of New York. With nearly 200 Handsome Illus., the majority of which are original with this work. Octavo. Cloth, $6.00; Leather, $7.00 "WOAKES. Post-Nasal Catarrh and Diseases of the Nose, causing Deafness. By Edward Woakes, m.d., Senior Aural Surgeon to the London Hospital for Diseases of the Throat and Chest. 26 Illustrations. Cloth, ^1.50 "WOLFF. Manual of Applied Medical Chemistry for Students and Practitioners of Medicine. By Lawrence Wolff, m.d., Demonstrator of Chemistry in Jeffer- son Medical College, Philadelphia. Cloth, $1.00 "WOOD. Brain "Work and Overwork. By Prof. H. C. Wood, Clinical Professor of Nervous Diseases, University of Pennsylvania. i2mo. Cloth, .50 "WOODY. Essentials of Chemistry and Urinalysis. By Sam E. Woody, a.m., m.d.. Professor of Chemistry and Public Hygiene, and Clinical Lecturer on Diseases of Children, in the Kentucky School of Medicine. Third Edition. Illustrated. i2mo. Cloth, gi.25 "WYNTER and "WETHERED. Clinical and Practical Pathology. A Manual of Clinical and Practical Pathology. By W. Essex Wvntick, m.d., Medical Reg- istrar and late Dem. of Anat, and Chem. at the Middlesex Hospital, and Frank J.Wethered, m.d., Asst. Phys. to the City of London Hospital for Dis. of the Chest. 4 Colored Plates and 67 other Illustrations. 8vo. Cloth, 54.00 "WYTHE. Dose and Symptom Book. The Physician's Pocket Dose and Symptom Book. Containing the Doses and Uses of all the Principal Articles of the Materia Medica, and Officinal Preparations. By Joseph H. Wythe, a.m., m.d. 17th Edition, Revised and Rewritten. Cloth, SSi.oo; Leather, with Tucks and Pocket, JS1.25 YEO'S Manual of Physiology. Fifth Edition. A Text-book for Students of Medicine. By Gerald F. Yeo., m.d. f.r.c.s., Professor of Physiology in Kind's College, I^ndon. Fifth Edition; revised and enlarged by the author. With 321 Wood Plngravings and a Glossary. Crown Octavo. Beitu; No. 4, N,"w Series of Manuals. Cloth, ;?3.oo ; Leather, ^^3.50. New Series of Manuals. FOR MEDICAL STUDENTS AND PHYSICIANS. Demi-Octavo. Price of each book, Cloth, $3.00 ; Leather, $3.50. The object held in view in the preparation of this Series was to make books that should be concise and practical, not burdened by useless theories and discussions, but containing all that is needed or necessary for the student and practitioner. IvTo pains have been spared to bring them up to the times, and the very low price at which they have been published is an additional point in their favor. Full circular, descriptive of the Series, will be sent upon application. WALSHAMS PRACTICAL SURGERY. A Manual for Students and Physicians. By Wm. J. Walsham, M.D., Asst. Surgeon to, and Demonstrator of Surgery in, St. Bartholomew's Hospital; Sur- geon to Metropolitan Free Hospital, London, etc. 236 Illust. 656 pp. Cloth, $3.00 ; Leather, ^3.50 From the Polyclinic. " While evidently intended to be a text-book for students, and therefore small in size and compactly written, is neverthe- less full enough for the use of those practitioners who desire a short account of the various surgical principles and operations involved in the treatment of the ordinary run of surgical cases. The author seems to be a conservative and judicious surgeon with advanced ideas.'' PARVIN'S-WINCKEL'S DISEASES OF WOMEN. Second Edition. A Treatise on the Dis- eases of Women. Including the Diseases of the Bladder and Urethra. By Dr. F. Winckel, Professor of Gynaecology and Director of the Royal University Clinic for Women, in Munich. Revised and Edited by Theophilus Parvin, m.d., Professor of Obstetrics and Diseases of Women and Children in Jeffer- son Medical College. Illustrated by 150 fine Engravings on Wood, most of which are new. 760 pp. Cloth, ^3.00; Leather, ;jS3. 50 GALABIN'S MIDWIFERY. A Manual of Widwifery. By Alfred Lewis Galabin, m.a., m.d., Obstetric Physician and Lecturer on Midwifery and the Diseases of Women at Guy's Hospital, London; Examiner in Midwifery to the Conjoint Examining Board of England. 227 Illustrations. 753 pages. Cloth, ^3.00; Leather, ^3.50 FroJit The Archives of Gyncecology , New York. " The illustrations are mostly new and well executed, and we heartily commend this book as far superior to any manual upon this subject." YEO'S MANUAL OF PHYSIOLOGY. Fifth Edition. A New Text-book for Students. Byj Gerald F. Yeo, m.d., f.r.c.s.. Professor of Physiology in King's College, London. 321 Illustra-| tions and a Glossary. 758 pages. Cloth, ;^3. 00 ; Leather, ^3.501 From Prof. Lewis A. Stimson, M.D., 57 East 33d Street, New York. " The brief examination I have given it was so favorable that I placed it in the list of text-books recommended in the cir- cular of the University Medical College." GOODHARTAND STARR, DISEASES OF CHILDREN. Second Edition. By J. F. Goodhart, M.D., Physician to the Evelina Hospital for Children ; Assistant Physician to Guy's Hospital, London. Second American from third English Edition. Revised and Edited by Louis Starr, m.d., Clinical Professor of Diseases of Children in the Hospital of the University of Pennsylvania, and Physician to the Children's Hospital, Phila. With many new Prescriptions and Directions for making Artificial Human Milk, for the Artificial Digestion of Milk, etc. 760 pages. Cloth, ^3.00; Leather, ^3.50 From The New York Medical Record. " As it is said of some men, so it might be said ot some books, that they are ' born to greatness.' This new volume has we believe, a mission, particularly in the hands of the young members of the profession. In these days of prolixity in medical literature, it is refreshing to meet with an author who knows both what to say and when he has said it." WARING'S PRACTICAL THERAPEUTICS. Fourth Edition. A Manual of Practical Thera- peutics, considered with reference to Articles of the Materia Medica. Containing, also, an Index of Diseases, with a list of Medicines applicable as Remedies, and a fall Index of the Medicines and Preparations noticed in the work. By Edward John Waring, m.d., f.r.c.p., f.l.s., etc. 4th Edition. Rewritten and Revised. Edited by Dudley W. Buxton, m.d., Asst. to the Prof, of Medicine at University College Hospital; Member of the Royal College of Physicians of London. 666 pages. Cloth, ^3.00; Leather, ^3,50 jj From The Kansas City Medical Record. i " As a work of reference it excels, on account of the several complete indexes added to this edition. It was deservedly popular in former editions, and will be more so in the one before us, on account of the careful arrangement of the subjects." REESE'S MEDICAL JURISPRUDENCE AND TOXICOLOGY. Third Edition. By John, J. Reese, m.d., Professor of Medical Jurisprudence and Toxicology in the University of Pennsylvania;! late President of the Medical Jurisprudence Society of Philadelphia ; Physician to St. Joseph's Hospital;! Member of the College of Physicians of Phila.; Corresponding Member of the New York Medico-Legal ' Society, etc. Third Edition. Revised and Enlarged. 666 pages. Cloth, ^3.00 ; Leather, ^3.50 From The American Journal 0/ Medical Sciences. — " This admirable text-book." From Cincinnati Lancet and Clinic. " We lay this volume aside, after a careful perusal of its pages, with the profound impression that it should be in the hands of every doctor and lawyer. It fully meets the wants of all students. . . . He has succeeded in admirably condensing into a handy volume all the essential points." THE MOST PRACTICAL SERIES OF TEXT-BOOKS. i PHYSIOLOGY. Landois. A Text-Book of Human Physiology. Third Edition. 692 Illustrations. 1889. INCLUDING HISTOLOGY AND MICROSCOPICAL ANATOM\^ with special reference to the requirements of Practi- cal Medicine. By Dr. L. Landois, Professor of Physiology and Director of the Physiological Insti- tute in the University of Greifswald. Third Ameri- can, translated from the Sixth German Edition, with additions, by Wm. Stirling, m.d., d.Sc, Bracken- bury Professor of Physiology and Histology in Owens College, Manchester; Examiner in Physiology in University of Oxford. With 692 Illustrations. En- larged, Revised and Improved. Royal Octavo. One Volume. Cloth, $6.50; Leather, $7.50 *^* The practical value of this book to the physician can scarcely be over-estimated. It is not a text-book as the term is generally understood, but a treatise on Phy- siology in its relations to practical medicine, and in- cludes much clinical information. " It is the most complete and satisfactory text-book on physiology extant. The translator and publisher have each done something to increase the value of the volume. Dr. Stirling has added numerous useful annotations and a large number of new plates. . . . We wish that every medical student and physician could be drilled on these volumes." — The N. V. Medical Record. SPECIMEN OP ILLUSTKATIONS. Yeo's Manual of Physiology. Fifth Edition. 1891.. A TEXT-BOOK FOR STUDENTS OF MEDICINE. By Gerald F. Yeo, m.d., f.r.c.s.. Professor of Physiology in King's College, London, Fifth Edition. With New Illustrations. 321 Wood Engravings and a Glossary. Crown Octavo. Being No. 4, New Series of Manuals. Cloth, $3.00; Leather, ^3.50 *5j;* This volume was specially prepared to furni.sh a new text-book of Physiology, elementary so far as c* to avoid theories which have not borne the test of time and such details of methods as are unnecessary for students. While endeavoring to save the student from doubtful and erroneous doctrines, great care has been taken not to omit any important facts that are neces.sary to an acquirement of a clear idea of the principles of Physiology. Such subjects as are useful in the practice of medicine and surgery are treated more fully than those which are essential only to an abstract physiological knowledge. A book in every way suited for student's u.se. " Dr. Yeo's manual has reached the position of Ijeing, we believe, the licst by far of the smaller text-lxxjks on I'hysiology." — Tlurapeutic Gazette, &CA ■raCIMIM nr ILLU^TKATIUN*. r PRACTICE OF MEDICINE. Taylor. Practice of Medicine. 1890. A MANUAL OF THE PRACTICE OF MEDICINE. By FREDERICK TaYLOR, M. D., Physician to, and Lecturer on Medicine at, Guy's Hospital, London; Physician to the Evelina Hospital for Sick Children ; Examiner in Materia Medica and Pharmaceutical Chem- istry, at the University of London. Cloth, ^4.00; Leather, ^5.00 " By consulting the most recent works, especially those of Fagge, Striimpell, Payne, Ziegler, Gowers, M. Mackenzie, Douglas Powell, Ralfe, H. Morris and Crocker, to whom I must express my indebtedness, I have sought to bring this book fully up to the modern state of knowledge. I have not, however, devoted much space to the discussion of theories, finding that the facts of medicine are amply sufficient to fill, and more than fill, a volume such as this, and being convinced that these facts require to be seized and held fast by the beginners in medicine, not only for the sake of diagnosis and treatment, but also for the right estimation of the various theories which are advanced. With a brief statement, therefore, of such views I have in most cases been content. ' ' " It is an entirely original work, by one accustomed to teacli his subject both didactically and clinically, who knows and understands how to present to the reader both the essential elements and the endless details of the science and art of medicine. How well Dr. Frederick Taylor has performed his task, may be learned almost ad aperturam. . . . The author has taken great pains to embody in this work the latest advances in our knowledge of the nature and treatment of disease. We find, for example, accounts of actinomycosis and the use of suspension, and even of the epidemic of Russian influenza which swept over Europe last winter. " We have noted with particular care, and we will say with particular approval, the extremely sensible remarks which Dr. Taylor has given us under the head of treatment. In some respects the sections on treat- ment must have been the most difficult part to write of a short treatise on the practice of medicine. Manifestly the first and the chief end to be attained, is the inculcation of sound therapeutical principles. But in the second place, the students and young practitioner must have something concrete supplied to them, in the shape of details to which they can refer, when they are either following the practice of their teachers or find themselves face to face with patients of their own. Dr. Taylor has succeeded admirably in fulfilling both these indications, if we may borrow what is itself a therapeutical phrase." — The Practitioner, London, Sep- tember, 1890. " Sedatives, Dr. Taylor further says, in speaking of capillary bronchitis, must be given with the greatest caution, or entirely avoided, for the reasons given. In referring to the treatment of chronic bronchitis the author recommends, among other good agents, turpentine, copaiba, and the more modem drug — terebene. This will, on examination, be found to abound in very many such practical observations, making the manual of great service to the physician." — Medical Bulletin, Philadelphia, January, 1891. " Dr. Taylor has given us a very valuable work. We are pleased to miss the long and interminable dissertations on etiology and pathological anatomy, these subjects being clearly and briefly stated. On the other hand, the pages of the book are mostly taken up with the subjects of symptoms, diagnosis, prognosis and treatment, all of the utmost importance in actual practice. The work is up to date in all essential particulars of medical advance. This is one of the books to buy for this season." — Medical World, Phila., December, 1890. " We have already spoken in warm praise of the book, and have only to add that it is just the one to put in the hands of a student who wishes to read up a subject while he is listening to lectures on practice ; it is full enough to be clear, without being full enough to confuse." — Medical and Surgical Reporter, Y)aS\aAA- phia, January, 1 891. " The book is just such a one as may lead the student to regard the mastery of medical science as an easy task, the subtle and obscure points having been placed in the background. It seems to us that in this the author has acted well. We know of no work that, while being satisfactorily full, addresses itself more readily to the understanding than does this. When this is mastered, the student will feel encouraged for greater tasks, instead of being disheartened and having his ardor disappointed at the very threshold of his studies." — Ainerican Practitioner and News, January 3d, 1 89 1. " So far as we are informed, this is the first instance in which Dr. Taylor has come before the Medical World as an author. His reputation as a teacher and practitioner has, for some time, been an enviable and extensive one. Many candidates for degrees, and many now in the ranks of the profession, can testify to his knowledge of medicine and his efficiency in his practice. His literary effort now just being presented deser\'es respect and fair examination on account of the author's record and position, irrespective of its intrinsic worth. But the book, we are convinced, has merits that will gain for it recognition, even if its author were unknown or nameless. It is a handbook on the practice of medicine, from which theory and superfluity have been eliminated, and facts of practical utility alone recognized." — Pacific Medical Journal, San Francisco, Feb- ruary, 2d, 1 89 1. " On the whole, we think it would be difficult to find another work on the same subject, which contained in a similar space so much information. Dr. Taylor's style of writing, too, is clear and readable, and we feel sure that his book will be widely read and appreciated." — The Dublin Journal of Medical Science, NEW AND REVISED EDITIONS. PQUIZ-COMPENDS.? A SERIES OF PRACTICAL MANUALS FOR THE PHYSICIAN AND STUDENT. Compiled in accordance with the latest teachings of prominent lecturers and the most popular Text-books. Bound in Cloth, each $i.oo. Interleaved, for the Addition of Notes, $1.25. They form a most complete, practical and exhaustive set of manuals, containing information nowhere else collected in such a practical shape. Thoroughly up to the times in every respect, containing many new pre- scriptions and formulae, and over 300 illustrations, many of which have been drawn and engraved specially for this series. The authors have had large experience as quiz-masters and attaches of colleges, with exceptional opportunities for notmg the most recent advances and methods. The arrangement of the subjects, illustrations, types, etc., are all of the most approved form. They are constantly being revised, so as to include the latest and best teachings, and can be used by students of any college of medicine, dentistry and pharmacy. No. I. Human Anatomy. Fifth Edition (1891), including Visceral Anatomy, formerly pub- lished separately. 16 Lithograph Plates, Tables, and 117 Illustrations. By Samuel O. L. Potter, m.a., m.d., late A. A. Surgeon, U. S. Army. Professor of Practice, Cooper Med. College^ San Francisco. Nos. 2 and 3. Practice of Medicine. Fourth Edition, Enlarged (1890). By Daniel E. Hughes,. M.D., late Demonstrator of CUnical Medicine in Jefferson Med. College, Phila. ; Physician-in- Chief, Phila- delphia Hospital. In two parts. Part I. — Continued, Eniptive and Periodical Fevers, Diseases of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, Kidneys, etc. (including Tests for Urine), General Diseases, etc. Part II. — Diseases of the Respiratory System (including Physical Diagnosis), Circulatory System and Nervous System; Diseases of the Blood, etc. *** These little books can be regarded as a full set of notes upon the Practice of Medicine, containing the Synonyms, Definitions, Causes, Symptoms, Prognosis, Diagnosis, Treatment, etc., of each disease, and including a number of prescrip- tions hitherto unpublished. No. 4. Physiology, including Embryology. Sixth Edition (1891). By Albert P. Brubaker, m.d., Prof of Physiology, Penn'a College of Dental Surgery; Demonstrator of Physiology in Jefferson Med. College, Phila. Revised, Enlarged and Illustrated. In Press. No. 5. Obstetrics. Illustrated. Fourth Edition (1889). For Physicians and Students. By Henry G. Landis, m.d., Prof of Obstetrics and Diseases of Women, in Starling Medical College, Columbus. Revised Edition. New Illustrations. No. 6. Materia Medica, Therapeutics and Prescription Writing. Fifth Revised Edition (1S91). With especial Reference to the Physiological Action of Drugs, and a complete article on Prescription Writing. Based on the Last Revision (Sixth) of the U. S. Pharmacopoeia, and including many unofificinal remedies. By Samuel O. L. Potter, m.a., m.d., late A. A. Surg. U. S. Army; Prof of Practice, Cooper Med. College, San Francisco. 5th Edition. Improved and Enlarged. No. 7. Gynaecology. (1891.) A Compend of Diseases of Women. By Henry MORRIS, M.D., Demon- strator of Obstetrics, Jefferson Medical College, Philadelphia. Many Illustrations. No. 8. Diseases of the Eye and Refraction. Second Edition (1888). Including Treatment and Surgery. By L. Webster Fox, m.d.. Chief Clinical Assistant Opthalmological Dept., Jefferson Medical College, etc., and Geo. M. Gould, m d. 71 Illustrations, 39 Formulae. No. 9. Surgery, Minor Surgery and Bandaging. Illustrated. Fourth Edition (1890). Including Fractures, Wounds, Dislocations, Sprains, Amputations and other operations ; Inflammation, Suppuration, Ulcers, Syphilis, Tumors, Shock, etc. Diseases of the Spine, Ear, Bladder, Testicles, Anus, and otlier Surgical Diseases. By Orville Horwitz, a.m., m.d.. Demonstrator of Surgery, Jefferson Medical College. 84 Formulae and 136 Illustrations. No. 10. Medical Chemistry. Third Edition (1890). Inorganic and Organic, including Urine Analysis. For Medical and Dental Students. By Henry Leffmann, m.d.. Prof, of Chemistry in Penn'a College of Dental Surgery, Phila. Third Edition. Revised and Enlarged. No. II. Pharmacy. Third Edition (1890). Based upon " Remington's Text-Book of Pharmacy." By F. E. Stewart, m.d., ph.g.. Professor of Pharmacy, Powers College of Pharmacy; late Quiz-Master at Philadelphia College of Pharmacy. Third Edition. Revised. No. 12. Veterinary Anatomy and Physiology. Illustrated. (1890.) By Wm. R. Ballou, M.D., Prof of Equine Anatomy, New York College of Veterinary Surgeons, etc. 29 Illustrations. No. 13. Dental Pathology and Dental Medicine. (1890.) Containing all the most noteworthy points of interest to the Dental Student. By Geo. W. Warren, d.d.s.. Clinical Chief, Penn'a College of Dental Surgery, Philadelphia. Illus. ,/-,•,, No. 14. Diseases of Children. (1890.) By Marcus P. Hatfield, Professor of Diseases of Children,. Chicago Medical College. With Colored Plate. JJI^- These books are constantly revised to keep up with the latest teachings and discoveries. Fro,m 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 concise, and are really the best line of text-books that could be found for cither student or practitioner. NERVOUS AND MENTAL DISEASES. Gowers' Diseases of the Nervous System, tion. Second Edi- 1891. A COMPLETE MANUAL OF THE DISEASES OF THE NERVOUS SYSTEM. By WiLLIAM R. GowERS, M.D., F.R.C.P., Lond., Prof. Clinical Medicine, University College, London ; Physician to National Hospital for the Paralyzed and Epileptic ; late Physician University College, London, etc. With about 375 Illustrations, including over 600 Different Figures. In Two Handsome Octavo Volumes. 1600 pages. Vol. I, Nearly Ready. Vol. 11, Ready September. =^^*The first American edition of this book, which was published in one rather unwieldy volume, was completely exhausted within eighteen months. In printing the second, it has been thought best to follow the style adopted by the English publishers, and issue it in two volumes. In this form it will be much handier for reading and refer- ence. Dr. Gowers has devoted a great deal of time and work in the revising; many sections have been rewritten, and the new matter will amount to about 100 pages, includ ing an important chapter on Multiple Neuritis, of which no good account exists, and a number of new illustrations. SPECIMEN OF ILLUSTRATIONS — FLEXOR CONTRACTION OF LEGS IN MYELITIS OF THE DORSAL REGION. A large number of the illustrations are original, having been made from special draw ings or from photographs of cases ; they not only serve to illustrate the text, but will be found of great value in the diagnosing of obscure cases. PRESS NOTICES OF FIRST EDITION. " It may be said, without reserve, that this work is the most clear, concise and complete text-book upor diseases of the nervous system in any language. And when the large number of such works which has appeared in Germany, France and England within the past ten years is considered, this implies high praise.' — The Afnerican Journal of Medical Science. " Taken as a whole, it promises to be the most useful work on diseases of the nervous system which we possess." — The Dtiblin Journal of Medical Sciences. " The student and practitioner will find in it a true friend, guide and helper in his studies of the diseases' of the nervous system. It is a most complete manual, presenting a thorough reflex of the present state of knowledge of the diseases of the nervous system. The care and thought that have been bestowed on its pro duction are evident on every page. In the presence of such ability, learning and originality, criticism can only take a favorable direction. The style and manner are accurate, studied and adequate — never diffuse. The illustrations call for special notice. They are numerous, new and original. No better manual on nervous diseases has been presented to the medical profession." — The London Lancet. " Gowers' manual is herewith recommended to the general and to the special student. It is not too' detailed for the former, while for the specialist it is explicit enough as a first-class book of reference. It is, on the whole, an admirable treatise." — The Journal of Nei-vous and Mental Diseases, New York. BY THE SAME AUTHOR. i Diseases of the Brain. Lectures on Diagnosis of Diseases of the Brain, delivered at University College Hospital. Second Edition. Illustrated. 8vo. Cloth, ;g2.oo Now Ready for 1892. 415? Year. The PHYSICIAN'S Visiting List. (LINDSAY & BLAKISTON'S.) CONTENTS. Almanac for 1892 and 1893; Table of Signs to be used in keeping accounts; Marshall Hall's Ready Method in Asphyxia; Poisons and Antidotes, revised for 1892; The Metric or French Decimal System of Weights and Measures; Dose Table, revised and rewritten for 1892; List of New Remedies for 1692; Aids to Diagnosis and Treatment of Diseases of the Eye ; Diagram Showing Eruption of Milk Teeth, Dr.'louis Starr; Posological Table; Disinfectants and Disinfecting; Examination of Urine, Dr. J. Daland, /;(7.t G67 1891